# MHApps Take Control – Medication – What How Why When – Information On Medication

Medication
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- Medication:what, how, why and when? Medication is used to remove, reduce or relieve the main symptoms of mental ill health. Medication can reduce the impact of symptoms for a lot of people. However, it is not always the case, and some people find the benefits of the medication are outweighed by the consequences of the unwanted side effects. It is widely accepted that a combination of medication and other kinds of therapy is the most effective approach to recovery.
  Many people find it very difficult to keep taking their medication and frequently give it up. This can be dangerous and may not deliver the result you are hoping for. Never stop or adjust your prescribed dose without consulting your doctor. If you are determined to give up your prescribed medication, talk to your doctor, explain why, and make sure you have some other kind of therapy or coping strategy in its place.
  Also, remember alcohol and street drugs have unwanted effects.
- Glossary 1. A drug or medicine is described as ‘a pharmaceutical product, used by humans in the prevention, diagnosis or treatment of disease.’
  2. An adverse drug reaction (ADR) is when a person receiving the normal dose of a medication experiences an effect from medication which is harmful and unintended.
  3. A side effect is ‘any unintended effect (good or bad).’
  (Adapted from the World Health Organisation definitions)

- “I know now Mary was using hash to self medicate, as she says herself. It also allowed her to live a life where she did not feel as exposed. Most of her friends in that scene had a chaotic lifestyle and she did not stand out as being different. It was only after a few years as her friends drifted back to mainstream living, did it become obvious to us that Mary was not a lazy waster, but something was going on for her which we could not explain.”

- How does medication work? Sometimes we can find it useful in understanding how medication works if we know a little about how our brain operates.
  Our brain is made up of millions and millions of nerves which communicate with each other using what is called a neurotransmitter. However, sometimes these messages do not get where they are intended to go or are rerouted to somewhere else. When this happens, according to the chemical imbalance theory, we need to take medication, which redirects and smoothes out the path, which the messages should take.
  The reality is that medication will work extremely well for some people, fairly well for others and very little or not at all for others. It is important to remember that if a medication is not working for you, as long as you are taking it as prescribed it is not your fault.
- Neurotransmitters Essentially, they help deliver messages throughout the brain’s nerve cells. These nerve cells, called neurons, are organised to control specialised activities. We each have somewhere between 10-100 billion neurons within our brains. Whenever we do anything, react, feel emotions, think, our neurons transmit messages in the form of electrical impulses from one cell to another. Nobody really understands the full workings of neurotransmitters and their effects on the brain.
- Serotonin Norepinephrine Dopamine Serotonin, norepinephrine and dopamine all work as biochemical messengers which regulate your mood in the brain. They are also associated with the sleep and wake cycle. If too much or too little serotonin, norepinephrine and dopamine are present it can result in too much emotion, over reaction to stress, and loss of sleep, appetite and interest in sex.
  Medications are available that can reduce or increase the levels of serotonin, norepinephrine and dopamine. Other medications work on the other side of the scale and tackle depression by elevating serotonin and improving a person’s mood.
- Dopamine Dopamine works in the brain helping it to regulate our movements. It also controls the flow of information from other areas of the brain, especially memory, attention and problem-solving skills.
  When dopamine is released it provides feelings of enjoyment, motivation to do, or continue doing, certain activities. Dopamine is released by naturally rewarding experiences such as food, exercise and sex. Without enough dopamine, people can feel fatigued and depressed, making it difficult to get motivated about anything. With too much dopamine we may experience hallucinations or paranoia for example.

- There is little hard evidence that hash or street drugs will cause schizophrenia (or other forms of mental illness). There is evidence however, which suggests it can hasten the onset if the person has a susceptibility to developing it. It is certainly accepted that there are drugs, which can induce psychosis. The difference is, when you stop taking the illegal drug, the psychosis will stop. If you have symptoms of schizophrenia it will not.

- Glutamate Glutamate is thought to be responsible for mood fluctuation. Lithium and anticonvulsant drugs can help to stabilise mood disorders.
  It takes a few weeks before lithium begins to relieve depression and mania in bipolar disorder. It works by bringing glutamate within a ‘normal’ range and over time it can curb both the highs and lows.
  Excess inositol is another chemical thought to be involved in affecting bipolar depression.
- Types of medication There are hundreds of different types of medication out there. We won’t even attempt to list them. You may be lucky and find one that works for you very quickly or it may take a while to find the one that suits you best. Remember medication on it’s own is limited. You will need to combine mental, physical and spiritual resources as well, in order to give yourself a full chance of living your life as you want.
  Medication can take time to work. Anything from days to months depending on the person’s own chemistry.
- Antipsychotics There are two types - ‘typical antipsychotics’ which have been on the market for more than fifty years and ‘atypical antipsychotics’, which have been more recently developed. Medication can be administered by tablet, syrup or injection. Injections can be beneficial for people who forget to take medication or for people who experience severe symptoms.
- Mood Stabilisers These are used to treat rapid and unstable mood changes. They can also be helpful in suppressing the swings between mania and depression for people experiencing bipolar disorder.

