Medication - choice and managing problems
Your doctor may offer you medication if you have a mental illness. Sometimes you might not want to take medication or feel it is not right for you. This section explains how you can try and deal with problems with medication.
- 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.
Types and GP choice.
What are the different types of medication?
If you have 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’ (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.
The following pages will be able to give you more information about:
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 Health and 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 might suggest a certain type of medication because they know more about it than other treatments. But 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 explain why you don’t agree. They should listen to your concerns and any suggestions you make.4 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 might worry that your doctor will make you go to hospital if you do not take the medication they suggest. Your doctor cannot threaten to detain you under the Mental Health Act (MHA) 1983 if you don’t accept a type of treatment.
Your doctor can only detain you under the Act if:
- you refuse treatment, and
- your illness puts you or others at risk of serious harm.
What should my doctor tell me before I take my medication?
Your doctor has to make sure:
- your care is their first concern, and
- you agree to treatment.
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, and
- tell you what the side effects are.
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.
You doctor should make sure you understand the information they have given you.8 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 you can do this any time. You could write a list of your questions before your appointment. There are some examples of questions at the end of this factsheet.
If you research medication on the internet you should only use reliable sources. You can download copies of Patient Information Leaflets from The Medicines and Healthcare Products Regulatory Agency website by using this link: www.mhra.gov.uk/spc-pil/index.htm
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 and side effects.
How long does medication take to work?
Medication can take a while 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 should not 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 any 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. 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:
In some cases you might be able to lessen side effects through changes to your lifestyle. Here are some suggestions you could try. You should always talk to your doctor before you make any changes.
Feeling tired or sleepy
You should always take your medication at the time of day your doctor said. 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 the following.
- Sexual dysfunction, such as problems reaching orgasm or getting an erection
- Producing breast milk
- Your periods stopping
- Growing more breast tissue, if you are a man
You might find sexual side effects embarrassing to talk about. But doctors will have talked to other patients about this sort of problem many times before. Your doctor should be able to find out what may be causing your sexual problems. They can suggest ways to make things better.
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. The National Institute for Health and Care Excellence (NICE) guidance says that people with psychosis and schizophrenia should have a physical health check every year.
What if I want to stop taking my medication?
You should talk to your doctor if you want to stop taking medication. You can 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 might tell you to gradually stop taking your medication over a few weeks or months. If you get serious side effects tell your doctor as soon as possible.
Talking to my doctor about my medication?
If you have questions about your medication you should 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 questions you could ask at the end of this page.
You can write to your doctor asking them to listen to your concerns. You can explain that the General Medical Council (GMC) and the National Institute for Health and Care Excellence (NICE) suggest they should listen to your concerns.
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 do not have a legal right to a second opinion. But it can helpful if there are questions or problems with your treatment.
If you feel your relationship with your doctor is not working or if you are still not happy, you can make a complaint. If you want to complain about an NHS doctor or service you have to use the NHS complaints process.
What can I do if my doctor treats me unfairly?
If you think your doctor’s behaviour is unprofessional you can report them to their governing body, the General Medical Council (GMC).
Unprofessional behaviour might be committing a crime, making serious mistakes or lying. You should not report your doctor to the GMC to solve a disagreement about medication.
You might be able to take legal action for clinical negligence if you feel:
- you have suffered harm because your doctor has given you a certain medication, or
- your doctor has given you the wrong medication and it had a bad effect on you.
Do I have to take medication?
You do not 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 under the Mental Health Act?
When you are detained under the Mental Health Act 1983 (MHA), 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.
If you don’t want to take medication you can try some of the suggestions in this factsheet. 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 can also come to meetings with you if you want them involved with your care.