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helping families & friends find better ways
Psychiatric medications
finding the appropriate medication and
• possible side effects and what should
The experience of mental illness can have
dosage, and in talking through concerns
be done if they occur;
a profound impact upon people's work,
about side effects.
• how long will it be necessary to take the
family and social lives, as well as on
Medications have both desired effects
confidence and self-esteem.
(eg reducing symptoms) and undesired
• sources of information about this
Most people need assistance in rebuilding
effects commonly called side effects (eg
medication (eg. internet sites,
their lives after experiencing mental
drowsiness). The aim is for each person to
illness. Ideally, treatment involves
find a medication that is tolerable and has
Looking up medications in medical
biological (medical), psychological and
the least number of side effects while it
texts, drug texts, or on the internet
social components. Whilst medications
effectively reduces symptoms. Adherence
can be overwhelming and alarming.
are the cornerstone of treatment for most
to a medication is much more likely when
Many possible effects are listed, but
mental illnesses, they are not sufficient
it is clear that the benefits of taking the
not necessarily in order of importance
in themselves to lead people to recovery.
medication outweigh the costs. Changes
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 that has the most benefit and the least
than one diagnosable and treatable
This guide may not be all encompassing
side effects for a particular person.
condition and may be prescribed a
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. This can cause frustration and confusion
knows whether the person:
General guidelines and
about whether the medication is working
• has a particular active medical condition;
precautions in relation
adequately or is in fact the right one.
• is taking any other prescription or
to psychiatric medication
It is best to be patient and communicate
non-prescription medicines including
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:
it is important to understand that both
• the name of the medication, what it is
symptoms and diagnoses can change
• is breastfeeding, pregnant or planning
supposed to do, and when it should
over time. Typically then, a person will be
to become pregnant.
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.
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
Common brand names
the medication and which do not. However, if a person is still
flupenthixol decanoate
experiencing discomfort or is worried or afraid, speaking with the
fluphenazine decanoate
doctor can provide reassurance and alert the doctor that a review
haloperidol decanoate
of medication may be required. Describe side effects in detail to
zuclopethixol decanoate
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,
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
it may not be working. A medication should be taken for at least
Common brand names
three weeks before a change is considered, unless severe, adverse
reactions necessitate discontinuation. Maximum improvement
may take several months.
Clozaril,Clopine
Other medications may be prescribed with the antipsychotic to
assist with the treatment of additional symptoms or side effects.
Typical (Conventional) antipsychotic medications
Long-term injectables
Common brand names
Common brand names
Risperdal Consta
Some possible side effects and precautions
Side effects include weight gain, drowsiness, sleep disturbance and
change in eating patterns, dizziness, excess saliva, and agitation.
For clozapine, there are a number of serious side effects requiring
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.
Medications for side effects
Commonly experienced side effects are thirst, nausea, stomach
(also called anticholinergic medications or antiparkinsonian agents)
upset, weight gain, slight shaking, swollen ankles and passing 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
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 brand names
Common side effects tend to occur at the start of treatment and
decrease in severity over time. These include drowsiness, dry
mouth, blurred vision, nausea, mild dizziness, ringing in the ears
Benztrop, Cogentin
Side effects of these medications can include dry mouth, blurred
If any of the following uncommon side effects are experienced
vision, constipation, drowsiness, difficulty in urinating and
contact your doctor urgently: skin rash, hives or itching, sore
worsening of glaucoma.
throat and flu-like symptoms, severe diarrhea, unusual bruising or 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
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 disorder when taken regularly over an extended period of time.
Common side effects early in treatment are mild stomach cramps,
The main medicines used are lithium carbonate and a range of
nausea and vomiting, mild diarrhoea, headache, weight gain,
drugs first marketed to treat epilepsy.
change in menstrual cycle, trembling of hands or arms, drowsiness or rash.
It is important to take the medication regularly as it can take a few weeks to notice the benefit. Often side effects are noticed
Uncommon side effects requiring urgent medical attention include
before the benefit of the drug.
severe stomach cramps, unusual bruising or bleeding, changes in 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
Common brand names
symptoms may be experienced: Severe dizziness, severe drowsiness
and racing heart beat. Contact your doctor immediately if you
lithium carbonate
Lithicarb, Quilonum SR
experience any of these symptoms.
sodium valproate
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.
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)
Common brand names
Common brand names
Arima, Aurorix, Genrix, Maosig
Cipramil, Celapram, Talam, Talohexal
Genrix, Fluohexal, Lovan,
Some possible side effects and precautions
Faverin, Luvox, Movox
The most serious adverse reaction seen with MAOIs is critically
Aropax, Oxetine, Paxetine
raised blood pressure often caused by eating tyramine-rich foods
(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, palpitations, yawning, rash, sweating, anxiety, restlessness,
If taken with certain food and medications, MAOI can produce
sexual dysfunction, bruising.
a severe reaction (critically raised blood pressure), which may rarely cause stroke or death.
