Q: I have Barrett’s esophagus, so my doctor prescribed Dexilant. Before that, the reflux was so bad it was going into my eustachian tubes like a volcano and setting my ears on fire. I thought I was exploding. At that point, I was taking Prilosec twice a day with no relief.

When my symptoms first began, I tried drinking water and not eating to avoid the horrible reflux. That didn’t work, so I turned to grape juice and was disappointed again.

Dexilant saved me. My doctor said it would reduce the risk of Barrett’s esophagus turning into cancer. Recently, the reflux has returned somewhat, and I would welcome any suggestions on managing it.

A: Barrett’s esophagus is a condition in which the cells lining the swallowing tube (esophagus) change to more closely resemble cells in the intestines. There is an increased risk for esophageal cancer if these cells continue to be exposed to stomach acid splashing up into the esophagus. However, the increased risk is modest.

Taking Prilosec (omeprazole) with grape juice is not ideal, because grape juice reduces the amount of omeprazole that can get into the bloodstream (Frontiers in Pharmacology, Dec. 4, 2024). The authors of this study warn that when people have conditions that require treatment with omeprazole, they should avoid drinking a glass of grape juice every day.

We do not know if grape juice might interact with Dexilant (dexlansoprazole). However, the intestines employ some of the same enzymes to metabolize these drugs, so we can’t rule out that possibility.

Q: I have a very sensitive system and react strongly to medications. After taking Prozac for a week, I became suicidal and then was hospitalized for 10 days.

While I was heavily medicated, I allowed my stockbroker to make irresponsible decisions and lost my life savings. I also shopped and spent indiscriminately when, in the past, I’ve always been a good saver.

This past spring, I’d had enough and spent eight painful, distressing weeks withdrawing from escitalopram. My doctor was “shocked and dismayed” that I was having withdrawal symptoms.

I currently take bupropion, which just gives me energy and helps with cravings. Recently, relatives have commented that I am more like my old self, more expressive, brighter and clearer. I know my brain has cleared and that I am thinking more coherently. I wonder why psychiatrists don’t notice the negative consequences of some antidepressants sooner and help more to ease withdrawal.

A: People react differently to medicines, including antidepressants. Most doctors know this, but they don’t always appreciate how it affects their patients’ life experience. We wish that they would pay closer attention when a patient says, as you did, “I react strongly to medications.”

Antidepressants are double-edged swords. They can save lives when they nudge people away from the brink of suicide. Sometimes they even restore the color and flavor to life.

On the other hand, most antidepressants can cause unpleasant or even dangerous side effects in some people, including suicidal ideation in some instances. Patients should be well-informed about potential benefits and risks before starting any prescription, and they should feel comfortable sharing any unexpected reactions with the prescriber.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com.