Patients taking active medications frequently experience adverse, nonspecific side effects that are not a direct result of the specific pharmacological action of the drug. Although this phenomenon is common, distressing, and costly, it is rarely studied and poorly understood. The nocebo phenomenon, in which placebos produce adverse side effects, offers some insight into nonspecific side effect reporting. We performed a focused review of the literature, which identified several factors that appear to be associated with the nocebo phenomenon and/or reporting of nonspecific side effects while taking active medication: the patient's expectations of adverse effects at the outset of treatment; a process of conditioning in which the patient learns from prior experiences to associate medication-taking with somatic symptoms; certain psychological characteristics such as anxiety, depression, and the tendency to somatize; and situational and contextual factors. Physicians and other health care personnel can attempt to ameliorate nonspecific side effects to active medications by identifying in advance those patients most at risk for developing them and by using a collaborative relationship with the patient to explain and help the patient to understand and tolerate these bothersome but nonharmful symptoms.
Emily Taylor, despite being reunited with her husband from prison, becomes severely depressed with emotional episodes and suicide attempts. Her psychiatrist, Jonathan Banks, after conferring with her previous doctor, eventually prescribes an experimental new medication called Ablixa. The plot thickens when the side effects of the drug lead to Emily killing her husband in a "sleepwalking" state. With Emily plea-bargained into mental hospital confinement and Dr. Banks' practice crumbling around him, the case seems closed. However, Dr. Banks cannot accept full responsibility and investigates to clear his name. What follows is a dark quest that threatens to tear what's left of his life apart even as he discovers the diabolical truth of this tragedy. Written by Kenneth Chisholm (kchishol@)