Understanding medication

It is easy to get confused about mental health medication, partly because there are so many different drugs, partly because new drugs are being introduced from time to time and partly because the same drug may be known by a variety of names depending on whether you are using the trade name, the generic name or the chemical group name.

The trade name of a drug, for example Mogadon, is the brand name given to the drug by the company which manufactures it. Each company will have a different name for the same drug.

The generic name of a drug, for example nitrazepam, describes the particular chemical family to which the drug belongs. Nitrazepam is the generic name for a drug used to treat insomnia. It is sold under trade names such as Mogadon.

The chemical group name of a drug describes the larger chemical family to which the drug belongs. For example, nitrazepam belongs to the family benzodiazepines which are used to treat insomnia and anxiety. Other drugs in the benzodiazepines family include diazepam (Valium) and temazepam (Planpak).

You can find out more about individual drugs, correct dosages and side effects from your GP, local hospital pharmacy department or chemist.  You can also ask your psychiatrist or mental health team.

It may be helpful to remember that most drugs used in the treatment of mental health problems fall into four main categories: anti-anxiety drugs, anti-depressants, anti-psychotics and mood stabilisers, each of which is described below.

Anti-anxiety drugs, also known as anxiolytics or minor tranquillisers, are used to treat anxiety. When they are used to treat sleeping problems they are known as 'hypnotics' or sleeping tablets.

Tranquillizers and sleeping tablets can be very effective in the short term but may become less effective on long term use and, when discontinued, can even produce the symptoms they are designed to reduce (known as the rebound effect). They can also be very addictive. For this reason they should only be prescribed for short periods of time ie two to four weeks and only for severe anxiety or sleep disorders.

Tranquillisers are quite commonly used to treat people with dementia, especially when there are particular problems with disturbed thoughts and seeing, hearing or smelling things that aren’t there. These drugs can be useful in some patients but sometimes only for a short time. These drugs may also just replace one set of symptoms with others, such as apathy. Sedatives are especially problematic when used with people with dementia as they can worsen confusion.

Anti-depressants are used to help relieve persistent low mood and other symptoms of depression, and also to improve motivation. They can be very effective but all have side-effects. They are not addictive.

Older anti-depressants include MAOIs (Monoamine oxidase inhibitors) and tricyclic anti-depressants. MAOIs are not used very much these days because of the dangers of interaction with certain substances, for example some meat and dairy products. The side effects of tricyclics may include dry mouth, drowsiness, blurred vision, trembling, constipation, urinary retention and sweating. Trycyclic anti-depressants are particularly toxic in overdose.

The newer, so-called SSRI (selective serotonin reuptake inhibitors) drugs, are less sedating and potentially less toxic than the tricyclic anti-depressants. However, they can cause nausea, diarrhoea and vomiting, and more occasionally other adverse effects such as headaches, restlessness, anxiety and disturbed sexual function.

With all anti-depressants, patients tend to become tolerant to many of the side-effects during treatment, and the risks can be further reduced by starting treatment with a low dose and raising it gradually. Most patients are continued on antidepressant treatment for at least 6 months, even when they have started to feel better, to avoid the risk of relapse.

Anti-psychotic drugs (also known as neuroleptics) are used to treat schizophrenia, the manic phase of bi-polar disorder (manic depression) and other conditions where psychotic symptoms occur. Anti-psychotics are sometimes called 'major tranquillisers' but this term is misleading because these drugs do more than just tranqullize. They are not addictive.

Traditional anti-psychotic drugs

The older anti-psychotic drugs can help to reduce agitation via a tranquillising effect which is different in mechanism to that of other tranquillisers but may still cause drowsiness. They can also help to relieve voice hearing and other hallucinations, as well as delusions, such as paranoia. They are thought to be effective in about two-thirds of patients with a diagnosis of schizophrenia, though it may take 2-3 weeks before they start working and more than 6 weeks to reach their maximum affect.

Unfortunately the older anti-psychotics frequently cause distressing side-effects, the most troublesome of which are movement disorders known as extrapyramidal symptoms. These can include tremor, slowing down of facial expression and body movements, restlessness in the legs (akathisia), and abnormal body movements (dystonia), all of which can be alleviated by reducing the dose, or by concurrent administration of a specific antidote such as procyclidine tablets. Longer term use, particularly with high doses, carries a significant risk of a permanent type of neurological damage, called tardive dyskinesia, which involves involuntary movements of the mouth and face.

Atypical anti-psychotic drugs

The newer anti-psychotic drugs are known as atypical because they have a different mode of action on the brain. Atypical antipsychotics, such as risperidone and clozapine, seem to be more effective than the older neuroleptics and cause fewer side-effects. In rare cases clozapine can cause a fatal blood disorder; thus patients are required to have regular blood tests during treatment.

As the name suggests, mood stabilising drugs are used to stablise mood. They are used to treat bi-polar affective disorder (manic depression) and severe depression.

Lithium is extremely effective for most people with a diagnosis of severe bi-polar affective disorder. However, overdose can be toxic at relatively low levels, causing tremor, unsteadiness, nausea, vomiting, diarrhoea and convulsions. For this reason, blood levels need to be monitored on a regular basis, usually every 3-6 months. At the correct dose, side-effects are few. Carbamazepine is sometimes used as an alternative to lithium in preventing the symptoms of manic depression, and is particularly effective in people with rapid swings between mania and depression.

Your doctor will consider a number of things when deciding which drug to prescribe for your symptoms. Most drugs are designed to treat particular problems or symptoms, for example anxiety or depression.

Your reaction to and sensitivity to a particular drug or class of drugs.

Some drugs work better for some people than others and it may take some time to find the right medication and the right dose for you. Your doctor should monitor and review the drugs s/he prescribes for you, checking their usefulness in controlling symptoms and their side-effects.

The side-effects or risks associated with a particular drug.

All drugs have side effects, some of them unpleasant. Some drugs may also carry an associated risk. For example Lithium, which is used to treat manic depression, can be toxic. It is important that you know about any side effects and risks associated with a particular drug and that you alert your doctor if you detect any changes or difficulties in your tolerance of your prescribed medicine.

His or her familiarity with or preference for the drug.

Some doctors prefer some drugs to others based on their experience of what works with other patients.

The cost of the drug.

By and large, newer drugs cost more than older drugs. Some health authorities will not allow staff to prescribe the newer, more expensive drugs.

You may find it helpful to ask the following questions if your doctor has prescribed you any form of medication:

• What is this drug designed to do?
  

Some drugs may be given to counteract the side effects of other drugs.

• How long will it be before it takes effect?
  

Some drugs take several weeks to have any effect.

• What are the side effects?
  
• Some drugs can have unpleasant and worrying side-effects.
  
• How long do I have to take the drug?

Some drugs should not be taken for more than a few weeks, some may need to be taken for months or years.

Do I need to take any precautions?

Some drugs should not be taken if you plan to drive and some should not be taken in combination with other drugs.