Many drugs have adverse effects that only become apparent with continued use. Medications that are processed by the liver and eliminated through the kidneys can impact those organs; others affect the production of hormones or neurotransmitters needed for the maintenance of whole body systems. Working closely with a physician to determine the lowest effective dose or to find alternatives when necessary, can avoid compromising health unnecessarily. Three classes of drugs that have major long-term side effects are corticosteroids, antipsychotics, and narcotic pain relievers. Stopping these medications without medical advice can be dangerous, as well.
Cushing's Syndrome
Corticosteroids are prescribed to prevent the rejection of transplanted tissues, as well as to treat inflammatory conditions such as asthma, arthritis, and Crohn's disease. These drugs mimic the effects of cortisol, a stress hormone secreted by the adrenal glands. Also called glucocorticoids, they work by suppressing the immune system, creating increased risk of infection. With long-term use, a set of symptoms known as Cushing's syndrome develops, which includes round face, fat deposits on the neck, upper body obesity and thin easily bruised skin that heals poorly. Cushing's also demineralizes bone; the New Zealand Dermatological Society reports that up to 50 percent of patients on long-term corticosteroid therapy develop bone fractures. Women with Cushing's may have increased facial and chest hair and men may suffer from erectile dysfunction.
Tardive Dyskinesia
Both typical and atypical antipsychotic drugs used in the treatment of schizophrenia work by blocking dopamine receptors in the brain. While they reduce symptoms of mental illness, long-term use of these medications increases the risk of movement dysfunction. Tardive dyskinesia, or TD, is characterized by involuntary muscle movements, particularly in the face. Tongue thrusting, writhing, blinking, lip smacking, puckering, chewing and frowning may interfere with talking and eating. Shaking arms and legs may interfere with walking. Repetitive hand motions are common manifestations of TD. Tardive dyskinesia may be permanent, with symptoms persisting after the drug is stopped. Newer atypical antipsychotics were thought to have fewer such effects. However, researchers at Yale University School of Medicine found that the incidence of TD among 352 patients at a community mental health center, the majority of whom were on atypical antipsychotics between 2000 and 2005, was similar to the incidence of TD among patients taking older drugs available in 1980. Other long-term side effects of medicines in this class are weight gain, high total cholesterol and triglycerides and the development of metabolic syndrome or type 2 diabetes.
Altered Brain Function
Long-term use of narcotic pain relievers, or opioids, are associated with constipation and addiction. A study conducted at Harvard Medical School that compared imaging scans of healthy individuals with prescription opioid-dependent patients revealed that visible alterations in the structure and function of the brain were associated with long-term opioid use. The changes affect mood regulation and impulse control as well as reward and reinforcement centers in the brain. The authors cited a dramatic increase in prescription opioid use and published the research findings in the July 2010 issue of "Brain."
References
- New Zealand Dermalogical Society, Inc.: Systemic Steroids (Corticosteroids)
- "Journal of Clinical Psychiatry", Incidence of Tardive Dyskinesia with Atypical versus Conventional Antipsychotic Medications: a Prospective Cohort Study. Woods SW, et. al., April 2010, 71(4)
- "Brain", Alterations in Brain Structure and Functional Connectivity in Prescription Opioid-Dependent Patients, Upadhyay J, et. al., July 2010, 133(Pt7)