Individuals who suddenly cease SSRI medications may experience discontinuation symptoms such as nausea, headaches,
Other side effects can include insomnia, dizziness, dry mouth,
insomnia and flu-like symptoms.
When treatment begins with a MAOIs, it is extremely important to
discuss the restrictions on both diet and medication (prescription and
Common brand names
non-prescription) with the doctor.
Anafranil, Clomipramine,
Dothep, Prothiaden
Melipramine, Tofranil
Other antidepressants
Common brand names
Common brand names
Avanza, Mirtazon, Remeron
Kalma, Xanax Alprax
Atenex, Ducene, Valium
Efexor, Efexor XR
Alepam, Murelax, Serapax
Some possible side effects and precautions
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
by sudden discontinuation.
Medications for anxiety disorders
(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 by persistent feelings of high anxiety. There are feelings of
Other information lines include:
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
These medications are used for the whole range of anxiety
(Mon-Fri 9am-6pm)
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
in helping to manage agitation. Some are used to help people to
Mental Illness Fellowship of Australia
Antidepressant medications, particularly the SSRIs, clomipramine,
Mental Illness Fellowship Victoria
venlafaxine and mirtazapine (see medications for depression
above) are used to treat a range of anxiety disorders without
Mental Health Research Institute
the tolerance and dependence problems associated with
benzodiazepines (Valium and drugs like it). Reboxetine may also
National Alliance of the Mentally Ill (NAMI) (USA)
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.
Mental Illness Fellowship of Australia
Mental Illness Fellowship of
Mental Illness Fellowship Victoria
Mental Illness Fellowship of WA Inc
08 8221 5072 www.mifa.org.au
Sth Australia Inc
03 8486 4200 www.mifellowship.org
08 9228 0200 www.mifwa.org.au
Mental Illness Fellowship Nth Qld Inc
08 8221 5160 www.mifsa.org
Schizophrenia Fellowship of NSW Inc
ARAFMI (Tas) Inc
07 4725 3664 www.mifnq.org.au
Mental Health Carers NT
02 9879 2600 www.sfnsw.org.au
Launceston 03 6331 4486
Schizophrenia Fellowship of Qld Inc
Mental Illness Fellowship of the ACT Inc
Moonah 03 6228 7448
07 3358 4424 www.sfq.org.au
02 6205 2021 www.mifact.org.au
Source: http://www.australasianpsychologyservices.co/Articles/SFPsychiatricMedications.pdf
In Vivo Hyperpolarized Carbon-13 Magnetic Resonance Spectroscopy Reveals Increased Pyruvate Carboxylase Flux in an Insulin-Resistant Mouse Model Philip Lee,1,2 Waifook Leong,1,3 Trish Tan,1,3 Miangkee Lim,1 Weiping Han,1,3,4 and George K. Radda1 The pathogenesis of type 2 diabetes is characterized by impaired insulin action andincreased hepatic glucose production (HGP). Despite the importance of hepatic metabolicaberrations in diabetes development, there is currently no molecular probe that allows mea-surement of hepatic gluconeogenic pathways in vivo and in a noninvasive manner. In thisstudy, we used hyperpolarized carbon 13 (13C)-labeled pyruvate magnetic resonance spec-troscopy (MRS) to determine changes in hepatic gluconeogenesis in a high-fat diet (HFD)-induced mouse model of type 2 diabetes. Compared with mice on chow diet, HFD-fed micedisplayed higher levels of oxaloacetate, aspartate, and malate, along with increased 13C labelexchange rates between hyperpolarized [1-13C]pyruvate and its downstream metabolites,[1-13C]malate and [1-13C]aspartate. Biochemical assays using liver extract revealed up-regu-lated malate dehydrogenase activity, but not aspartate transaminase activity, in HFD-fedmice. Moreover, the 13C label exchange rate between [1-13C]pyruvate and [1-13C]aspartate(kpyr->asp) exhibited apparent correlation with gluconeogenic pyruvate carboxylase (PC) ac-tivity in hepatocytes. Finally, up-regulated HGP by glucagon stimulation was detected byan increase in aspartate signal and kpyr->asp, whereas HFD mice treated with metformin for2 weeks displayed lower production of aspartate and malate, as well as reduced kpyr->asp and
Progress in Neuro-Psychopharmacology & Biological Psychiatry 30 (2006) 1356 – 1358 Response to hydrocodone, codeine and oxycodone in a CYP2D6 poor metabolizer Margaret T. Susce, Elaina Murray-Carmichael, Jose de Leon ⁎ University of Kentucky, Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA Available online 24 April 2006 Codeine is metabolized by the cytochrome P450 2D6 (CYP2D6) to morphine. Codeine is a much weaker agonist at μ opioid receptors than