helping families & friends find better ways
Psychiatric medications
Introduction finding the appropriate medication and • possible side effects and what should
dosage, and in talking through concerns be done if they occur;
The experience of mental illness can have
about side effects. • how long will it be necessary to take the
a profound impact upon people’s work,
family and social lives, as well as on Medications have both desired effects medication;
confidence and self-esteem. (eg reducing symptoms) and undesired • sources of information about this
effects commonly called side effects (eg medication (eg. internet sites,
Most people need assistance in rebuilding
drowsiness). The aim is for each person to pamphlets).
their lives after experiencing mental
find a medication that is tolerable and has
illness. Ideally, treatment involves Looking up medications in medical
the least number of side effects while it
biological (medical), psychological and texts, drug texts, or on the internet
effectively reduces symptoms. Adherence
social components. Whilst medications can be overwhelming and alarming.
to a medication is much more likely when
are the cornerstone of treatment for most Many possible effects are listed, but
it is clear that the benefits of taking the
mental illnesses, they are not sufficient not necessarily in order of importance
medication outweigh the costs. Changes
in themselves to lead people to recovery. or frequency of occurrence and the
Instead, medications will alleviate or ease in medications and/or in dosage need to
benefits of the medication may not
symptoms for most people, providing be achieved in partnership between the
be well presented. Discussing concerns
a window of opportunity to begin the person taking the medication and the
with the doctor or a health professional
journey to recovery. doctor to find optimum outcomes.
can be helpful.
The ongoing use of medications will New medications are becoming
It is also important to remember
also assist in stabilising symptoms and available regularly, so it is worth
that people may experience more
preventing relapse. pursuing the search for a medication
than one diagnosable and treatable
that has the most benefit and the least
This guide may not be all encompassing condition and may be prescribed a
side effects for a particular person.
as new medications or ‘brands’ may be combination of medications.
marketed. If you are unsure about a A feature of most psychiatric medications
Before starting or changing any psychiatric
particular medication, check with your is that they may only begin to have a
medication it is important that the doctor
doctor or pharmacist. beneficial effect after several weeks.
knows whether the person:
This can cause frustration and confusion
General guidelines and about whether the medication is working • has a particular active medical condition;
adequately or is in fact the right one.
precautions in relation • is taking any other prescription or
It is best to be patient and communicate non-prescription medicines including
to psychiatric medication well with the doctor about the suitability complementary or herbal treatments;
Finding the right medication – persist! of the medication.
• is smoking, consuming alcohol or
In searching for the right medication, It is useful to request information about: street drugs;
it is important to understand that both
• the name of the medication, what it is • is breastfeeding, pregnant or planning
symptoms and diagnoses can change
supposed to do, and when it should to become pregnant.
over time. Typically then, a person will be
begin to take effect;
prescribed a variety of medications. It is It is important to take all medications
important that the person who is taking • how the medication is to be as directed, not just on an as
the medication understands what that taken ie. daily, with food etc; needed basis. Most medications for
particular medication is aiming to achieve. • any food, drinks, other medicines and mental illnesses do not work when taken
Similarly the person plays an active role activities the person should avoid while irregularly, and extra doses can cause
in partnership with the treating doctor in taking this medication; unnecessary side effects.
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Psychiatric medications
continued...
Any unusual feeling may be a side effect and should be Long-term injectables
reported to the doctor. After taking a medication for some time, (often used for people under a Community Treatment Order)
people will be better able to identify which feelings go with Generic name Common brand names
the medication and which do not. However, if a person is still
flupenthixol decanoate Fluanxol
experiencing discomfort or is worried or afraid, speaking with the
fluphenazine decanoate Modecate
doctor can provide reassurance and alert the doctor that a review
haloperidol decanoate Haldol
of medication may be required. Describe side effects in detail to
zuclopethixol decanoate Clopixol
the doctor before changing or stopping any medication.
Some possible side effects and precautions
Medications for psychosis Side effects include constipation, dry mouth, blurred vision,
dizziness (especially after standing up quickly), difficulty in urinating,
General information
rapid heart rate, weight gain, allergic reactions, impaired alertness,
Medications for pyschosis are called ‘antipsychotics’. drowsiness or sedation, breast enlargement and/or tenderness,
Psychosis is a condition in which the functioning of a person’s and a change in menstrual cycle for women. Breast enlargement/
brain is severely disrupted, affecting their thoughts, perceptions, engorgement or tenderness can also occur in men.
