Medication - choice and managing problems

Your doctor may offer you medication if you experience symptoms of a mental illness. Sometimes you might not want to take medication or feel it is not right for you. This page explains how you can try and deal with problems with medication. This section is for people who live with mental illness and their carers.

Overview

  • Your doctor may offer you medication to help with symptoms of a mental illness.
  • Medication is not the only treatment that might be right for you. You may find talking therapies, self-help and alternative therapies useful too.
  • You might have to try different medicines before you find the one that works for you.
  • Your doctor should tell you any risks and benefits of taking medication before you start taking it. They should also tell you how to take it.
  • You may get side effects from your medication. Many will wear off over time. It is important that you find the balance between treating your symptoms and managing side effects.
  • If you have a problem with your medication talk to your doctor about it.
  • You should speak to your doctor before stopping medication.
  • You can take a friend, relative or advocate if you find it hard to talk to your doctor.

On this page, the word ‘doctor’ means psychiatrists and general practitioners (GPs). Other medical practitioners do have prescribing powers, such as some nurse practitioners. But for ease on this page we refer to your doctor. You can find out more about the prescribing powers of different medical professionals by clicking the link below:

www.psnc.org.uk/dispensing-supply/receiving-a-prescription/who-canprescribe-what/

Types & GP choice

What are the different types of medication?

If you experience symptoms of a mental illness, your doctor may offer you medication to help with your symptoms.

You can take medication by mouth as a tablet or liquid. You can also get medication as an injection. This is called a ‘depot’. This is pronounced “dehpoh”. If you are given medication as a depot it can help keep the medication in your system for longer. Depot injections can help you remember your medication.

You can find more information about:

  • Antidepressants by clicking here.
  • Antipsychotics by clicking here.
  • Mood stabilisers by clicking here.
  • Benzodiazepines by clicking here.

How does my doctor decide what medication to give me?

Your doctor uses different information to decide which medication to give you and how much you should take. They might look at:

  • guidance produced by the National Institute for Healthand Clinical Excellence (NICE),
  • any medication that helped you before,
  • your physical health,
  • if you smoke, drink alcohol or take recreational drugs,
  • the effect it might have when taken with other medication,
  • any side effects linked to the medication, or
  • if you want to take a particular medication.

Your doctor should explain to you all of your medication options. This is so you can make the right choice for you. They should not pressure you to take a drug or treatment.

The General Medical Council (GMC) says that doctors should be open and honest about why they have made a decision.

If you don’t agree with your doctor, then you can explain why you don’t agree. They should check your understanding and listen to your concerns. For example, they should listen to you if you want to try a particular medication. Your doctor should also talk to you about other treatments such as talking therapies.

You can find more information about ‘Talking therapies’ by clicking here.

You might worry that your doctor will make you go to hospital if you don’t take the medication they suggest. Your doctor shouldn’t threaten to detain you under the Mental Health Act (MHA) 1983 if you don’t accept a type of treatment. Your doctor can only take steps to detain you under the Act if:

  • you refuse treatment, and
  • your illness puts you or others at risk of serious harm.

You can find more information about the ‘Mental Health Act’ by clicking here.

How can I organise my medication?

If you have to take different medications, you could use a medication box. They’re sometimes known as a dosette boxes. These are plastic boxes with small compartments that clearly show which pills need to be taken at what time of day.

You can ask your pharmacist about medication boxes, or search for one online.

Medication boxes aren’t suitable for all types of medication and aren’t free on the NHS.

Starting medication

What should my doctor tell me before I take my medication?

Your doctor must make sure:

  • your care is their first concern, and
  • provide a good standard of practice and care.

To make sure they do this, your doctor should:

  • explain the benefits and risks of taking a medication,
  • tell you why they are giving you a medication
  • tell you what the side effects are.
  • give you a rough idea of the time span of treatment, and
  • discuss arrangements for follow up and reviewing medication. Adjusting the type and dose of medicine and for issuing repeat prescriptions.

You will also get an information leaflet with your medication. This is called a Patient Information Leaflet. This will give information on things like dosage, common side effects and special warnings.

You may get side effects from your medication. Your doctor should give you an overview of what these might be. We talk about side effects in more detail below.

Your doctor should make sure you understand the information they have given you. They should ask if you have any questions and answer these honestly.

Your doctor doesn’t have to give you information if they think it could cause you serious harm. Serious harm means more than just a risk of you refusing treatment. It is unusual for doctors to withhold information for this reason.If your doctor does withhold information from you, they should explain why in your medical notes.

If you want to talk to your doctor about your medication book an appointment with them. You can write a list of your questions before your appointment. There are some examples of questions in the checklist at the end of this page.

Where can I get Patient Information Leaflets?

