"There was a lot of anxiety," he says. "I made my career doing epilepsy research and then — to have a seizure? . . . I was angry." White switched to another medication.
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Figuring out whether an outburst is chemically induced gets more complicated when you factor in suggestibility: If a person thinks a drug may make him drowsy or dizzy, there's a good chance he'll feel drowsy, dizzy or both. This is called the "nocebo effect," a harmful consequence that results from the expectation of a harmful consequence.
"The principle of informed consent obligates physicians to explain possible side effects when prescribing medications," reads a paper published last year in the American Journal of Bioethics that discussed how nocebo effects could be minimized. "This disclosure may itself induce adverse effects."
"We want to warn people of potential side effects, but not suggest," Spencer says.
It's a fine line. Doctors need a way to discuss side effects without patient examinations deteriorating into a graduate seminar on deconstruction. Is "irritability" the same as moodiness? What about anxiety?
"It's a fuzzy term," Daniel Safer, an associate professor of psychiatry and behavior sciences at Johns Hopkins Medicine, says of irritability. In 2009, Safer wrote a paper that recommended limiting use of the term. The problem? It has too many meanings.
"There is the frequent non-specific use of the term in psychiatry and then the dictionary meaning of the word," Safer wrote in an e-mail. "Next is the fact that it is a subjective term that is self reported."
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Another issue: How to compare irritability in people taking a certain drug with that of naturally irritable people not taking the drug? As Safer says, "Predisposition hasn't been studied much."