A guide to mental health medication

Antidepressants

What are antidepressants? 

Antidepressants are medicines that help with mental health conditions such as depression and anxiety, as well as certain phobias, bulimia, and some physical conditions for managing long term pain. 

How do antidepressants work? 

Antidepressants work on the neurotransmitters in the brain, chemicals that pass messages between your body’s nerve cells and to your organs. Some of these chemicals, like serotonin and noradrenaline, are linked to mood and emotion. 

These medicines may treat the symptoms; however, they don’t always deal with the causes. That’s why they’re often prescribed alongside talking therapies to help deal with the root causes.

What are the different types of antidepressants? 

There are several different types of antidepressants, and they mostly affect the same brain chemicals, causing similar effects. However, some people may respond to certain antidepressants better than others, and they may cause different side effects. 

The different types are: 

• Selective serotonin reuptake inhibitors (SSRIs) - the most commonly prescribed antidepressant in the UK, they work by blocking the reuptake of serotonin into the nerve cell that released it, meaning the serotonin acts for longer in your body and brain. Examples include citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline. 

• Serotonin and noradrenaline reuptake inhibitors (SNRIs) - may be prescribed if SSRIs are not effective or suitable. They work similarly to SSRIs but also have a noticeable effect on your noradrenaline reuptake, as well as serotonin. Examples include duloxetine and venlafaxine. 

• Tricyclics – so called because of their three-ring chemical structure, they affect the reuptake of noradrenaline and serotonin to make their effects last longer. Examples include amitriptyline, clomipramine, dosulepin, doxepin, imipramine, lofepramine, nortriptyline, and trimipramine. 

• Monoamine oxidase inhibitors (MAOIs) - these work by making it more difficult for an enzyme called monoamine oxidase to break down noradrenaline and serotonin. They are usually prescribed by specialists and require dietary precautions due to potential interactions with certain foods. Examples include isocarboxazid, moclobemide, phenelzine, and tranylcypromine.  

• Other antidepressants – there are other antidepressants like agomelatine, mirtazapine, reboxetine, and vortioxetine that don’t fall under the above categories, but can be prescribed to certain people for depression or anxiety. 

What are the side effects of antidepressants? 

Like all medicines, antidepressants can cause side effects, and most should ease off after a couple of weeks as your body gets used to the medication, but some may carry on for an undetermined period. You may be reviewed by a healthcare professional after the first few weeks of taking antidepressants and they will check in with you to see how the medicine is working, including any side effects.  

Common side effects of antidepressants include: 

• Mood changes – feeling angrier or emotionally unstable 

• Feeling agitated, confused, shaky, or anxious 

• Sleep problems 

• Increased weight 

• Headaches 

• Dry mouth 

• Blurred vision 

• Nausea or sickness 

• Dizziness, drowsiness, or sleepiness 

• Appetite loss 

• Indigestion and stomach pain 

• Diarrhoea, constipation, or difficulty peeing 

• Increased sweating  

• Heart rhythm problems including palpitations or fast heartbeat 

• Sexual problems, including low sex drive, orgasm difficulty, and erection problems 

It’s uncommon, but some people (particularly those aged 24 or under) may experience suicidal thoughts or an urge to self-harm in the period just after starting to take an antidepressant medicine. You should call 999 or go to A&E immediately if you feel like you want to end your life or harm yourself at any time. 

The above list is not all the possible side effects of antidepressants and it’s important to know that they vary depending on the type of antidepressant you’re taking. Some side effects are rare but serious and may require urgent help. Always read the Patient Information Leaflet that comes with your medicine. 

You can report any suspected side effects using the Yellow Card safety scheme website. 

Can you stop or come off antidepressants? 

You will usually continue taking the medication for at least 6 months after your symptoms improve. You’ll usually agree on a plan with your doctor to reduce your dose over an agreed period to help with any withdrawal symptoms. Do not stop taking an antidepressant suddenly or without talking to your doctor first. 

