This article was originally published on My Mental Health on 13 October 2020.
Many with mental health issues struggle with their medication, because they can often feel nauseous , dazed, and unable to focus or even carry a conversation as side effects from them. Their speech is slurred, and they feel like zombies. Some may experience stiff shoulders and excessive weight gain.
Over time, they can become shadows of their former selves — Appearing sad, melancholic and lethargic. Watching them suffer makes the family feel a sense of despair and helplessness. You wonder about the loss of their potential, and what might have been. Yet, you need to continue to support them through their mental health treatment.
Medication and therapy are two important pillars of ones’ treatment. When adhered to, both will help one gradually return to their former self: confident and able to face the challenges of life.
The struggle with medication is real, because many do cause side effects. Will they be a permanent feature, plaguing one for the rest of their lives? Advances in medicine mean that medicine today are generally more effective, or come with fewer side effects. It is definitely possible for one to recover. Parents, family and caregivers involved should exercise patience, empathy and understanding to support one in this critical phase.
Do discuss with a psychiatrist as to what might be the best option for the patient in terms of suitable medications. It should be both effective and affordable, but also cause fewer side effects. Every person responds differently to medications, and a period of trial and error may be necessary to find the right medications and dosage.
Caring for a loved one with a mental health condition can be a strenuous and lonely journey. However, recovery is possible, with proper medication, therapy and the support of family and friends.
Here are some frequently asked questions on how to manage your loved one’s medication and their side effects.
“I am worried that my loved one’s medications may be too expensive. What can I do?”
Discuss this with your loved one’s doctor. MOH maintains a Standard Drug List (SDL) of subsidised medications in Singapore. Medications on the SDL have been assessed to be cost-effective and essential for treating common medical conditions in Singapore.
The SDL contains many commonly used psychiatric medications that are available in public hospitals, specialist outpatient clinics, and polyclinics. Doctors in public healthcare institutions will usually opt for medications on the SDL first.
If your loved one is taking a medication not on the SDL or a branded version of a medication, the doctor may be able to switch to a cheaper, generic, or subsidised alternative if available and appropriate.
You can find a list of subsidised medications in Singapore here.
What are the side effects of some of the medications?”
There are various types of psychiatric medications used to manage different mental health conditions, and each type is associated with different side effects.
It is important to note that different people can respond to the same medication differently, so a person may experience a certain side effect from the medication but another person taking the same medication may have no side effects at all. Some side effects may also gradually improve as your loved one’s body gets used to the medications. Regardless of which medication your loved one is taking, he/she should avoid drinking alcohol as it may worsen the side effects experienced.
Some common types of psychiatric medications and the side effects associated with them are listed below:
Antidepressants are medications commonly used to treat depression. Despite the name, antidepressants are also used to treat other medical conditions such as anxiety. Some examples of antidepressants are fluoxetine (Prozac), sertraline (Zoloft), and venlafaxine (Efexor).
Some antidepressants, especially the older generations like amitriptyline, may cause more side effects than others. Some common side effects and how your loved one can cope with them are:
- Nausea and vomiting (try taking the antidepressant with or after food)
- Weight gain
- Diarrhoea (drink plenty of water to prevent dehydration)
- Insomnia (try taking the antidepressant in the morning) or sleepiness (try taking the antidepressant in the evening)
- Sexual problems
- Feeling tired or weak (do not drive or use heavy machinery; the symptoms should improve after one to two weeks as the body gets used to the medication)
Antidepressants, especially the older generations, may cause a life-threatening illness called “serotonin syndrome”. Newer generations of antidepressants are less likely to cause serotonin syndrome, but it can still occur if they are mixed together with the wrong medications. A person with serotonin syndrome may become disoriented or restless, have a high temperature, and have tremors or muscle rigidity. If you notice these symptoms in your loved one, stop taking the antidepressant immediately and bring your loved one to the hospital.
Anxiolytics (or anti-anxiety medications) are medications used to reduce the symptoms of anxiety such as panic attacks and worry. Some common examples of anxiolytics are benzodiazepines like lorazepam and diazepam.
Benzodiazepines are usually prescribed only for short durations each time as people can build up tolerance to them if taken over long periods, and some people may even become dependent on them. The most common side effect of benzodiazepines is:
- Drowsiness or feeling tired during the day (do not drive or use heavy machinery; the symptoms should improve after one to two weeks as the body gets used to the medication)
If you notice your loved one having more serious side effects such as finding it difficult to remember things, experiencing hallucinations or delusions, or if their breathing becomes very slow or shallow, stop the medication immediately and inform his/her psychiatrist.
