However, their beneficial effects can also reduce underlying pathology which not only improves quality of life, but also may reduce the need to use non-prescribed drugs.  A key task is often to encourage clients to take the substances they don't enjoy and which are often socially taboo and to stop taking substances which make them feel better (in the short term) and are socially accepted in their circle.

An understanding of the differing philosophies about the role of prescribed medication in mental illness, as well as the substances themselves is likely to allow for improvements in service delivery in this area.

While this web page may assist in a broad understanding of psychiatric drugs, discussion with a the client's doctor or pharmacist is recommended to help identify possible issues, areas for observation and intervention.

Categories

Antianxiety and sleeping medication
Antidepressants
Antipsychotics
Antimanic drugs

Management Issues

Become informed
Education
Report side effects and drug changes
Support a multi-disciplinary approach

Categories

Antianxiety and sleeping medication (Anxiolytics and hypnotics)

Benzodiazepines are used to treat insomnia (short-term), anxiety disorders, and as adjuncts to antipsychotics to reduce agitation.  In addition they are also used to treat alcohol withdrawal, some side effects of antipsychotics, and are occasionally used as a muscle relaxant for those with bone and muscle problems.

The major difference between most sleeping pills and anti-anxiety medication is simply the time it takes for the substance to act and wear off.

Benzodiazepines are also used to get intoxicated, particularly when other substances are not available. Other times, clients become addicted without realising it. 

Sudden withdrawal can lead to agitation, anxiety, insomnia, nausea, hallucinations, delirium and seizures.

When mixed with other depressants, particularly alcohol and heroin, they can be lethal.

It is for this reason that cognitive behavioural therapy is generally the first line of treatment in anxiety disorders.

An alternative to benzodiazepines for the treatment of anxiety is buspirone which does not seem to have the same addition potential.

Click  here for a list of common benzodiazepines (from Infoxchange)

Antidepressants

Antidepressants are not only used in the treatment of depression, they are also used to treat anxiety disorders (particularly obsessive and panic disorders) and chronic pain.  

Clients should be instructed that the full effects of antidepressants may take two to four weeks and that they usually should continue taking antidepressants for a month after normal mood returns.

Some of the newer antidepressants have fewer side effects and are less likely to cause overdose.  However, overdose risk is increased in those who are also drug dependent and prescriptions should be limited to one week at a time.

Antipsychotics

Antipsychotic drugs are primarily used in the treatment of psychosis to reduce the symptoms of hallucinations, delusions, and thought disorder.  They have also been shown to help prevent relapse in schizophrenia.

They are also used in the treatment of acutely disturbed states such as in alcohol associated delirium.

Some of the side effects of these drugs include:
- muscle stiffness and spasm (dystonic reaction)
- feelings of agitation and restlessness - (akathisia)
- Parkinson like symptoms of fine tremor of the hands and rigidity
- Reduced libido

These side effects may be treated by reducing the dose or by another group of medications called anticholinergics.  These also have side effects of dry mouth, constipation, blurred vision and urinary retention.

Antimanic drugs

Lithium is the most common substance used to treat bipolar affective disorder (manic-depression).

At therapeutic levels it may also cause a fine tremor, muscle weakness, problems with memory and concentration, weight gain, increased thirst and increased urination.

Toxic levels can cause increased tremor, nausea and vomiting, painful joints, difficulty in walking, and confusion.  Dehydration from illness or sweating in hot weather can cause toxicity.

Carbamazepine is also use to manage mania, particularly those who do not respond to lithium.  However, this drug reacts with many substances including dextro-propoxyphene (Doloxene)  which is sometimes used by drug addicts.  This drug also reduces the effects of oral contraceptives which can result in pregnancy.

Management Issues

Education
Clients taking medication to manage mental illness should understand the reasons for the medication, likely positive as well as side effects. Non-specialist staff may need to assist clients in accessing  this information from their doctor if they don't already have it.

Interactions of prescribed and non-prescribed drugs should also be discussed with the client. 

Report side effects and drug changes
Any observation of side effects should be discussed with the client and the client's doctor. Report increases or changes in non-prescribed drugs to the doctor of clients on prescribed medication.

Support a multi-disciplinary approach
Multi-disciplinary staff have a role in supporting adherence to medical regimes.  If staff have any reservations about a client's drug regime, they should be discussed with the medical practitioner and not the client as this may undermine therapeutic relationships.