Research from a variety of sources demonstrates that psychotropic medications have induced a number of unanticipated physiological and psychological client reactions. Although a great deal of literature is published concerning potential expected side effects from psychotropic medications, little is understood regarding other unexpected reactions that may cause significant client discomfort. These unanticipated psychotropic reactions may be considered as effects that may be rare and therefore not accounted for in randomized clinical drug trials. Like any medication, psychotropic medications do not produce the same effect in everyone. Some people may respond better to one medication than another. Mental health counselors are advised to be aware that some unexpected reactions can be important in determining client outcomes. In this article, we discuss the client's right to be informed about unanticipated side-effects of their medication regimen and the ethical question as to how much information to give clients.
********** Treatment of diagnosable mental health disorders with psychotropic medications can be problematic. While some mental health professionals propose that psychotropic medications have little or no therapeutic value, and in certain cases may produce damaging side effects (Breggin & Cohen, 2000; Glasser, 2003; Glenmullen, 2001), others recommend caution in the use of psychotropic medications and stress that side effects cannot be predicted (Burns, 1999; Ingersoll, Bauer, & Burns, 2004). Still other professionals suggest that mental health counselors who do not refer for psychotropic medication evaluation as an adjunct treatment to mental health counseling may risk unethical practice (Buelow, Hebert, & Buelow, 2000; King & Anderson, 2004). Regardless of the position taken, few advocates discuss the unanticipated reactions that clients may have to psychotropic medications. While some clients experience annoying expected side effects, other clients may experience completely unanticipated effects, and still others may experience no known side effects. Variables such as age, sex, body size, body chemistry, physical illnesses, drug interactions, diet, and habits such as smoking can influence the medication effect. These unanticipated reactions are rare and they are not usually accounted for in randomized clinical drug trials conducted by pharmaceutical companies. More common side effects, which are discovered during these trials, are normally conveyed on drug warning labels issued by the U.S. Food and Drug Administration.
Furthermore, when clients take multiple psychotropic medications or other prescription medications, there is a possibility that their body's unique chemical biology may create symptomatology that cannot otherwise be accounted for. If unanticipated effects do occur, clients may incorrectly believe they are suffering from an additional unrelated physiological or psychological malady. This may lead prescribing physicians to presume that these unexpected symptoms are evidence of a new medical condition that requires further assessment and perhaps additional medication treatment. Alternatively, family members, mental health counselors, and others may be tempted to dismiss clients' symptomatology as psychosomatic presentations. These issues can be challenging for mental health counselors who may be the first to hear of their clients' unanticipated reactions (King & Anderson, 2004; Sansone, Gaither, & Rytwinski, 2004). Moreover, the ethical issues surrounding unanticipated medication reactions can be crucial to client well-being. Mental health counselors would do well to systematically and ethically address the issues of unanticipated effects from psychotropic medications. This begins with a basic understanding of psychopharmacological effects.
PSYCHOPHARMACOLOGY AND THE MENTAL HEALTH COUNSELOR
Education of basic psychopharmacology is of "paramount importance" (Scovel, Christensen, & England, 2002) to competent and ethical mental health practice (King & Anderson, 2004). …