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 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, 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 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 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 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.
Real Life 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.