Withdrawal symptoms may include: 

• Headaches 

• Aching muscles and/or joints 

• Nausea or sickness 

• Increased sweating 

• Heart racing, fluttering, pounding or skipping a beat 

• Dizziness or unsteadiness 

• Sleep problems, strange dreams, and tiredness 

• Feeling low or having a hard time controlling emotions 

• Restlessness, irritability, anxiety, or tearfulness 

• Confusion or concentration problems 

• Unusual feelings in your body – for example, ‘brain zaps’, which may feel like you've had an electric shock in your head 

Some people will experience some of these symptoms while coming off antidepressants, although other people may not experience any. If you do get them, they should wear off in a few weeks. 

Antipsychotics

What are antipsychotics? 

Antipsychotics are a type of psychiatric medication, available on prescription for the treatment of psychosis. They can be used to treat certain types of mental health concerns that have psychotic experiences as one of the symptoms. This includes: 

• Schizophrenia 

• Schizo-affective disorder 

• Some forms of bipolar disorder 

• Severe depression 

• Psychotic symptoms of a personality disorder 

They can also be used to treat other health problems, including physical ailments such as persistent hiccups, balance problems and nausea, and agitation or psychotic experiences in dementia.  

They can be taken in various forms and ways. It’s most common as a tablet or liquid you swallow, but you can also get depot injections (slow release) every few weeks.  

They can only be prescribed by a healthcare professional, such as a psychiatrist, a doctor or GP, a specialist nurse prescriber, or a specialist pharmacist.  

How do antipsychotics work? 

Antipsychotic medication don’t offer a cure for psychosis, but they can help lessen the severity and intensity of symptoms you may face. Symptoms may not disappear completely for everyone, but many people experience significant improvement and feel more stable so they can live their life as normally as possible. They also help to reduce the risk of symptoms returning. These symptoms may include: 

• Paranoia or hearing voices 

• Delusions or hallucinations 

• Agitation or anxiety 

• Incoherent speech or confusion 

• Violent or problematic behaviour 

• Mania 

You may also find that some antipsychotics work better for your symptoms than others, or you may find that certain antipsychotics aren’t right for you. 

What are the different types of antipsychotics? 

Most antipsychotics fall into one of two categories, first generation (older) or ‘typical’ antipsychotics, or second generation (newer) or ‘atypical’ antipsychotics. 

• First generation (older) antipsychotics: 

Sometimes referred to as typicals, these medicines divide into different chemical groups which act similarly and have similar side effects (such as neuromuscular problems), but they are not all the same. Some may cause more severe movement disorders, while others will have a drowsier effect.  

• Second generation (newer) antipsychotics: 

Sometimes referred to as atypicals, these medicines may cause less severe neuromuscular and sexual side effects than typicals, but can cause metabolic issues, such as rapid weight gain and changes to your blood sugar levels. 

What are the side effects of antipsychotics? 

Every antipsychotic has its own side effects, and not everyone who takes the medication will experience side effects, but many people do. Here are some of the most serious, and in some cases rare, side effects that are possible with any antipsychotic: 

• Antimuscarinic effects (changes to the chemical acetylcholine in your body leading to blurred vision, confusion, agitation, constipation, problems weeing, drowsiness, dry mouth, erection problems, hallucinations, hot or dry skin, decreased sweating, increased eye pressure, low blood pressure, nausea, or heart rhythm problems) 

• Bed-wetting 

• Blood disorders 

• Body temperature changes 

• Emotional changes 

• Tardive dyskinesia

• Eye conditions 

• Heart problems 

• Liver disorders 

• Metabolic syndrome 

• Weight gain 

• Seizures 

• Skin problems 

• Neuromuscular side effects 

• Suicidal feelings or behaviour 

You should call 999 or go to A&E immediately if you feel like you want to end your life or harm yourself at any time. 

The above list is not all the possible side effects of antipsychotics and it’s important to know that they vary depending on the type of antipsychotic you’re taking. Some side effects are rare but serious and may require urgent help. Always read the Patient Information Leaflet that comes with your medicine. 

You can report any suspected side effects using the Yellow Card safety scheme website. 

Can you stop or come off antipsychotics? 

