12 Times to Try Lifestyle Changes Before Medication
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Americans often rush—or get rushed—into taking drugs too quickly.
Sometimes doctors prescribe them for problems—back pain, heartburn, and insomnia, for example—without first giving lifestyle changes a chance.
Or they diagnose people when they're in the “predisease” stage of a condition—think mild bone loss or slightly elevated blood pressure or blood sugar levels—and immediately start treating them with drugs when simple steps are often enough.
Here, 12 such situations, and what to do instead.
1. ADHD
Drugs: Antipsychotics such as Abilify and Seroquel.
Risks: Side effects include constipation, difficulty breathing or swallowing, dizziness, drowsiness, fast or irregular heartbeat, fever, seizures, and weight gain.
Nondrug options: Behavioral therapy plus educational interventions and exercise. (In some cases, a stimulant such as Adderall or Ritalin may also be necessary, but first consult with a specialist.)
When to consider a drug: Antipsychotics should be used for ADHD only if other psychiatric conditions are diagnosed, such as bipolar disorder.
2. Back & Joint Pain
Drugs: Nonsteroidal anti-inflammatories such as Advil, Aleve, and Celebrex; opioids such as OxyContin and Percocet.
3. Dementia
Drugs: Antipsychotics such as Abilify and Seroquel.
Risks: Generally the same as those listed for ADHD, as well as stroke and death.
Nondrug options: Establish a regular routine, do calming activities, and have frequent social contact. It’s also a good idea to rule out underlying conditions that can sometimes lead to disturbed behavior, such as constipation, infection, or hearing or vision problems.
When to consider a drug: If the patient suffers from delusions, hallucinations, or other serious mental illness, or presents a danger to himself or others.
4. Mild Depression
Drugs: Antidepressants such as Celexa, Cymbalta, Lexapro, and Prozac.
Risks: Many side effects, including diarrhea, drowsiness, headaches, agitation, sexual dysfunction, and suicidal thoughts.
Nondrug options: Exercise, meditation, and various forms of talk therapy.
When to consider a drug: If therapy alone isn’t enough or depression is severe. Reassess after six weeks and consider switching drugs if you aren’t getting better.
5. Heartburn
Drugs: Proton-pump inhibitors (PPIs) such as Nexium, Prevacid, and Prilosec.
Risks: Reduced stomach acid, which impairs the body’s ability to absorb certain nutrients and medication, and increases the risk of gastrointestinal and other infections. Long-term use may increase the risk of fractures, dementia, heart attack, and kidney disease.
Nondrug options: Eat smaller meals, don’t lie down soon after eating, lose excess weight, and avoid trigger foods, including acidic or greasy meals. For occasional heartburn, try OTC products such as Maalox, Pepcid AC, Tums, or Zantac 75.
When to consider a drug: If heartburn occurs twice weekly or more for four weeks or longer and your doctor diagnoses gastroesophageal reflux disease, which occurs when stomach acid backs up into the esophagus and damages it. In that case, consider a PPI for a few months while your esophagus heals.
6. Insomnia
Drugs: Sleeping pills such as Ambien, Belsomra, and Lunesta.
Risks: Dizziness, next-day drowsiness, impaired driving, dependence, and worsened sleeplessness when you try to stop.
Nondrug options: Cognitive behavioral therapy (CBT) for insomnia, where a provider teaches you good sleep habits and suggests ways to change your behavior, such as cutting out naps or not using your laptop in bed.
When to consider a drug: If you have short-term sleep problems caused by a stressful event such as a death in the family or a divorce, or if CBT alone doesn’t provide enough relief.
7. Low Testosterone
Drugs: Testosterone topicals (such as AndroGel and Axiron), patches (Androderm), and injections (Aveed).
Risks: Blood clots in the legs, sleep apnea, an enlarged prostate, and possibly an increased risk of a heart attack or stroke. Topical forms can transfer to others, causing the growth of body hair in women and, if pregnant, transfer the hormone to their babies. Children exposed to the hormone have experienced enlargement of the penis or clitoris, the growth of pubic hair, an increased libido, and aggressive behavior.
Nondrug options: Treat conditions that can decrease testosterone, such as diabetes or obesity. Also discuss nondrug ways to boost energy and vitality by exercising, getting enough sleep, and couples therapy with your partner.
When to consider a drug: If you have hypogonadism, which is very low testosterone levels caused by a genetic disorder; damage to the testicles from injury or chemotherapy; or another cause.
8. Osteopenia, or Preosteoporosis (Bone Density at the Low End of Normal)
Drugs: Bisphosphonates such as Actonel, Boniva, and Fosamax.
Risks: Diarrhea, nausea, vomiting, heartburn, esophageal irritation, and bone, joint, or muscle pain. Long-term use may increase the risk of thigh fractures.
Nondrug options: Consume foods high in calcium and vitamin D, do weight-bearing exercises such as walking or lifting weights, and quit smoking. Plus take steps to prevent falls by, for example, avoiding sleeping pills and installing grab bars in the bathroom.
When to consider a drug: If bone-density tests show you have full-blown osteoporosis. Even then, consider taking a break after five years to reduce the risk of lasting side effects.
9. Overactive Bladder (Sudden or Frequent Need to Urinate)
Drugs: Anticholinergics such as Detrol and Oxytrol.
Risks: Constipation, blurred vision, dizziness, confusion, and an increased risk of dementia.
Nondrug options: Cut back on caffeine and alcohol, and try bladder training (slowly increasing the time between bathroom visits) and Kegel exercises (repeatedly tightening and relaxing the muscles that stop urine flow).
When to consider a drug: If several weeks of nondrug strategies don’t provide enough relief.
10. Prediabetes (Blood Sugar Levels at the High End of Normal)
Drugs: Blood-glucose-lowering drugs such as Actos and Glucophage.
Risks: Dizziness, tiredness, muscle pain, and in rare cases other symptoms caused by a dangerous buildup of lactic acid and a vitamin B12 deficiency.
Nondrug options: Exercise, eat a healthy diet rich in nonprocessed and nonstarchy foods, and lose weight.
When to consider a drug: If you develop full-blown type 2 diabetes.
11. Prehypertension (Blood Pressure at the High End of Normal)
Drugs: ACE inhibitors, angiotensin receptor blockers (ARBs), calcium channel blockers, and diuretics.
Risks: Diuretics can cause frequent urination, low potassium levels, and erectile dysfunction. ACE inhibitors and ARBs can cause high potassium levels and reduced kidney function. Calcium channel blockers can cause dizziness, an abnormal heartbeat, flushing, headache, swollen gums, and less often, breathing problems.
Nondrug options: Quit smoking, cut back on sodium and alcohol, lose excess weight, and exercise.
When to consider a drug: If you develop true hypertension.
12. Obesity
Drugs: The weight-loss drugs Belviq, Contrave, Qsymia, and Xenical.
Risks: Constipation, diarrhea, nausea, or vomiting are common. The drugs also cause rare but dangerous side effects, including leaky heart valves with Belviq and liver damage with Xenical.
Nondrug options: If you’ve been unable to lose weight on your own by exercising more and eating less, ask your doctor about formal weight-loss programs.
When to consider a drug: If lifestyle changes have failed and you are obese or overweight and have heart disease or type 2 diabetes. If you haven’t lost at least 5 percent of your weight after three months, stop because it’s unlikely to help.
—Additional reporting by Ginger Skinner
Editor's Note: This special report and supporting materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
This article also appeared in the September 2017 issue of Consumer Reports magazine.
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