Antidepressants
Antidepressants are medications that are used to treat major depressive disorder as well as various anxiety disorders like OCD and panic disorder. They mostly work by increasing levels of the neurotransmitters serotonin and noradrenalin in certain parts of the brain. The most commonly prescribed antidepressants are the Selective Serotonin Reuptake Inhibitors (SSRIs), which include Fluoxetine, Citalopram, and Sertraline, which are favoured because of their relatively low side effect profile. Other commonly prescribed antidepressants include Mirtazapine, Trazodone and Venlafaxine. Antidepressants can cause a range of side effects including increased thoughts of suicide, nausea and restlessness, and usually take several weeks to start working. While not technically ‘addictive’, stopping these drugs suddenly can cause withdrawal symptoms, some of which can be severe.
Anxiolytics
Anxiolytics are medications that are used to treat anxiety. While Benzodiazepines such as Diazepam are very quick and effective at treating anxiety, they are often not prescribed for long periods of time because of the potential for abuse, tolerance, and the risk of serious withdrawal symptoms if stopped suddenly. Anxiolytics that may be prescribed longer-term include Pregabalin, Beta Blockers (such as Propranolol), and Buspirone. Side effects of Anxiolytics include sedation, memory problems, and trouble with coordination.
Hypnotics
Hypnotics, or sleeping pills, are drugs used primarily to help with insomnia. These drugs include the ‘z-drugs’ like Zopiclone and other drugs similar to Benzodiazepines. Sometimes sedating antidepressants like Trazodone are used. Other hypnotics include Melatonin, which is a natural hormone that helps regulate sleep, and antihistamines such as ‘Nytol’, which can be bought over the counter without a prescription. Side effects include daytime fatigue, cognitive impairment, and tolerance to the sleep-giving effects.
Stimulants
Stimulants are prescribed mainly to treat Attention Deficit Disorder (ADD) and some sleep disorders like narcolepsy. They work by increasing the levels of dopamine and noradrenalin in certain areas of the brain. Side effects include insomnia, appetite loss, and increased heart rate. Many stimulants can induce feelings of euphoria or wellbeing and so have a high ‘abuse’ potential.
Antipsychotics
Antipsychotics were traditionally prescribed to treat psychosis, but have been increasingly used to treat conditions like bipolar disorder. They work by blocking the effect of dopamine, a chemical that transmits messages in the brain. Antipsychotics can be ‘typical’ (1st generation), and include drugs like Haloperidol and Chlorpromazine, or ‘atypical’ (2nd generation), which include drugs like Quetiapine and Olanzapine. While both generations of drugs have a similar efficacy, the side effects can be markedly different – sedation and weight gain are typically more common with atypical antipsychotics, while movement disorders like akathisia are usually more common with the older drugs. As with all psychiatric drugs, these drugs should be discontinued slowly to prevent discontinuation effects and ‘rebound’ psychosis.
Mood Stabilisers
Mood stabilisers are typically used to treat bipolar disorder, but many are also effective at treating epilepsy. Some mood stabilisers, such as Lamotrigine, are only used to treat bipolar depression, whereas drugs like Lithium and Sodium Valproate can treat both mania and depression. These drugs can have some significant side effects – for example, many mood stabilisers, if taken by a woman during pregnancy, can increase the chances of causing birth defects. Drugs such as Lithium may have a narrow therapeutic window, where there is only a slight difference between an effective dose and a toxic dose. Many professionals today are using antipsychotic drugs as a first-line in treating bipolar mania, which are typically faster acting.
If you are currently taking medication and you’re thinking of coming off it, you might find it helpful to have a look at the ‘Coming off Medication’ page on the website; you’ll find the link at the right hand side of this page.
“Know Your Medication”: Online Resource
Our free online course looks at a brief history of medications used in mental health, a basic overview of the way neurotransmitters and synapses are involved in their efficacy, the various factors that influence whether or not medications are useful for a person’s recovery, some potential adverse effects and contraindications, the alternatives to medications and why and how people may reduce or stop taking them.