It’s important that you do not stop taking your antipsychotic medication suddenly or without talking to your doctor first. 
 
There's no perfect time to try coming off antipsychotics, because everyone’s experience is different, and many factors might affect what happens next. You may want to come off antipsychotics for several reasons, including to stop experiencing side effects or to try other ways of mental health care.  

However, some doctors will recommend that you keep taking them for some time to reduce the risk of your symptoms returning or withdrawal symptoms. Some people can come off antipsychotics quickly and easily, but others can’t. Your symptoms may return if you stop taking medication. If you are considering coming off antipsychotics, you should know that: 

• It is safest to come off slowly and gradually, rather than stopping suddenly. Your doctor or healthcare professional will advise you on how to safely reduce your dose gradually in order to minimise the risks of withdrawal symptoms 

• It helps to have people you love and trust around you to support you through this period, or find people who have been through similar experiences to you 

Withdrawal symptoms may include: 

• Nausea or vomiting 

• Insomnia 

• Runny nose 

• Diarrhoea 

• Anxiety 

• Sore muscles 

• Skin sensations 

• Dizziness or vertigo 

• Headaches 

• Loss of appetite 

• Agitation or irritability 

• Shaking or restlessness 

• Sweating 

• Mood changes or feeling withdrawn 

• Temperature changes

Sleeping pills & minor tranquillisers

What are sleeping pills & minor tranquillisers? 

Sleeping pills and minor tranquillisers are forms of sedative medicines. They slow down your body and brain’s functions, whether that’s your breathing, heart rate, or thought processes. Often prescribed for anxiety or insomnia, they’re sometimes referred to as hypnotics or anxiolytics, and usually split into three categories: 

• benzodiazepine medication for anxiety or insomnia 

• non-benzodiazepine sleeping pills 

• non-benzodiazepine anti-anxiety medication 

How do sleeping pills & minor tranquillisers work? 

They don’t offer cures for anxiety or insomnia, since they don’t address the underlying causes of these conditions, but they can provide short-term relief to help you feel calmer and more relaxed. They can reduce your symptoms of anxiety, such as agitation or shakiness, and help you overcome insomnia and restore a healthy sleep routine. 

What are the different types of sleeping pills & minor tranquillisers? 

Benzodiazepines are one of the most common forms of sleeping pills. These medicines slow down your body and brain’s functions by increasing the effects of gamma aminobutyric acid (GABA) in your body, which reduces activity in areas of the brain that are responsible for reasoning, memory, emotions, and essential functions (like breathing). This should help you feel relaxed and sleepy while reducing your anxiety. They’re usually prescribed when anxiety or insomnia is having an impact on your daily life. 

Non-benzodiazepine medication for insomnia and anxiety include: 

• The Z drugs – zopiclone and zolpidem – these act in similar way to benzodiazepines and act for only a short period of time 

• Antihistamines – mainly used for treating allergy symptoms, they can have drowsiness as a side effect and help with short-term insomnia. They are slow acting and may leave you with a ‘hangover’ effect  

• Melatonin – a natural hormone produced by your pineal gland. Prolonged-release melatonin is licensed for short-term treatment of insomnia in adults aged 55 and over but may be used off-licence in younger people too.

• Chloral hydrate and clomethiazole – these are older drugs with a high dependency rate so are not usually offered for insomnia, only in rare circumstances 

• Barbiturates – used as a sedative before benzodiazepines become widely administered, they are rarely prescribed these days 

• Non-benzodiazepine anti-anxiety medication – buspirone or pregabalin are benzodiazepine-free forms of help for anxiety 

What are the side effects of benzodiazepines? 

Benzodiazepines have a wide range of potential side effects, which differ between drugs and may affect people differently. The most common side effects include: 

• Confusion or memory problems 

• Constipation 

• Unsteadiness 

• Light-headedness 

• Dry mouth 

• Blurred vision 

• Nausea 

• Muscle weakness 

• Dizziness or drowsiness 

• Slurred speech 

Less common side effects include: 

• Low blood pressure 

• Increased saliva 

• Digestive problems 

• Skin rashes 

• Tremors 

• Libido fluctuations 

• Incontinence 

• Problems urinating 

• Headaches 

Rare side effects include: 

• Jaundice (yellowing of skin or eyes) 

• Blood disorders 

• Breast development in people assigned male at birth 

You should call 999 or go to A&E immediately if you feel like you want to end your life or harm yourself at any time. 