emotions and behaviour. A person experiencing psychosis These medicines can also cause movements such as motor
will have confused thoughts and speech, and difficulty in restlessness, tremor, muscle stiffness or rigidity and muscle jerking,
distinguishing reality. also eye rolling and other involuntary body movements. These are
Antipsychotic medications are used for treating schizophrenia, managed with a range of side-effect medications (see below).
schizophreniform psychosis, schizoaffective disorder, substance- Long term use of these medicines can result in tardive dyskinesia
induced psychosis and other conditions where psychotic symptoms
which is a syndrome of involuntary movements, especially around
(ie. hearing voices, hallucinations, confused thinking or delusional
the mouth. The involuntary movements include lip puckering,
ideas) are present.
chewing movements and tongue protusion, involuntary leg jiggling,
Interactions between prescribed medications and other drugs such or movement of neck, trunk, or pelvis. Contact your doctor
as alcohol and illicit drugs is often unpredictable. Report to the if you are experiencing any of these symptoms.
doctor if illicit drugs are being used.
Atypical antipsychotic medications
The medication may take a few weeks to work so it is important
for people to continue with the treatment even when they think Oral
it may not be working. A medication should be taken for at least Generic name Common brand names
three weeks before a change is considered, unless severe, adverse
amisulpride Solian
reactions necessitate discontinuation. Maximum improvement
aripiprazole Abilify
may take several months.
clozapine Clozaril,Clopine
Other medications may be prescribed with the antipsychotic to olanzapine Zyprexa
assist with the treatment of additional symptoms or side effects. risperidone Risperdal
quetiapine Seroquel
Typical (Conventional) antipsychotic medications
ziprasidone Zeldox
Oral
Long-term injectables
Generic name Common brand names
Generic name Common brand names
chlorpromazine Largactil
risperidone Risperdal Consta
haloperidol Serenace
pericyazine Neulactil Some possible side effects and precautions
pimozide Orap
Side effects include weight gain, drowsiness, sleep disturbance and
thioridazine Aldazine change in eating patterns, dizziness, excess saliva, and agitation.
thiothixene Navane
trifluoperazine Stelazine For clozapine, there are a number of serious side effects requiring
zuclopethixol Clopixol close monitoring during treatment. Regular blood tests will be taken
to check for signs of the serious (but infrequent) blood condition
agranulocytosis (decrease in number of white blood cells that can
lead to serious infection and death). Some heart conditions can
also develop and monitoring for these will be done also. At certain
dosages, seizures may also occur.
2
Medications for side effects Commonly experienced side effects are thirst, nausea, stomach
upset, weight gain, slight shaking, swollen ankles and passing
(also called anticholinergic medications or antiparkinsonian agents)
a lot of urine. If any of the following symptoms are noticed
General information contact your doctor immediately: severe shaking, blurred vision,
These are used to treat the involuntary muscle effects drowsiness, weakness, twitching, diarrhea, vomiting, slurred
of antipsychotic medications. Many involuntary symptoms speech or impaired concentration. Lithium can affect the kidneys
include: and thyroid gland. Blood tests will monitor for any changes in
• loss of facial expression; thyroid or kidney function.
• lack of drive to initiate movement; Carbamazepine is an epilepsy medication found to be effective
• feelings of restlessness in the muscles – can’t stay still; in managing mania and preventing recurrence of mania and
• muscle stiffness or rigidity; depression. The right dose is determined by response to treatment
• muscle jerks or spasms. and checking the level of drug in the body (bloodtest).
Common side effects tend to occur at the start of treatment and
Generic name Common brand names
decrease in severity over time. These include drowsiness, dry
benzhexol Artane
mouth, blurred vision, nausea, mild dizziness, ringing in the ears
benztropine Benztrop, Cogentin
and headache.
If any of the following uncommon side effects are experienced
Side effects of these medications can include dry mouth, blurred
contact your doctor urgently: skin rash, hives or itching, sore
vision, constipation, drowsiness, difficulty in urinating and
throat and flu-like symptoms, severe diarrhea, unusual bruising or
worsening of glaucoma.
bleeding, or yellow skin or eyes (jaundice).
Medications for mood disorder If the dose of carbamazepine is too high the following symptoms
can be experienced: severe nausea, vomiting, shaking, clumsiness,
General information irritability, restlessness or agitation, confusion or changes in vision.
Mood disorders are sustained abnormal emotional states that Contact your doctor immediately if you experience any of these
disrupt people’s lives. Feelings that range from depression and symptoms.
sadness to elation and excitement are often the experience of
Sodium Valproate is an epilepsy medication found to be effective
people who suffer a mood disorder.
for treating acute mania and recurrences of mania or depression.