To explore this resource, and more, head over to our e-learning site where you will need to create a free account.
Personal Experience
Firstly, I would like to say how grateful I am to the NHS, in particular, for the commitment and compassion of the staff in the field of mental health.
Since my diagnosis, which took a little time to establish in the early 1990’s, I have led a relatively good life. I served in the Parachute Regiment of the Army as a junior soldier before taking over the reins of our family business from my father who passed away at just 49 years old.
So at just 19 years of age, I was exposed to a great deal of stress as we maintained the business and even opened a new branch in York. Following this I spent a couple of years selling cars. Although lucrative it was a little boring waiting for people to come to the showroom!
Following the first breakdown I was prescribed Lithium, which along with some other factors, helped keep me stable. Unfortunately in August 2011 I was sectioned and the medical staff agreed that lithium was no longer having the stabilising effect on me that it once did. I had been taking it for some 16 years. Also, blood tests were indicating that my liver function was starting to be affected. So they listened to my wife and I, and it was agreed that I should change my medication, moving over from Lithium to Depakote, along with Olanzapine.
Then in 2017 to try and prolong the episodes of being up or down, it was agreed that I would try Quetiapine alongside the Depakote, which had successfully proved to work for my twin brother Mark – who also interestingly had also been diagnosed with Bi Polar disorder.
Initially, until the optimum dosage was established and my body got used to the new medication, I still experienced minor mood swings, but these gradually diminished. I’m confident now that we have settled on the correct dosage and I have felt stable and well for over 4 months. In both of these medication changes my wife Shirley and I felt in full control of these decisions with excellent medical input.
For me, there are at least three key people who listen and help me to understand how I can successfully manage Bipolar. Firstly my wife Shirley; we have been married 25 years this year and her support and care for me over the years has been amazing. We can both recognise the early signs of becoming unwell. When facing a possible manic episode you can’t always see this for yourself, as you feel really well, so it’s critical for me to respect Shirley’s view on how I am. This leads me on to the next person who I value highly and that’s my Community Psychiatric Nurse. I’ve had the same guy for over two years and he is a great support and understands me well. Continuity makes a real difference. He has helped me recognise the signature or pattern my condition portrays and enables me to take early action to avoid a relapse. The third person, who offers me a reassurance and understanding of Bipolar, is my Consultant Psychiatrist, who in conjunction with my CPN offers further insight particularly with regard to medication.
Regarding negative experiences, I suppose one comes from when I have had to stay in hospital. Because you are mixed with all sorts of people, suffering all sorts of conditions, it’s a very difficult environment to recover in. One minute you may be talking to someone who is recovering from substance abuse and the next minute you may be speaking to someone battling depression. In that chaotic environment, sometimes it’s difficult to communicate how you are feeling to staff, and you may feel you are not being listened to.
Mental health seems to be climbing the agenda and is being spoken about much more openly than ever before, however I think there is a lot of work to do to recognise its effect on people’s lives and how it can be overcome and managed.
In my role as a Trustee at my local Mind, I was invited to visit Westminster and had the privilege to share with MP’s my experience of living with a long term mental health condition, and they seemed to listen. This caught me by surprise! On the whole, I have a lot more positive experiences than negative ones. In July 2017 I became a Grandad for the first time with the birth of my grandson. My daughter also gave birth to our equally gorgeous baby granddaughter recently. Life can be so rewarding when you consider how blessed we are as a family.
Life can also be a little tough with bipolar, but with the help of my family, my Christian Faith, and all my mental health team, I’m looking forward very positively to the next few months, and dare I say it, years ahead.
Coming off Medication
For many people, medication is really beneficial for their mental wellbeing. It can help to alleviate the intensity of distressing thoughts and feelings. Medications prescribed by medical doctors are well controlled and regulated in the UK, and there are clear guidelines on how they should be used. People who choose to continue taking medication for long periods should remain in contact with the person who prescribes it to ensure that everything is going well.
