In her early teens, Heem Verma began feeling far from her normal self. She would get moody and easily frustrated — a change most people would peg to teenage angst. However, in Verma’s case, she was diagnosed with a hypoplastic uterus and ovarian failure, a condition characterized by abdominal pain, hot flashes and irregular menstrual cycles. Her doctors put her on a plethora of medications. During the course of her treatment, she realized how the medication was taking a toll on her mental state. “I would be angry all the time. I was restless and sleepless during the nights. Even little activity got me fatigued,” Verma, now a 22-year-old writer based in Mumbai, told Re:Set. These changes were not something that her doctor had adequately prepared her for. “I don’t recall ever having a conversation about the side effects of these medications [in terms of mental health] apart from the occasional mood swing.”
“I don’t recall ever having a conversation about the side effects of these medications [in terms of mental health].”
In their quest for better physical health, are patients put in precarious situations where their mental health takes a backseat? Especially in treatments where there are few medical alternatives, many report finding it difficult to cope with the additional side effects like mood swings and loss of concentration that medications cause to their mental well-being.
Most of the women Re:Set spoke to for this piece, stated that it was oral contraceptive pills (OCPs) that wreaked the most havoc on their mental health. OCPs are sometimes prescribed to treat symptoms of ovarian disorders. However, many mentioned that its repercussions weren’t addressed by their healthcare provider at the time of prescription.
20-year-old Pooja Ganesan was being treated with OCPs for polycystic ovary syndrome (PCOS) and endometriosis. PCOS is a hormonal disorder where the ovaries develop small collections of follicles, which may result in irregular menstrual cycles, weight gain and pelvic pain. Endometriosis is a condition where a tissue grows outside the uterus, which in Ganesan’s case causes her to experience painful cramps during menstruation.
She told Re:Set that her doctor warned her to watch her alcohol consumption as it could lower the effectiveness of OCPs, but did not provide additional information on how it could impact her mentally. “I became more sensitive towards people’s opinions, [and would feel] extremely emotional, insecure and had multiple breakdowns in the middle of work. I started losing sleep because I would wake up with a panic attack, which eventually led to not being able to get out of my bed most days in the morning,” she recalled. Eventually, she brought it up with her doctor, who dismissed her concerns, “I was told that it is in my head. If I believe I would have side effects, then I would.” She describes the six months that she was on the medication as “one of the darkest times” of her life, which eventually led to the decision to stop taking the prescribed medicines. “It seemed overwhelming to me back then. I continued having painful cramps, but I was in a better state [of mind] for the rest of the month.”
“I started losing sleep because I would wake up with a panic attack which eventually led to not being able to get out of my bed most days in the morning.”
Having undergone treatment for the same condition, freelance writer Pratika Yashaswi, 25, echoes Ganesan’s sentiments, “[The pills] destroyed me mentally. I kept losing my temper for no reason and I was in a lot of pain. And not to mention, [there was] random tearing up, anxiety and eventually, depression.” The pills were the only new addition in her daily routine and the disruptions that it caused in her mental state left her unable to take up the professional opportunity that she had moved to Mumbai for.
Re:Set spoke to Dr. Nimmi Rastogi, a consultant obstetrician and gynecologist from Delhi, to understand the protocols in place for disclosing such vital information to patients. She asserts that trained doctors know the importance of explaining both the physical and mental side effects to patients. She insists that doctors generally do not prescribe such medication to people who are prone to mental health illnesses, especially those with a history of endogenous depression or depression which is not being treated. “We inquire about their premenstrual syndrome symptoms which gives us an idea of how much their behaviour and emotions fluctuate as a result of hormones [like estrogen and progesterone].” Synthetic versions of these hormones are used in OCPs; hence, it is important for the doctor to gauge the patient’s potential reaction to OCPs. “Further evaluation and questions regarding family mental health history also gives us an insight into whether OCPs are suitable for the patient and their well-being,” she added.
Rastogi stated that due to the large volume of patients that doctors tend to every day, it’s possible that they may rush through the history and not mention all possible side effects. “Doctors need to ensure that the patient’s history [is duly noted], more time is spent with the patient during the consultation stage because some of these drugs like OCPs are taken on a long-term basis so the side effects need to be explained thoroughly.” She insists that patients should be forthcoming with their practitioners, be transparent about their physical and mental health history and raise their concerns.
Another medication that is often discussed for the effects it has on mental health is isotretinoin, known by trade names like Accutane and Acutret. It is used to treat severe forms of acne. According to Harvard Health Publishing, high doses of the drug can cause depression, irritability, aggression, and psychosis.
One woman, on the condition of anonymity, said that she was prescribed the medication by a doctor in Bengaluru to treat her acne. The 26-year-old lawyer revealed that her doctor only asked if she was unmarried because getting pregnant during treatment could be harmful to the fetus. She later Googled it and was also told by a friend that it could cause depression and suicidal tendencies; she decided to return the medication.
Dr. Shaila Shenoy, a Mumbai-based dermatologist, told Re:Set that there are no written protocols in India for prescribing Accutane at present. “During the consultation, we ask about [the patient’s] mental health history to prescribe the medicine suitably,” she said, adding that if a patient does have a history of depression or reacts poorly to the medicine, she would then opt to prescribe a simpler, less potent alternative than isotretinoin.
Asked whether the onus is on the patient to be more upfront about their mental health with their doctors, Ganesan said that it is a shared responsibility between the doctor and patient. “Before prescribing any drug, they ask if you’re allergic to anything. They should ask our history with mental health as well,” she reflected. Verma agrees, saying that this issue needs to be highlighted more prominently, “Only when patients start expressing their discomfort can issues be redressed. But first, it is the responsibility of practitioners to relook at their approach [by being more cautious about mental health needs].” Patients raising concerns about the need for doctors to be considerate of their mental health during treatment suggest that medical training curriculum have increased emphasis on these subjects.
The Medical Council of India (MCI) has responded by upgrading its syllabus in 2018 to include awareness about mental well-being and matters of public health. A holistic approach by medical practitioners with equal emphasis on both physical and mental health is essential to fully aid a patient’s healing process.
Editor’s note: This story borrows from individuals’ lived experiences. As pointed out, different types of medication impact people differently. Please make an informed decision by speaking to your healthcare provider, after due diligence and by paying attention to your body.