Mood stabilizers are medications that relieve the symptoms of The right dose is determined by response to treatment and
mood chages such as mania and severe depression. They also checking the level of drug in the body (blood test).
prevent the recurrence of mania and depression in bipolar
Common side effects early in treatment are mild stomach cramps,
disorder when taken regularly over an extended period of time.
nausea and vomiting, mild diarrhoea, headache, weight gain,
The main medicines used are lithium carbonate and a range of
change in menstrual cycle, trembling of hands or arms, drowsiness
drugs first marketed to treat epilepsy.
or rash.
It is important to take the medication regularly as it can take
Uncommon side effects requiring urgent medical attention include
a few weeks to notice the benefit. Often side effects are noticed
severe stomach cramps, unusual bruising or bleeding, changes in
before the benefit of the drug.
vision, spots before eyes, confusion, lethargy, vomiting, swollen
Each medicine has its own particular precautions. Blood tests are face, yellow eyes or skin (jaundice), hair loss or change in hair
required with each to check that the dose is effective and texture, and persistent fever or sore throat.
to monitor for problems specific to each medication.
When the dose of sodium valproate is too high the following
Generic name Common brand names symptoms may be experienced: Severe dizziness, severe drowsiness
carbamazepine Tegretol, Teril and racing heart beat. Contact your doctor immediately if you
lithium carbonate Lithicarb, Quilonum SR experience any of these symptoms.
sodium valproate Epilim, Valpro Other antiepileptic drugs have been used in bipolar disorder. You
should request specific information on these medications from
Some possible side effects and precautions your doctor or health care professional when they are prescribed
Lithium carbonate is a simple element found in nature, (see drug information contact at end of leaflet).
some mineral waters and in the human body. At the right
dose, determined by blood monitoring, lithium treats the
symptoms of mania and helps prevent recurrence of manic
and depressive symptoms.
3
Medications for depression Some possible side effects and precautions
Side effects can include constipation, dry mouth, weight gain,
General information
blurred vision, difficulty in urinating, dizziness (especially after
These are used for treating symptoms of depression, such as standing up suddenly), sleepiness/sedation, rapid heart rate,
persistent sadness, hopelessness, poor appetite, insomnia, lack arrhythmias. Rarely, behavioural complications such as mania or
of energy, difficulty in concentrating and diminished interest psychosis, seizure in susceptible patients.
in usually pleasurable activities.
Tricyclic antidepressants may increase the frequency of seizures with
It will take a few weeks before noticing any improvement in people who experience epilepsy, and episodes of seizures may occur
symptoms although some side effects may be experienced. The for those who are not diagnosed with epilepsy.
medications may need to be taken for some time to improve
mood and maintain the improvement. Tricyclic medication may interfere with the rhythm of the heart,
especially when taken in overdose.
Selective serotonin reuptake inhibitors (SSRI) are most commonly
prescribed because of their safety and tolerability. If these Other side effects such as worsening of glaucoma, and difficulty
do not work then other antidepressant medications may be passing urine should be closely monitored by the treating doctor.
tried. Special precautions may need to be followed when changing Individuals who suddenly cease tricyclic medication may experience
from one antidepressant to another as combining antidepressant withdrawal symptoms such as nausea and headaches.
medications can result in serious reactions.
Monoamine oxidase inhibitors (MAOI’s)
Selective serotonin re-uptake inhibitors (SSRIs)
Generic name Common brand names
Generic name Common brand names moclobemide Arima, Aurorix, Genrix, Maosig
citalopram Cipramil, Celapram, Talam, Talohexal
phenelzine Nardil
escitalopram Lexapro
tranylcypromine Parnate
fluoxetine Genrix, Fluohexal, Lovan,
Prozac, Zactin Some possible side effects and precautions
fluvoxamine Faverin, Luvox, Movox The most serious adverse reaction seen with MAOIs is critically
paroxetine Aropax, Oxetine, Paxetine raised blood pressure often caused by eating tyramine-rich foods
sertraline Xydep, Zoloft (strong flavoured foods or foods needing an aging process to bring
out the flavour). This is particularly a risk with phenelzine and
Some possible side effects and precautions
tranylcypromine. Always consult your doctor or pharmacist before
Side effects can include nausea, vomiting and diarrhoea taking ANY prescribed or non-prescribed medicine including those
especially early in treatment, insomnia or increased sedation obtainable from the supermarket or health food store.
(particularly in young patients), abnormal dreams, headache,
If taken with certain food and medications, MAOI can produce
palpitations, yawning, rash, sweating, anxiety, restlessness,
a severe reaction (critically raised blood pressure), which may rarely
sexual dysfunction, bruising.
cause stroke or death.