However, it is perfectly reasonable that people would want to be free of medication. Some of the reasons for this are:
- Feeling that medication has done what it was supposed to do and isn’t needed anymore
- Unpleasant side-effects
- Wanting to start a family or wanting to breastfeed
- Stigma
- Wanting to try other ways of managing distress
The general advice is to speak to a doctor or prescriber before stopping medication so that the easiest way of doing so can be explored. There are other important things to think about, such as:
- Having a support network for difficult times
- Being conscious of not using other substances to replace the effects of medication (eg alcohol)
- Getting some knowledge about a healthy lifestyle, including how physical activity and a balanced diet can help
- Preparing an Advance Statement which can include preferences for if coming off doesn’t go well
There are only limited circumstances where a person can be forced to take medication; these are set out in the Mental Health Act. Therefore, anyone should be able to discuss coming off with their doctor/prescriber. Ask for a second opinion if necessary.
It’s important to remember that there are certain medications which shouldn’t be stopped suddenly as this can be dangerous. These include Lithium, Clozapine and benzodiazepines.
“Coming off Medication”: Online Resource
Our free online course looks specifically at coming off medications. It discusses various drug groups and the associated adverse effects that may occur when stopping them, the reasons why stopping slowly is healthier, some strategies for how to stop, when it might be important to stop suddenly and managing long term adverse effects of having stopped medications too quickly.
To access this course, and more, head to our e-learning site where you will need to create a free online account.
Personal Experience
Coming off medication is not a decision to be taken lightly and certainly is not right for everyone. Before making a decision to come of medication it is vital that you do your research and determine whether you feel it really is what you want to do. No one has the right to make that decision for you and both taking medication and coming off medication come with risks, it is about balancing those risks to achieve a life that you’re happy with. For me, coming to terms with my condition, reading about self-management techniques, symptoms and triggers, as well as developing my own self-awareness were vitally important to successfully reducing and coming off medication without having a negative effect on my mental health.
My advice to anyone who is considering coming of medication would be to hope for the best but prepare for the worst. What I mean by this is that you need to have a plan in place in case you react badly. I read a huge amount about what can happen when coming off medication and also about alternative ways of managing bi polar disorder such as exercise and relaxation techniques. I think it is very important that you have the support of those close to you, your friends, family, and professionals involved in your care and make sure they are aware of when they need to act to ensure your safety should you become unwell during this period of change.
I have a diagnosis of bipolar disorder and before coming off my medication I wrote a very detailed person care plan, detailing the types of things that people need to look out for and agreeing what should be done in the event that various scenarios should take place. The plan included detailing my known triggers, what types of behaviour I may exhibit if I were to head towards a depressive episode and the types of activities I should be encouraged to do to try and prevent this, but also the same for an episode of mania. I described how people should approach me if they were worried about my mental health, for example I stated that I would like people to give specific examples of what they concerned about, rather than just saying that they are worried to enable me to decide whether their concerns are justified. I made a plan with my psychiatrist about the rate and which I would reduce my medication and how often I would check in with professionals during this period. I made sure that both myself and my family were aware of who should be contacted if I were to become unwell at various points. I also made a plan for what I would like to happen should I need to be hospitalised again, who I would like to visit, who should be informed and at what point people should act on my behalf.
Many people tried to persuade me not to come off my medication, that it was too risky and that I should carry on the medication that had stabilised me, however I was very unhappy with the side effects of the medication and how it was impacting on my life. I felt that I had a much better understanding of myself having come to terms with my diagnosis and wanted to give myself a chance at managing my condition without the use of mood stabilisers and antipsychotics. I am not against medication and know that the time may come in the future when I will need to take medication again, however at the moment I have been medication free, and stable, managing my condition myself, for nearly three years. I am able to lead a normal life, unaffected by the side effects of medication and I can honestly say that coming of medication, for me, was the best decision I could have made.