Overcoming Nausea: Coping with Medication Side Effects in Psychiatry

Nausea after taking medication?

I have been taking psychiatric medication for five years, but in the past couple of years, I have experienced what seems to be a psychological barrier related to medication.
Whenever I take psychiatric drugs, I feel nauseous, but I do not feel nauseous when taking other medications like Tylenol or vitamins.
In the past, I could swallow ten or more pills at once without any issues, but now I feel nauseous even after swallowing just one pill.
The nausea occurs immediately after swallowing, and it is not due to the pills getting stuck in my throat.
The feeling of nausea worsens as I become aware that there is medication in my stomach, and it typically lasts for over an hour after taking the medication.
There have been several instances where I took the medication and vomited it all back up within a few minutes.
I have tried over-the-counter antacids, but they did not help, and I am unsure if this is a gastrointestinal issue.

Currently, I am stable on the following medications: lithium, Mirtazapine, and Quetiapine.
Because I feel nauseous shortly after swallowing these medications, I suspect that it is not a side effect of the drugs but rather a psychological barrier.
Initially, I had a mental block against taking medication (thinking I was not ill) and felt that swallowing pills was akin to swallowing plastic, which triggered my nausea.
I have discussed this issue with my regular physician, who believes it may be a psychological barrier and advised me to endure and gradually overcome it.
However, the daily nausea from taking medication has led to a fear of taking it, and it is not simply a matter of enduring it.
I would like to ask the doctor a few questions:
1.
If my nausea is a side effect of the medication, is it possible to experience vomiting as a side effect of the same medication after taking it for over a year?
2.
If the nausea is indeed a side effect, how can it be alleviated? If it is a psychological barrier, are there any methods to improve this situation? Thank you for taking the time to answer my questions!

Evonne, 20~29 year old female. Ask Date: 2021/03/20

Dr. Peng Liyun reply Psychiatry

Hello, thank you for your hard work.
The answer to the first question is yes.
Common solutions for side effects include using symptomatic relief medications, adjusting the medication dosage, and switching medications.
If psychological factors are involved, which can be more complex, it is recommended that you discuss thoroughly with your physician (for example: the significance of medication and illness to you, the impact on your life, etc.) to seek a resolution.
Best wishes, Dr.
Peng Liyun, Department of Child and Adolescent Psychiatry, Shun'an Jiannan Rehabilitation Hospital.

Reply Date: 2021/03/20

More Info

Overcoming nausea associated with psychiatric medications can be a challenging experience, especially when it leads to a fear of taking necessary medications. Your situation, where you have been on psychiatric medications for five years and are now experiencing nausea specifically related to these medications, raises several important considerations.

1. Understanding Medication Side Effects: It is indeed possible for side effects, such as nausea, to develop even after long-term use of a medication. While many side effects tend to occur shortly after starting a medication, some can emerge later due to changes in your body’s metabolism, interactions with other medications, or even changes in your mental state. In your case, the nausea could be a side effect of the medications you are taking, such as lithium, methylphenidate (often referred to as "Concerta" or "Ritalin"), and other psychiatric medications.
2. Managing Nausea: If the nausea is indeed a side effect of the medications, there are several strategies you can consider to alleviate this issue:
- Timing and Method of Administration: Taking medications with food or a full glass of water can sometimes help reduce nausea. If you are currently taking them on an empty stomach, this could exacerbate the feeling of nausea.

- Medication Formulation: If swallowing pills is a significant issue, you might discuss with your doctor the possibility of switching to liquid formulations or dissolvable tablets, which may be easier to tolerate.

- Antiemetic Medications: Your healthcare provider might consider prescribing anti-nausea medications (antiemetics) to help manage this side effect.

- Gradual Dose Adjustment: Sometimes, taking a lower dose and gradually increasing it can help your body adjust better to the medication.

3. Psychological Factors: Given your description of feeling a psychological barrier to taking the medication, it is crucial to address this aspect as well. The sensation of swallowing pills feeling like "swallowing plastic" suggests a strong aversion that could be rooted in anxiety or a psychological response. Here are some strategies to consider:
- Cognitive Behavioral Therapy (CBT): Engaging in therapy can help you explore and address the underlying fears associated with taking medication. A therapist can work with you to develop coping strategies and gradually desensitize you to the act of swallowing pills.

- Mindfulness and Relaxation Techniques: Practicing mindfulness, deep breathing, or relaxation exercises before taking your medication may help reduce anxiety and nausea.

- Support Groups: Connecting with others who have similar experiences can provide emotional support and practical advice on managing medication-related issues.

4. Consulting Your Healthcare Provider: It is essential to maintain open communication with your psychiatrist or healthcare provider about these issues. They can help determine whether the nausea is a side effect of your current medications or if it is more psychological in nature. They may also consider adjusting your treatment plan, which could involve switching medications or adding adjunct therapies to help manage your symptoms.

In summary, while nausea can be a side effect of psychiatric medications, it is also possible that psychological factors are contributing to your experience. Addressing both the physical and psychological aspects of your situation is crucial. Working closely with your healthcare provider will help you find the most effective strategies to manage your nausea and maintain your mental health.

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