Individuals who suddenly cease SSRI medications may
Other side effects can include insomnia, dizziness, dry mouth,
experience discontinuation symptoms such as nausea, headaches,
gastrointestinal disturbance
insomnia and flu-like symptoms.
When treatment begins with a MAOIs, it is extremely important to
Tricyclic antidepressants discuss the restrictions on both diet and medication (prescription and
Generic name Common brand names non-prescription) with the doctor.
amitriptyline Endep, Tryptanol
clomipramine Anafranil, Clomipramine,
Genrix, Placil
dothiepin Dothep, Prothiaden
doxepin Sinequan
imipramine Melipramine, Tofranil
nortriptyline Allegron
4
Psychiatric medications
continued...
Other antidepressants Benzodiazepine medications
Generic name Common brand names Generic name Common brand names
mirtazapine Avanza, Mirtazon, Remeron alprazolam Kalma, Xanax Alprax
mianserin Lumin, Tolvon clonazepam Paxam, Rivotril
reboxetine Edronax diazepam Atenex, Ducene, Valium
venlafaxine Efexor, Efexor XR lorazepam Ativan
oxazepam Alepam, Murelax, Serapax
Some possible side effects and precautions
temazepam Temaze, Euhypnas, Normison
Mianserin and Mirtazapine can cause sedation, weight gain,
dry mouth, dizziness, weakness and, very rarely serious blood Some possible side effects and precautions
changes. The doctor will monitor for any changes especially Side effects can include drowsiness, dizziness, fatigue,
in the first 12 weeks of treatment (bloodtest). irritability, difficulty in coordinating movements, dependence
Reboxetine is a specific noradrenaline reuptake inhibitor with long term use, may precipitate seizures in susceptible
antidepressant. Common side effects include dry mouth, nausea, individuals, paradoxical reactions such as acute rage, excitement
insomnia, racing heartbeat, difficulty urinating. or stimulation may occur rarely.
Venlafaxine is a selective inhibitor of both serotonin and As with all medications, take as directed. These drugs have high
noradrenaline (SNRI). It has a side effect profile similar to the potential for misuse and dependence. Do not increase the dose
SSRIs. As the dose increases there may be increase in blood or suddenly stop taking them without discussion with your doctor.
pressure. The doctor will monitor this. When stopping venlafaxine Withdrawal reactions, including restlessness, nervousness,
a discontinuation syndrome similar to that with SSRIs may be confusion, weakness, anxiety and convulsions can be caused
experienced. by sudden discontinuation.
Medications for anxiety disorders Further information
(also called anxiolytic medications) Further information about psychotropic medications may also
be obtained from the Psychotropic Drug Advisory Service at the
General Information
Victorian Mental Health Research Institute on 03 9389 2920.
The anxiety disorders are a group of illnesses, each characterised
Other information lines include:
by persistent feelings of high anxiety. There are feelings of
continual or extreme discomfort, tension with fear of panic attacks, Medicines Line (NSW) 1300 888 763 (Mon-Fri 9am-6pm)
usually without discernible cause. Consumer Adverse Medicine Events Line (NSW) 1300 134 237
(Mon-Fri 9am-6pm)
These medications are used for the whole range of anxiety
disorders, including social anxiety disorder, social phobia, Queensland Medications Helpline (QLD) Freecall 1800 632 763
generalised anxiety disorder, post traumatic stress disorder and
panic disorder with or without agoraphobia. They are also useful Useful references
in helping to manage agitation. Some are used to help people to
sleep.
Mental Illness Fellowship Victoria
Antidepressant medications, particularly the SSRIs, clomipramine, www.mifellowship.org
venlafaxine and mirtazapine (see medications for depression Mental Health Research Institute
above) are used to treat a range of anxiety disorders without www.mhri.edu.au
the tolerance and dependence problems associated with
National Alliance of the Mentally Ill (NAMI) (USA)
benzodiazepines (Valium and drugs like it). Reboxetine may also
www.nami.org
be used in the treatment of panic disorder.
Alprazolam is used for the treatment of panic disorder with
or without agoraphobia.
Temazepam is prescribed to help with sleeping
Clobazam is used, short-term, for acute anxiety.
Diazepam and Clonazepam are also used as
anti-epileptic/seizure medications.
Occasionally Clonazepam may be used for agitation.
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MIFV2013/02
©Mental Illness Fellowship Victoria Published 2013 (ACN 093357165)
Mental Illness Fellowship Victoria - for people with mental illness, their families and friends
276 Heidelberg Road Fairfield Victoria 3078 T: 03 8486 4200 F: 03 8486 4265 W: www.mifellowship.org ACN 093 357 165