If you research medication on the internet you should only use reliable sources. You can download copies of Patient Information Leaflets. You can get these from The Medicines and Healthcare Products Regulatory Agency website by using this link:
www.mhra.gov.uk/spc-pil/index.htm

What are Medicines Use Reviews?

You can also go to your pharmacist for a Medicines Use Review (MUR). This is a free service. In an MUR you can speak to a pharmacist about all the medications you are taking. They can explain what your medications are for. They can also tell you about any potential side effects.

Adjustment & side effects

How long does medication take to work?

Medications can vary in how long they take to start to work. For example, some antidepressants can work straight away. Or they might take a few weeks.

If you don’t think your medication is working, you should talk to your doctor. You shouldn’t stop taking your medication without speaking to your doctor first.

Your doctor can decide if you need to change the dose or medication. If you feel there are urgent reasons why you need to stop your medication, tell your doctor about these. You have the right to ask questions and choose your medication based on what you think is right for you.

Are there any side effects?

When you take medication, you might get side effects. These can sometimes be unpleasant. Your doctor should always tell you the common side effects.

Side effects can go away after a few weeks or months of taking medication. Some side effects might last longer. It is important that you find the right balance between medication that helps your symptoms and has the least side effects.

If you feel the side effects are very bad, the first thing to do is talk to your doctor. They might change your dose or suggest a different medication. They may also be able to give you other drugs to help with the side effects.

You can use a scale like the Glasgow Antipsychotic Side Effects Scale to monitor your side effects.

The Glasgow Antipsychotic Side Effects Scale (GASS) is a questionnaire you can do by yourself. There are 22 questions about different side effects. You can take this to your doctor to help you decide how to manage the side effects. You can download the GASS here:

www.sussexpartnership.nhs.uk/sites/default/files/documents/glasgow_antipsychotic_side-effect_scale_gass_-_jan_18_0.pdf

In some cases, you might be able to lessen side effects through changes to your lifestyle. Here are some suggestions you could try.

Feeling tired or sleepy

You should always take your medication at the recommended time of day. If you are not sure you can ask your doctor. Or it might tell you when to take the medication on the label.

Your medication might make you feel more tired or sleepy. Make sure that you are taking the right amount, and that you aren’t taking more than you need to. You might feel more tired when you first start taking the medication.

Sexual side effects

Sexual side effects can include problems reaching orgasm or getting an erection.

You might find sexual side effects embarrassing to talk about. But doctors are used to talking to patients about these types of problems.. Your doctor might be able to find out what is causing your sexual problems. They can suggest ways to make things better.

Weight gain

Some medication can make you feel hungry and put on weight. You should try to:

  • eat a healthy, balanced diet with high fibre, vegetables and complex carbohydrates,
  • stay away from or limit sugary drinks and snacks,
  • fit exercise into your routine in a way that you enjoy it, and
  • make sure you have a proper sleeping pattern.

Your doctor can give you advice on how to stay healthy.

NICE guidance says that people with psychosis and schizophrenia should have a physical health check every year. NICE stands for The National Institute for Health and Care Excellence.

You can find more information on wellbeing and physical health on our website. You can click the following link: www.rethink.org/advice-and-information/living-with-mental-illness/wellbeing-physical-health/

What is the Yellow Card system?

The Medicines and Healthcare Products Regulatory Agency (MHRA) is an agency in the United Kingdom. It is their job to make sure medicines and medical devices work and are safe.

The MHRA runs the Yellow Card system. You can use the system to report bad side effects.

You can find out more about the Yellow Card system by clicking this link:
www.yellowcard.mhra.gov.uk/the-yellow-card-scheme/

How can I report bad side effects?

You can report bad side effects online by clicking on the following link:
www.yellowcard.mhra.gov.uk/

Stopping

What if I want to stop taking my medication?

You should talk to your doctor if you want to stop taking medication. You might get withdrawal effects when you stop taking medication. This can often happen if you’ve been taking the medication for a long time.

Your doctor should tell you the best and safest way to withdraw from your medication. They might tell you to gradually lower the dose of your medication over a few weeks or months.

If you get serious side effects tell your doctor as soon as possible.

You can also get advice from a pharmacist about the best way to stop taking your medication.

It is best to not suddenly stop taking medication without getting advice from your doctor or a pharmacist. This could lead to issues, such as bad withdrawal effects.

Talking to your GP

How can I talk to my doctor about my medication?

If you have questions about your medication you can make an appointment with your doctor. You can prepare for your appointment by making a list of questions and any concerns you have.

You can take someone to the appointment with you for support. This could be a carer, friend, relative or advocate. We have given some suggestions of questions you could ask at the end of this section.

