Finding the right medication. Why take medication?

by Rethink

One of the main treatments used to combat the symptoms of mental illness is medication in various forms. Psychiatric drugs can be given in the form of tablets, syrups or injections. They act on the chemical balance in the brain so that thoughts, feelings and behaviour are normalised. These drugs can have side-effects which are troubling and for which additional medication can be prescribed.

Individuals respond differently to these drugs and it may take some time to find the most suitable medication and the right dose. The psychiatrist should carefully and regularly review the drugs s/he prescribes, checking for both their usefulness in controlling symptoms and their side-effects. Some of the newer drugs have fewer side-effects than older ones and can be more effective in treating symptoms. Research into more sophisticated medication is continuing.

It can be more expensive to prescribe the newer drugs, so psychiatrists may try older, less expensive ones first. If the person taking the medication is unhappy with its effects, s/he can request a medication review. This can be done either through your psychiatrist or GP. Second opinion doctors in your area can be recommended by the Rethink National Advice Service on 0208 9746814 Mon, Wed, Fri 10am-3pm and Tue, Thur 10am-1pm or [e-mail]

why take medication?

Medication can help the majority of people who have been diagnosed as experiencing severe mental illness. It builds a foundation for recovery, which, when combined with other types of vital support and the avoidance of undue stress, can make life much easier to cope with. Over a period of time, medication often enables a person to return to a more active life. It also helps reduce the number of relapses which require readmission to hospital.

As with all medication, however, people can and do experience unwanted and sometimes unpleasant side-effects. These will be different, both in nature and degree, from one individual to another. It is important, therefore, that those who are taking medication and carers are aware both of the characteristics of the medicine and any reactions to it.

why are there so many drugs?

If you investigate a bit about psychiatric medication you will realise there are lots of different types of drugs. Drugs are classified by different categories and within each category, into different classes. The symptoms you have determine which category of drug you have. Categories of drug include:

• antidepressants, for depressive symptoms
• antipsychotics, for psychotic symptoms
• mood stabilisers, for balancing mood
• anxiolytics, for anxiety

Classes of drugs tend to work in different ways. For instance among antipsychotics there are old and new classes of drugs. The class of drug that is prescribed for you depends on several factors. These include:

• risks concerning your health and side effects
• other medication you are on
• medications you have tried and have not worked or not been tolerated
• cost of medication (see "Is Cost a Factor?", NSF 1995 & 1999)
• your age, and
• your ethnic background.

Even taking all this into consideration it is hard to tell which individual drug will be best for you. Often you may have to try a couple before you find one that suits you.

Why are drugs known by more than one name?

Drugs used in the treatment of mental illness may be known by:

• a descriptive name, used to refer to these drugs in general
• the trade name
• the generic name
• the chemical group to which the drug belongs

descriptive names

The kind of drugs used to treat schizophrenia are generally collectively referred to by the descriptive terms:

• antipsychotic - meaning that the drug reduces psychotic symptoms
• neuroleptic - meaning that the drug works by acting upon the nervous symptom

Occasionally these drugs are called "major tranquillisers" but this term can be misleading because it suggests only the function of calming and sedating.

The older drugs are sometimes described as "established" medication. Although referring to the fact that the drugs have been commonly used over the years, this term may suggest that these drugs are more reliable and so be misleading. The term, however, is falling out of use.

trade and generic names

The trade name of a drug (for example, Largactil) will vary from one drug company to another and may also depend on the way in which the substance is formulated of taking, or on the country in which it is marketed. In contrast, the generic name (in this case, chlorpromazine), which defines the chemical nature of the substance, does not vary.

A brand name should always begin with a capital letter, whereas the generic name does not (unless of course it starts a sentence). Except for prescription purposes, the drugs are commonly referred to by their generic names.

chemical group names

Drugs are also divided into groups or classes according to their chemical make-up. Chlorpromazine, for example, is one of the many phenothiazines.

Drugs within the same chemical class tend to be basically similar to each other in the effects they produce, although there are exceptions. Major differences in action tend to occur between drugs of different chemical classes.

How does psychiatric medication work?

