Early last spring, I woke up with what seemed to be a bad cold. A steady cough grew worse as fluid filled my lungs.
I needed to see a doctor. But as anyone in Massachusetts knows full well, scheduling an appointment with a primary care doctor on short notice is a nearly impossible task.
I did, however, live down the street from an urgent care center run by Atrius Health. So I got an appointment, and a nurse practitioner examined me.
Her diagnosis: bronchitis and possible pneumonia of the left lung. She prescribed an antibiotic and the powerful steroid prednisone.
Two days later, I almost killed myself. And then again a week later. And three weeks after that.
Unbeknownst to me, prednisone frequently causes mood swings. In my case, the drug jacked up my clinical anxiety so high that I couldn’t think about anything else.
My experience reflects the fragmented dysfunction of our health care system, where patients are thrown into several spinning wheels that rarely exchange information and coordinate care. The problem is especially bad with mental health, because therapists, psychologists, and pharmacists usually don’t confer with primary care doctors.
As a result, doctors “may not be aware of medication supplied by secondary care colleagues, resulting in unintended drug interactions,” according to a review of literature published in 2009 in the journal Mental Health in Family Medicine.
“Communication difficulties, complex medicine regimens, unclear roles and responsibilities, patient factors, and the involvement of multiple professionals may increase the risk of medicine reconciliation errors,” the study said.
That’s assuming, of course, you can even find a primary care physician. Across the country, including Massachusetts, there is a significant shortage of such doctors.
To fill the void, urgent care centers have rapidly sprung up in the Bay State. From 2010 to 2021, the number rose from 15 to 173, according to the Massachusetts Health Care Policy Commission. In 2023, the Urgent Care Association says, there were 207 centers in the state.
The industry has attracted the notice of private equity firms. National chains like American Family Care, CareWell, and ConvenientMD are some of the largest owners of urgent care centers in Massachusetts; all of them count private equity firms as investors, including Lorient Capital, Bain Capital, Iron Path Capital, and BPEA Private Equity.
Atrius, the urgent care center I visited that fateful day, is owned by Optum, a unit of UnitedHealth Group, the largest health insurer in the country.
Urgent care centers are places to go for nonemergency problems like rashes, cuts, flu, sore throats, and asthma. They have certainly relieved pressure on overcrowded, understaffed places like hospital emergency rooms and primary care physicians’ offices.
But urgent care centers are lightly regulated. Though they need to be licensed, there are no uniform standards for quality of care, what kinds of data they need to collect and report to the state, or even what constitutes an urgent care center.
Too few questions
Though urgent care centers for the most part treat relatively minor ailments, they can prescribe powerful drugs, which, I unfortunately discovered, can have negative consequences.
The Atrius urgent care center in Davis Square was less than a five-minute walk from my apartment. I was really tired; I had coughed so hard the previous night I hadn’t slept.
The nurse practitioner examined my throat and had me get X-rays of my lungs. She quickly glanced at my medical record, which showed I was on an antidepressant and two anti-anxiety drugs — clonidine and gabapentin.
If she had asked about those prescriptions, she would have discovered that I have long suffered from depression, anxiety, and post-traumatic stress disorder. I once checked myself into a hospital’s mental health ward for a weekend.
Doctors commonly use corticosteroids like prednisone to suppress the body’s immune system, which is particularly helpful to patients suffering from inflammatory arthritis, allergies, and even multiple sclerosis. In 2022, doctors wrote 18 million prednisone prescriptions to treat 8.7 million Americans, according to ClinCalc.com.
However, studies and patient testimonies have shown that corticosteroids can cause severe psychiatric side effects, including hypomania — extremely heightened moods or behavior. A person can experience racing thoughts, obsessiveness, and hypersensitivity.
A study published by the journal Mayo Clinic Proceedings in 2006 found that 6 percent of patients taking corticosteroids suffered severe mental reactions and nearly 30 percent suffered mild to moderate reactions.
“The neuropsychiatric adverse effects of corticosteroids are complex, unpredictable, and often severe,” the article said.
“It is important that clinicians in all specialties become aware of the potential psychiatric adverse effects associated with corticosteroids and explain these effects to their patients.”
But the nurse practitioner didn’t say anything. She wrote a prescription for me to take two 20 milligram tablets of prednisone every day for five days. The clinic’s seemingly overworked pharmacist, whose job includes alerting patients to potential side effects, said nothing either. Instead, without a word, she handed me the bag of meds and that was that.