You can find more information about ‘Advocacy’ by clicking here.

What can I do if I disagree with my doctor?

If you disagree with your doctor, talk to them about why you disagree and what you might prefer instead. Find out why the doctor has made their decision and if they will change their mind. If they won’t change their decision, ask why.

You can write to your doctor asking them to listen to your concerns. You can explain that the GMC and NICE say they should listen to your concerns. The GMC stands for the General Medical Council. NICE stands for the National Institute for Health and Care Excellence.

You could try to get a second opinion. A second opinion is when another doctor gives you an opinion about your diagnosis or treatment. You don’t have a legal right to a second opinion. But it can be helpful if there are questions or problems with your treatment.

If you feel your relationship with your doctor isn’t working or if you are still not happy, you can make a complaint.

You can find more information about:

  • Second opinions by clicking here.
  • Complaints by clicking here.

What can I do if my doctor treats me unfairly or badly?

If you think your doctor’s behaviour is unprofessional you can report them to the General Medical Council (GMC). The GMC is their governing body.

Unprofessional behaviour might be committing a crime, making serious mistakes or lying. You shouldn’t report your doctor to the GMC to solve a disagreement about medication.

You might have suffered harm because the medication your doctor gave you wasn’t right. You might be able to take legal action for clinical negligence. Your doctor might have given you the wrong medication which had a bad effect on you.

You can find out more information about:

  • Clinical Negligence by clicking here.
  • Legal Advice by clicking here.

Refusing medication

Do I have to take medication?

You don’t have to take medication if you don’t want to. You have to agree to treatment. To make decisions about treatment you have to:

  • make the decision without being pressured by family, friends or health professionals, and
  • understand the treatment including the benefits, risks, other treatment and what happens if you don’t take it.

Can I refuse medication if I am in hospital under the Mental Health Act?

When you are detained under the Mental Health Act 1983, doctors can give you medication even if you don’t agree to it.

Your doctor should still ask if you will accept treatment before they give it to you. Your doctor should ask you questions and look at your medical notes so that you get the right medication.

You can get an Independent Mental Health Advocate (IMHA) when you are in hospital. An IMHA can help you in meetings with your doctor. Your friends and family should also be able to go to meetings with you if you want them involved with your care.

You can find more information about the ‘Mental Health Act’ by clicking here.

Checklist questions

Some questions you could ask your doctor

  • What is my diagnosis? Can you explain it to me?
  • What are my medication options?
  • How does the medication work?
  • Why did you choose this medication?
  • What is the usual dose of this medication?
  • What time of day should I take my medication?
  • What symptoms should this medication help?
  • Are there any treatments apart from medication?
  • What are the side effects? Will they be short-term or long-term?
  • What are the chances of getting side effects such as weight gain or sexual side effects?
  • Are there any other medications that I could try instead if I wanted to?
  • How long will it take to work?
  • How long will I have to take it for?
  • Can I get a repeat prescription?
  • What should I do if it doesn’t work?
  • What should I do if I get bad side-effects?
  • Who will review my medication and how often?
  • Can I drink when taking this medication?
  • Can I smoke when taking this medication?
  • Will the medication affect any other drugs or herbal remedies I am taking?
  • Can I drive while taking this medication?

Useful contacts

The main 3 advocacy organisations in England are:

Pohwer
Provides advocacy services in over 50 different areas across the country.

Telephone: 0300 456 2370
Address: PO Box 14043, Birmingham, B6 9BL
Email: pohwer@pohwer.net
Website: www.pohwer.net

Voiceability
Provides advocacy services in different areas across England.

Telephone: 01223 555800
Address: Mount Pleasant House, Huntingdon Road, Cambridge, CB3 0RN
Website: www.voiceability.org/;

The Advocacy People
An independent charity providing free, confidential advocacy services.

Telephone: 0330 440 9000
Address: PO Box 375 Hastings, East Sussex, TN34 9HU
Email: info@theadvocacypeople.org.uk
Website: www.theadvocacypeople.org.uk/

Electronic Medicines Compendium UK
The EMC has information about medications. You can look up the ‘Patient Information Leaflet’ (PILs) and the ‘Summary of Product Characteristics’ (SPCs) for your medication.

Website: www.medicines.org.uk/emc/

Yellow Card Scheme
The Yellow Card Scheme monitor the safety of all healthcare products in the UK to ensure they are safe.

Telephone: 0800 731 6789 (9am to 5pm Monday - Friday only).
Address: Freepost Yellow Card Scheme, MHRA,10 South Colonnade, Canary Wharf, London E14 4PU
Email: yellowcard@mhra.gov.uk
Website: www.yellowcard.mhra.gov.uk/the-yellow-card-scheme/

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