Antipsychotics are medications used to manage psychosis. “Psychosis” refers to conditions that affect the mind, where the person has some disconnection with reality, often having symptoms like hallucinations or delusions. Antipsychotics are categorised into first generation such as haloperidol, and second generation such as risperidone (Risperdal) and olanzapine (Zyprexia).
Second generation antipsychotics are generally associated with fewer side effects than first generation antipsychotics. Some common side effects are:
- Dry mouth, constipation, blurred vision (more common in first generation antipsychotics)
- Side effects related to physical movement such as tics, tremors, muscle rigidity or spasms, restlessness (more common in first generation antipsychotics)
- Weight gain (the risk is higher for some second generation antipsychotics)
- Tiredness or sleepiness
- Sexual problems
If your loved one is prescribed a second generation antipsychotic, the doctor will usually monitor your loved one’s weight, glucose levels, and lipid levels regularly. For some second generation antipsychotics such as clozapine, the doctor may even monitor your loved one’s white blood cell count.
Long-term use of first generation antipsychotics may lead to a condition called “tardive dyskinesia”. This causes uncontrollable muscle movements commonly around the mouth, and can range from mild to severe. Some people can recover partially or fully once the medications are stopped, but it can also be irreversible for some people. If you suspect your loved one is experiencing tardive dyskinesia, consult his/her psychiatrist immediately.
Mood stabilisers are used primarily to treat bipolar disorder and mood swings associated with mental health conditions. Some common examples of mood stabilisers are lithium and some anti-seizure medications such as valproic acid (Epilim) and carbamazepine (Tegretol).
Excessively high levels of lithium in the blood can cause some serious side effects, therefore your loved one’s psychiatrist will regularly check and monitor the level of lithium in the blood through blood tests. Some possible side effects of lithium are:
- Excessive thirst
- Frequent urination
- Fine tremors of the hands
- A metallic taste in the mouth
- Swelling of the ankles
- Stomach pains or discomfort (especially at the beginning of the treatment)
At high blood levels, lithium may also cause:
- Severe tremors, muscle twitches, loss of coordination of arms and legs
- Slurred speech, blurred vision
Some of the common reasons which can cause the blood lithium level to rise are:
- Dehydration (stay well-hydrated by drinking enough water every day and avoid drinking too much caffeinated drinks like coffee, tea, cola)
- Big changes in the amount of salt taken from the diet (try to keep the amount of salt in the diet consistent; do not go on a low or high salt diet without first talking to the psychiatrist)
- Interactions with other medications (always inform the doctor or pharmacist that your loved one is taking lithium when he/she is prescribed new drugs; the doctor or pharmacist will check whether the new medication can interact with lithium)
Some possible side effects of anti-seizure medications used as mood stabilisers are:
- Changes in appetite
- Diarrhoea or constipation
- Blurred vision
- Problems with coordination or balance
- Uncontrollable shaking of a part of the body
- Uncontrollable movements of the eye
Similarly, some common medications can interact with anti-seizure medications. Always inform the doctor or pharmacist that your loved one is taking the anti-seizure medication when he/she is prescribed new drugs.
For information on the common side effects caused by psychiatric medications, click here.
My loved one is refusing his/her medications. What can I do?
Family support is vital to persuading him/her to resume their medications. Talk to your loved one without being judgmental, to understand his/her reasons for refusing his/her medications. Some common reasons are:
- A lack of awareness and understanding of the severity of their mental illnesses
- They cannot manage the side effects of the medications
- They feel that the medications are not working for them
Manage your loved one’s expectations of the medications he/she is taking. Remind your loved one that some of the medications can take up to 6 weeks for the full effects to be felt. Let your loved one know you are there for him/her, and slowly persuade him/her by addressing his/her concerns.
Consult his/her doctor or therapist if you need further help.
For further support, please reach out to Caregivers Alliance Ltd, a social service agency that provides information and advice to caregivers of persons with mental health issues.
The contributors are Programme Managers at Caregiving and Community Mental Health Division, Agency for Integrated Care. Ho Kim Fung is also a trained Pharmacist.
Images by Freepik.