A woman looking at a blue pill in one hand while holding a red pill in her other hand

Side Effects: Choose Your Own Adventure!

When treating multiple sclerosis (MS), whether it’s the actual disease itself with DMTs (disease-modifying therapies), or symptoms with prescription medication, you’ll probably run into this problem. Every available treatment option you have seems to come with side effects!

It might even get to the point that you’re not choosing one medication over another because it works better. Instead, you might make your choice because the side effects of one are more tolerable than the side effects of the other. When it comes to treating and managing MS, it can sometimes feel like a "choose-your-own-adventure" game… only it’s usually not as fun, because the adventure is medicine.

Side effects are just part of the game

It’s just a sucky part of the reality of using prescription medications. Some medications may cause very minor side effects, while others can cause more severe side effects. Some medications even have the potential to cause the very problem you are trying to treat in the first place! And it’s not limited to only medications used when treating MS.

For example, one possible side effect of antidepressants is an increase in the severity of your depression. Another example is how headache medication can sometimes cause headaches! But of course, you might not experience any side effects at all. Everyone is different and might respond differently to a medication than how someone else does.

Looking for an alternate choice of medication

I’ve had this problem multiple times over the years. I’ll start a new prescription medication to try to treat a new or worsening MS symptom, but it ends up causing me some pretty unpleasant side effects. So, I then try an alternative choice: a different medication that’s supposed to do the same thing.

The goal is simply to find a medication that achieves your treatment goal with the least side effects possible. While I usually end up finding something that works with few or no side effects at all, it often feels like “there’s always something” when it comes to side effects.

In my experience, the side effects of most of the medications I’ve been on are typically not too bad. They are either easily manageable or so subtle that after a while I’ll just get used to them and may even forget they are even there. But for many of the other medications I’ve tried, the side effects were simply intolerable for me. They did more harm than they did good.

Sometimes the choice is easy to make

It may be because the medication caused me a minor allergic reaction, because it was too sedating, or because it poorly affected my cognition. For example, one of the many antidepressants I’ve tried recently caused me to experience what was essentially the worst cog fog I had ever experienced.

Throughout the day I would continuously forget what I was even doing, and it felt nearly impossible to plan ahead or complete simple tasks. So, I had to move on and keep trying different options until I found a good balance between how well it worked and its side effects.

Sometimes it's not

The reason I wanted to talk about this today is that I’m kind of stuck trying to choose between two medications at the moment of my writing this. Something I realized, when talking to someone else about this, is that lots of other people have this problem, too. Having to choose the lesser of two evils.

For me, the number-one symptom that’s holding me back in life is, you guessed it, fatigue. I’ve tried a few different medications since my battle with fatigue began, including Amantadine, Provigil (modafinil), Nuvigil (armodafinil), Ritalin (Methylphenidate), and Adderall (dextroamphetamine-amphetamine). Nuvigil and Adderall definitely worked the best for me, but their pros and cons are pretty different (in my own experience), which is where the “choose-your-own-adventure” game begins.

Medication number one makes me feel more awake but doesn’t help me cognitively, and medication number two improves my cognition and focus but kicks in much more slowly and doesn’t feel as intense. But medication one can sometimes feel so overstimulating that I can’t get anything done because my thoughts are all over the place. Medication two, however, quiets all my thoughts, allowing me to better focus and ultimately accomplish much more in a day. But sometimes it causes me to overheat and feel really nauseous... Medication one doesn’t do that, but it does cause frequent urination, dry mouth, and dizziness.

This back-and-forth of pros and cons can go on forever! Which is why I’m having trouble choosing between the two.

Choose your own adventure

Just like you have to decide which choices will lead you down a better path in a choose-your-own-adventure book, you have to decide which treatment option is best. You have to try to determine which medication option will lead to the most favorable outcome for you. The tricky part is that it’s not always an objective choice with a right and wrong answer. A lot of the time it’s mostly subjective, coming down to what side effects you’re willing to deal with in order to get the positive effects that you want.

It may not always involve such high stakes, but it’s still a personal choice. So, don’t think of it as "a bunch of possible side effects." Think of it as your own personal healthcare edition of a "choose-your-own-adventure" book! With real-life consequences.

What about you? Have you ever found yourself stuck in this kind of medical decision-making? How do you usually "choose your own adventure?" Share your experiences with others in the comments below!

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This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The MultipleSclerosis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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