The above list is not all the possible side effects of benzodiazepines and it’s important to know that they vary depending on the type of medicine you’re taking. Some side effects are rare but serious and may require urgent help. Always read the Patient Information Leaflet that comes with your medicine. 

You can report any suspected side effects using the Yellow Card safety scheme website. 

Can you stop or come off benzodiazepines? 

You can come off benzodiazepines, but the longer you take them, the harder it will likely be for you to stop taking them. It is also more likely that you will experience withdrawal symptoms. That’s why you shouldn’t stop taking them suddenly, you should speak with your doctor or other healthcare professional to reduce your dose gradually. 

Withdrawal symptoms include: 

• Nausea, vomiting, or abdominal cramps 

• Sleep problems 

• Restlessness or concentration problems 

• Anxiety 

• Face and neck pain 

• Headaches 

• Dizziness 

• Nightmares 

• Low libido 

• Blurred vision or increased sensitivity to light, noise, touch, and smell 

• Loss of appetite 

• Sore eyes or tongue 

• Tinnitus 

• Unsteadiness 

• Weight loss 

• Panic attacks 

More severe withdrawal symptoms may include: 

• Confusion 

• Depression 

• Delusions 

• Derealisation 

• Depersonalisation 

• Seizures 

• Paranoia 

• Memory loss 

• Hallucinations 

• Burning sensations in skin 

• Muscle twitching 

• Psychosis 

Lithium & other mood stabilisers

What are mood stabilisers? 

Mood stabilisers are a psychiatric medication used to treat bipolar disorder, mania and hypomania, recurrent severe depression, and schizoaffective disorder. 

The drugs often called ‘mood stabilisers’ are all very different chemical substances to each other, but they are so grouped because they can all help to stabilise your mood, particularly if you experience extreme highs, extreme lows, or mood swings between the two.  

What are the different types of mood stabilisers? 

There are three main types of mood stabiliser: 

• Lithium – this is commonly used to treat bipolar disorder and can be prescribed as lithium carbonate or lithium citrate. It’s important that periodic blood test monitoring is carried out when taking this medicine, due to its narrow therapeutic window.  

• Anticonvulsants – also referred to as anti-epileptic medication, the most prescribed medicines are carbamazepine, lamotrigine, and valproate 

• Antipsychotics – some antipsychotics can be used as mood stabilisers, including haloperidol, olanzapine, quetiapine, and risperidone 

What are the side effects of mood stabilisers? 

Since the different mood stabilisers are all very different drugs with different active ingredients, the side effects vary considerably depending on which one you’re taking. You can find the full list of side effects listed in the Patient Information Leaflet enclosed with your medicine, but if you’re concerned about any side effects, you should speak to your doctor. 

You should call 999 or go to A&E immediately if you feel like you want to end your life or harm yourself at any time while taking mood stabilisers. Some side effects are rare but serious and may require urgent help. 

You can report any suspected side effects using the Yellow Card safety scheme website. 

Can you stop or come off mood stabilisers? 

Coming off mood stabilisers is a decision made in partnership with your doctor. You might prefer to take medication for years if it helps you feel more stable and get on with your life. Or you may use if for a short while to give you time and stability to find other long-term coping mechanisms.  

If you decide to come off your mood stabiliser, it’s important that you do so in conjunction with your doctor so that they can gradually reduce your dose over an agreed period, whether that’s lithium, anticonvulsants, or antipsychotics. 

Depending on the mood stabiliser, withdrawal symptoms may include but are not limited to:

• Fits or seizures 

• Mood swings 

• Anxiety or irritability 

• Symptoms of bipolar disorder 

• Headaches 

• Dizziness 

• Eye, sight or sensory problems 

• Abnormal menstruation 

• Muscle spasms 

• Sleep problems or fatigue