Research Every Drug You Take: Yes, Even Your Blood Pressure Medication

Subtitle: Your nerve-pain meds may be making you hard to live with, and you may not even be realizing it

[Epistemic Status: A much needed sanity waterline-raising correction]

TL;DR: I strongly recommend you thoroughly research every chemical you put into your body.

Introduction

I’ve come across a lot of people who are unaware of the fact that the drugs they’re being prescribed are psychoactive, dependence-causing, or even cognitively dulling. This includes prescription medications, over-the-counter drugs, and supplements.

A friend was prescribed a beta blocker for blood pressure (extended release propranolol[1], iirc). He had no idea drugs in this class were, for better or worse, effectively “downers”. And even though he swears he didn’t feel anything from it, knowing him well it was obvious to me and others that it clearly had an effect on him. He would slouch more, had a noticeable change in his posture, was less pressurized in his speech, and was a bit less cognitively sharp. He isn’t someone I would describe as having particularly good introspection skills or somatic awareness (neither a meditator, nor a psychonaut… just a rationalist). But I was still surprised to find out he hadn’t researched his prescription, nor ever noticed its broad effects on him.

Gabapentin and Propranolol

The same pattern appears everywhere. Someone I know was prescribed gabapentin for nerve pain. Over the course of 6 months, she started to look visibly restless – a common effect from the “interdose withdrawal” of such drugs. She would take it at night; by afternoon you could tell she wouldn’t sit still, and had a lower threshold for anger and irritation. Her nerve pain hasn’t improved, making this prescription a possible net-negative. Hopefully discontinuation will be gradual and mild in rebound anxiety, which isn’t guaranteed (cf. gabapentin withdrawal support groups).

The Anticholinergic Trap

Here’s one that catches people completely off-guard: anticholinergics. These are sold over-the-counter for wildly different purposes – sleep aids, anti-nausea medication, allergy relief, motion sickness. The active ingredient is often the same compound: diphenhydramine (Benadryl’s active ingredient) or similar anticholinergics.

“I take this for allergies, this as a sleep-aid, this one for motion sickness, this one for my cold… and now I’m seeing the fucking Hat Man“

I’ve heard from multiple people working in ERs about elderly patients coming in delirious, only to discover they’d been taking diphenhydramine from three different sources simultaneously – a sleep aid, an anti-nausea medication, and an allergy medication – with no idea they were stacking the same drug. Anticholinergics are particularly problematic long-term: they’re associated with cognitive decline and increased dementia risk in older adults. So, if you don’t want to see the fucking Benadryl Hat Man, be sure to research your meds.

The Benadryl Hat Man is waiting for you if you don’t thoroughly research your meds

Other Common Oversights

Melatonin is sold as a gentle sleep aid, and most people take it without a second thought. The long-term effects? Potential suppression of endogenous production, hormonal effects (it is a hormone, after all), possible effects on reproductive function, and for some people, increased anxiety or depression with chronic use. (Breaking news: “melatonin might increase risk of heart failure”).

DXM (dextromethorphan) is in a lot of OTC cough syrups and pills. It’s a dissociative – the same class as ketamine and PCP – and at even slightly elevated doses produces mild dissociative effects. People sometimes notice they feel “weird” or “spacey” when taking cough medicine but don’t connect it to the mechanism of action. (Note: at high doses, and in combination with THC, it may even catalyze free-wheeling hallucinations). (Note 2: research suggests low-dose DXM is a potential neuroprotective agent). (Note 3: DXM is also a mild anti-tolerance drug).

L-tyrosine, sold as a nootropic supplement, is a dopamine precursor. It can absolutely affect mood, motivation, and anxiety – and can interact poorly with various medications or conditions. I personally use it on occasion (perhaps twice a month, 500mg in the morning) as a gentle pick-me up. But people take it daily, as prescribed, without ever realizing it might be the thing keeping them up at night (paradoxically, it has a non-zero benefit for people with restless legs syndrome).

Even acetaminophen (aka. Paracetamol, Tylenol) – perhaps the most “innocuous-seeming drug” in your medicine cabinet – has psychological effects beyond pain relief. Recent research suggests it blunts emotional processing and reduces both positive and negative affect. People taking it regularly for chronic pain may find themselves feeling emotionally flatter, less empathetic, or having a harder time connecting with others. It’s subtle enough that you’d never attribute it to your pain reliever, but meaningful enough that it affects your quality of life and relationships.

Trazodone, clonidine, and in exceptionally reckless prescribing circumstances, even alprazolam, are often handed out with minimal discussion of long-term dependence, withdrawal profiles, or cognitive effects. The conversation is often “take this for sleep” or “take this for anxiety” without the adult-to-adult discussion of what you’re actually signing up for.

Why this happens

Doctors often don’t mention these effects because (a) they have 15 minutes with you, (b) they’re focused on the primary indication and assume secondary effects are less relevant, (c) they lack the phenomenological vocabulary to describe subjective experiences, or (d) they genuinely don’t know – medical education emphasizes mechanism and primary effects, not the phenomenal character of a given drug.

This is a systemic issue rather than a personal failing. But it does means the burden falls on you.

What to actually do

Never assume your nerve pain drug or your blood pressure medication is “just for the body”. More often than not, it has real (if often mild) emotional and cognitive effects. It’s all one system, after all. Mind and body.

When researching a drug:

• Check PubMed for the academic literature on side effects and long-term outcomes
• Check patient forums (Reddit, patient advocacy sites) for the (even if mild) subjective effects they induce – what it actually feels like to be on this drug and to get off of it
• Look up the mechanism of action and think through what that implies for other systems
• Ask ChatGPT or Claude: “What are the cognitive, emotional, and subjective effects of [drug name]? Include both common side effects and rarer phenomenological reports. What should I know about long-term use and dependence?”
• Ask your doctor directly about cognitive, emotional, and dependence effects (but don’t assume they actually know much about it)
• Consider whether the tradeoff is worth it for you specifically, given your particular circumstances
• Read high-quality “subtle drug” literature like The Good Drug Guide, by David Pearce

Sometimes the tradeoff is genuinely worth. Beta blockers might save your life. Gabapentin might be the only thing standing between someone and unbearable pain. I would never say that the goal is to reject pharmacology, but I do want to strongly nudge people dear to me to think of what they put in their body through the lens of informed consent.

You better know the real long-term valence effects of what you’re taking, lest you find yourself plagued by anger, anxiety, depression, or mental viscosity whose source you can’t identify.

Metta!

1 For a less centrally-active beta blocker, see: atenolol. H/T Maija Haavisto for the tip.