- Which medication is best? Choosing a suitable medication is not always as straight forward as it may appear. Everyone reacts to medications in different ways. One medication may work well for one person but produce unwanted side-effects in another. It is therefore very important you insist that your doctor or nurse gives you as much time and information as possible, so that you can know what to expect. Together, you and your doctor can make a joint decision that suits you best.
  At the outset, you should see your doctor often. This enables both of you to assess and monitor any side or negative effects you may notice and they can be addressed quickly. The doctor may suggest reducing the dose or finding an alternative medicine better suited to your needs. Do not be afraid to ask for a reduction or an increase in medication if you think it might help.
- Side effects All drugs can produce unwanted side effects in various degrees. These will vary from person to person. Sometimes, but not always, they can disappear completely with a lower dose or by switching to another medication.
- Side effects can include: · feeling drowsy
  · having a dry mouth
  · having too much saliva
  · feeling restlessness
  Some of these will settle down with time. If you experience severe body movements, stiffening up of your joints, facial movements that you cannot control or anything you are worried about, waste no time in seeing your doctor.
  You can be prescribed a number of different medications, some to manage the main symptoms and some to manage the known side effects. It is always best to be on as low an effective dose as possible. It is also important that your medication is reviewed regularly, at least every six months.
  Different drugs do not always work well together, so be sure to let your doctor know all the medications you are on.

- “From a medical perspective, the difficulty of treating a person who Is misusing drugs or alcohol and is at the same time experiencing symptoms of mental illness is knowing where the unwanted effects of the alcohol and drugs end and the mental health difficulty begins. This is really very complicated.”

- Why do we take medication at the times we do? For medication to work effectively it has to remain within what is called a therapeutic range. The thick purple line below represents the upper line of therapeutic range. The blue area represents the ideal therapeutic range; the red line below represents the bottom therapeutic range. When you first take your medication it takes a while to build up in your body to a sufficient level for it to work properly. As the medication reaches the therapeutic range it begins to work, if you can keep it within this range and the medication is of benefit to you it will begin to work.
  In the graphic above the wavy white line represents the amount of medication in your system. It will be at the bottom red line when you wake up in the morning.
  When you then take your medication it rises through the range to just below the upper therapeutic range.
  As the day progresses the level will begin to dip down until you take your medication again and it will increase.
  If you do not take your medication or you miss a dose, it will drop out of the therapeutic range into or below the bottom red range and be of little use.
  If this happens do not be tempted to take a double dose to catch up, just revert back to the prescribed dose and time. Consult your doctor if you are worried.
  If you do take a double dose by mistake or you are prescribed a dose that is too high, the positive effect of medication may not increase, but the side effects may cause more harm than good.
  A consultant psychiatrist is usually the person who prescribes medication and develops a treatment plan. He or she leads a multidisciplinary team (MDT), all of whom will have a role in working with you and your family members towards the goal of good mental health.

- So what we are saying in this group is that prescribed medication when it works throws a blanket over the experiences, which basically dampens them down to a barely audible level, leaving room for thoughts about living our lives as we choose. Alcohol or illegal drugs puts a net curtain over the experiences allowing us to interact with the experiences in a uninhibited way, not always good, and without either medication or alcohol or illegal drugs, we are left to the mercy of our own coping mechanisms, which at any given time can be bearable or terrifying.”

- Can we trust we will receive their support? If there is even a small bit of paranoia or bizarre beliefs, can we be sure our relatives or friends or the authorities are not out to harm us? At the very least they might be colluding with the people we believe might harm us. It’s a vicious cycle.”

- It is well known that people self medicate with alcohol or drugs or both. For a lot of people the problem is the lack of control they have over the quantity of either substance used. Users report a small amount helps, but it is often too difficult to stop there. Frequently, people find themselves addicted and unable to stop at all.

- The main difficulties initially for people experiencing a mental health issue, is who to speak to? What to say? And if they do speak to someone, can they be trusted?

Medication
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