Neuroleptic medications act in very complex ways, but they all either act on the sites in the brain sensitive to dopamine, to serotonin or to both. The effect that they have on positive or negative symptoms depends on the extent to which they act on each system. The strength of the side effects they produce depends on the strength with which they bind to these sites and to which particular part of the brain they are attracted. The ideal drug will bind strongly enough to the sites to control the symptoms, but not strongly enough to produce side effects, and at the same time attach to the serotonin and dopamine sites in the right proportion.

New developments in drugs are attempting to direct the drugs to specific types of sites in specific regions of the brain, and investigating the roles of other chemicals and the sites to which they are attracted.

how soon do the drugs work?

Some effects of medication - sedation, for example - will appear soon after taking the drug but diminish as treatment progresses. It may, however, take weeks or even months of regular medication before the most important changes in the behaviour of someone experiencing mental illness become fully established at a stable level. It may also take a long time before the effects of a change in treatment or in the dose of medication become fully apparent. This is why it isn't advisable to change drug or dose too frequently, although long-term medication should certainly be reviewed regularly, say every six months or even sooner if there are problems.

how long do the effects of the drugs last?

How long the benefits of an drug last depends not only on the actual drug but also on its formulation and on how it is given. Longer-acting medication may be given in a special formulation by intramuscular injection and is known as a "depot" preparation because the drug is stored at the site of injection and is slowly absorbed into the body over a period of weeks.

Shorter-acting medication is usually taken by mouth as tablets, capsules or syrup. If a more immediate and certain effect is called for, a sterile solution may be injected intramuscularly or, rarely, intravenously.

All drugs you must take regularly to have a constant effect and control your illness. However, some drugs continue to have an effect once you stop taking them. This does not include controlling your symptoms but may lead to withdrawal symptoms, a kind of side effect of the drug. Stopping taking your medication may lead to your illness returning or to withdrawal symptoms. It is best to talk to your GP or psychiatrist if you want to come off any medication you are on.

injections or pills?

Whereas some tablets need to be taken at least once a day, depot preparations only need to be injected every few weeks. This can help overcome the problem of forgetting to take pills. Not many psychiatric medications are available in this form so if you are advised to have this type of treatment, your choice may be limited.

Regular reviews. Combining drugs. Does medication work for everyone?

All medication needs to be continuously reviewed so that it is effectiveness can be monitored as well as any side effects that you might be experiencing. Reviews provide an opportunity for you to ask questions and discuss concerns with the your GP of psychiatrist. This may result in an adjustment or change of medication. It is important that any decision to reduce or stop medication are made to jointly by you and your psychiatrist or GP, so that any effects of withdrawal you may have are carefully monitored. It may be helpful for friends and family to know about what is happening so they can help in recognising any signs of improvement or relapse.

combining drugs

You may be prescribed a number of different medications for you mental illness. Like when you have a cold you may be prescribed something to clear your nose and something to soothe your throat so you may be given an antipsychotic and a mood stabiliser. When prescribing two different drugs the GP or pharmacist should check whether the drugs interact.

You will usually be prescribed only one drug from a single category, for example, one antipsychotic. If this does not work as well as hoped it is usually better to try another drug, perhaps from a different class such as a newer drug, but you should not initially be prescribed another drug from the same class in addition to the first drug. This is thought as bad practice. Very few people need to be prescribed drugs in this way and if you are prescribed more than one drug of the same class you may like to ask your GP or psychiatrist why this is and of what benefit this is to you.

does medication work for everyone?

Medication is one of the first line treatments of most severe mental illnesses. Usually after trying one or two drugs you will find a medication that suits you and relieves your symptoms to a large degree without causing too many debilitating side effects. For some people it may take a time to find the combination of drugs which works for them. Because of the large number and variety of drugs, most people will find one that helps. However, not all people will respond equally well to medication and while some people may resolve a quality of life that allows them to work, others may not reach this. What is important is about reaching the best level of recovery for you. This may include having a social life, doing some voluntary work or being able to attend a day hospital. All these goals can be reached with the aid of medication and with the addition of talking therapies, occupational therapy and support in hospital or the community.

About the Author

www.rethink.org
Rethink is the largest severe mental illness charity in the UK. We are dedicated to improving the lives of everyone affected by severe mental illness, whether they have a condition themselves, care for others who do, or are professionals or volunteers working in the mental health field.