Atrius did not respond to requests for comment.
Months lost
Two nights later, around 1 a.m., I jolted awake. I heard what sounded like a baby’s high-pitched squeal. It was so loud that I thought the noise originated from the street.
To my horror, the squeal came from inside me. My lung was so congested that whenever I exhaled, the air made that noise.
Whhhhheeeeeeeeeeee.
The sound was horrific. I couldn’t ignore it. It was so loud.
Whhhhheeeeeeeeeeee.
I retreated to the living room. I tried to read. I put on noise-canceling headphones.
Whhhhheeeeeeeeeeee.
At this point, I was getting desperate. My heart was pounding. My head ached. I couldn’t stop thinking about it. The noise would never cease. It would last forever.
Fortunately, I had somehow mustered enough logic to wake up my roommate.
She managed to calm me down by getting me to listen to, of all things, a Spotify channel that played music from Tibetan singing bowls.
The next few weeks were hell. The prednisone seemed to amplify a specific anxiety I have carried deep inside me since I was a teenager. I always feared running out of things, whether it was money, friends, or, in this case, work.
The thought of sitting at my desk with nothing to do, while my fellow reporters hurried about their jobs, absolutely terrified me. I felt so ashamed and isolated. I started to come into work late and leave early.
None of this, of course, made any sense. But my brain was on fire. And I didn’t know what was happening.
“I don’t think I’m going to make it,” I told a friend.
One day, I was lying on the couch when my roommate offhandedly mentioned that she heard prednisone could cause these side effects. I googled the subject, and sure enough, she was right.
I was elated. I couldn’t wait to discuss it with my psychiatrist, Chris, whom I met online once every two months.
“Hey, Tom,” Chris greeted me on my computer screen. “How are you?”
“Not too good,” I said. “I’m really freaking out.”
I told him I went to the urgent care center for my bronchitis. I didn’t even need to finish the story; Chris instantly knew what had happened.
“Oh, no,” he said, sounding alarmed. “How’s your anxiety level right now?”
“Off the charts,” I replied.
“Let me guess, they gave you a cortisteroid. Probably prednisone?” he said.
“Yes!” I said.
Chris explained that prednisone’s mental side effects were well known among psychiatrists.
“So why didn’t the urgent care folks warn me about this?” I said. “They saw my medical records.”
“Because that’s not how they operate,” Chris said. “They don’t do collaborative medicine. They only treat the problem in front of them. If you go to an urgent care center for a broken foot, they will only focus on the broken foot.”
And that’s something inherently wrong with fast-growing retail health care ventures like urgent care centers. Though highly accessible and convenient, they add yet another layer to an already fragmented health care system in which doctors, nurses, psychiatrists, and pharmacists don’t communicate and share information.
That’s especially troubling for people like me who struggle with mental health issues and require complex medications.
Steroids are safe for most people. But with people who are prone to mood disorders, caution is definitely warranted.
That means medical professionals, even employees at urgent care centers, need to be aware of mental health histories, especially if they prescribe drugs.
Over the following weeks, Chris tweaked my medications, but nothing seemed to work.
My body just needed time to rebalance itself, he said. Unfortunately, there was no timeline he could offer on when I would recover. Perhaps days. Maybe even months.
I did eventually recover.
But I was so angry. Before I caught bronchitis, I was feeling pretty good. And now, through no fault of mine, I was struggling with a mental health crisis. It was an error that nearly cost me my life and could have been easily avoided.
However, there was a silver lining.
“I have to thank you, Tom,” Chris recently told me. “Because you brought this to my attention and were so open about your struggles, I am now warning my patients about the potential side effects of steroids should they get prescribed the medication. I have a dozen patients with similar circumstances as you.”
“You might have saved their lives,” he said.
HELP IS AVAILABLE: Are you or someone you know in trouble? Or feeling alone? You are not alone. You can reach the National Suicide Prevention Lifeline by dialing or texting 988. The Spanish Language Line can be accessed by pressing 2 after dialing. An online chat can be started at 988lifeline.org. A call, chat, or text will connect you with a local crisis center. The American Foundation for Suicide Prevention has additional resources at afsp.org/get-help.
Thomas Lee is a freelance journalist who has been a business reporter at the Globe, the San Francisco Chronicle, and other newspapers. While at the Star Tribune in Minneapolis, he was part of a team that won the 2013 Gerald M. Loeb award for breaking news.