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Electroconvulsive Treatment (ECT)

Medication for mental health conditions: effectiveness and side effects

Most of the people we spoke to had taken a range of different medications to try to address their mental health problems over the years. Although people had tried a wide variety of medications over their lifetime, the three main types of medications people spoke about were: antidepressants, antipsychotics, and minor tranquilisers e.g. for anxiety and sleeping. 

Antidepressants are thought to work by either increasing the production of brain chemicals like serotonin, or prolonging their effect. Although they work for many people, they don’t help everyone. When they do work, it can take many weeks for them to be effective, and people may have to try several before they find one that works for them, further delaying any benefit. The people we spoke to had often been offered ECT when their antidepressants hadn’t led to an improvement in their well-being and they had then become very unwell.

Antipsychotics are prescribed when people have been experiencing psychosis, including seeing or hearing things or holding unusual beliefs that other people don’t share. Although antipsychotics aren’t a cure for psychosis, they can help lessen some distressing experiences associated with psychosis. Most antipsychotics are taken by mouth although some are given by a slow release (depot) injection. Antipsychotics are sometimes known as ‘major tranquilisers. They are different to what people normally call tranquilisers (minor tranquilisers) used for anxiety and insomnia.

Although frequently used over the short term to good effect, some people who were on medication for their mental health became concerned about being on it for too long, or even for the rest of their lives. Yvonne says in the past she tried to “fight against the medication,” and didn’t want to be on it. But she accepted life-long medication use after someone said her situation was similar to a diabetic taking insulin. Suzanne had been taken off medication a few times, but had found she always needed to go back on it eventually. But Beattie said she was given too many drugs when she was manic, and they made her depressed. Antidepressants gave her some relief but she thinks some other drugs (antipsychotic drugs) caused her friend’s diabetes and her husband to get symptoms like Parkinsons. She has now joined local user group and sits on service user committees and thinks people are given too many drugs for too long.

Effectiveness of medication
Medication often took time to work and most people tried a number of different medications before they found one that worked for them. Enid is now taking an antidepressant that regulates the melatonin cycle (a substance that helps the body respond to night and day), which helps her sleep at night and this, she feels, keeps her well. You can read more about medication here: ‘Managing mental illness and recovery’.
 

Helen was diagnosed with manic depression and kept “going high” on antidepressants. However, quetiapine was “brilliant” because it allowed her to wind down and sleep at night.

Helen was diagnosed with manic depression and kept “going high” on antidepressants. However, quetiapine was “brilliant” because it allowed her to wind down and sleep at night.

Age at interview: 60
Sex: Female
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And then, so, and at the moment I’ve been on this quetiapine. It’s similar to olanzapine, I think, which is a slight antidepressant. Only slight because obviously it’s a danger, I kept going high all the time with antidepressants. And that’s the trouble with diagnosing manic depression. You don’t go to the doctor when you’re high and happy. And, but this quetiapine dopes you up big time, which is brilliant. You take it at 8 o’clock at night so you can begin to wind down and knock yourself out for the night. And at, in the beginning I was knocked out till about 11. I couldn’t drive till 9 or 11. I had to learn to do everything in the afternoon. But that’s two or three years on now and the effects have lessened. 
 

When Sunil was given antidepressants as a student in 1980 he improved quite rapidly. Later in life he was prescribed carbamazepine (for mood instability) that he felt kept him well for 18 years.

When Sunil was given antidepressants as a student in 1980 he improved quite rapidly. Later in life he was prescribed carbamazepine (for mood instability) that he felt kept him well for 18 years.

Age at interview: 56
Sex: Male
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Now this happened a very long time ago. We are talking about 1980-81, and basically because I was a medical student, and because there were students from my own year still doing attachments to psychiatry somehow it was decided that it would be better for me if I wasn’t a patient in [name of place], because I would then have the embarrassment of being seen by my own fellow students from my year. So I actually got admitted into a hospital in a nearby neighbouring city about 20 miles away in [name of place] and I was an inpatient for about a month and I was given antidepressants. And I responded quite rapidly and I was discharged after about four or five weeks.

But then in the year 2007 after I’d been in this new job for about four or five years, I had my next or third bout of mental illness in my life. Now the actual gap between the second episode when I was a research registrar in [name of place] and me being the consultant in the second consultant job in the [name of place], I was actually illness free for more than 18 years, there was more than an 18 year gap between the two episodes. And one of the reasons that I was so well, was that towards the end of my illness in [name of place], one of the senior registrars finally decided to put me on a drug which was probably only relatively new in being used for bipolar illness it is anti-convulsant drug, which stops people having fits, but it was also thought to have a beneficial effect in stabilising the mood of patients with bipolar illness. And this drug is called carbamazepine which is an anti-convulsant. So carbamazepine kept me well for more than eighteen and a half years.
 

While Jane couldn’t see how antidepressants had benefitted her, antipsychotics had “balanced [her] out”. However they did also make her put on weight, which she said isn’t good for your mental health.

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While Jane couldn’t see how antidepressants had benefitted her, antipsychotics had “balanced [her] out”. However they did also make her put on weight, which she said isn’t good for your mental health.

Age at interview: 38
Sex: Female
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Well, I don’t really know what it’s done. I think, personally I can’t see, I can’t very obviously see how the antidepressants benefited me. I mean I ended up not depressed but I think I was working through a lot of things and that was making me not be depressed. I can see that the antipsychotics slowed me down when I needed to be slowed down, because like I was in psychosis and I was just all over the place. But it slowed me down and made me put on weight and that’s not good for your mental health anyway. And then once I got put onto a different antipsychotic, I guess it kind of balanced me out. It would certainly be the antipsychotic that had obviously played a more important role than the antidepressants. 
Sunil had good and bad experiences with medication. In 1988 he was in and out of hospital for eighteen months and was prescribed thyroxine for an underactive thyroid and lithium for bipolar disorder, which he felt shouldn’t have been given because it interferes with the thyroid gland. He felt his treatment was mismanaged. He has since heard that a depressive episode that is untreated usually lasts about eighteen months anyway, so he was not sure if it was the medication that helped him or just the episode coming to a natural end (for more see ‘Diagnosis’ and ‘Staying in hospital’).

For others, medication gave temporary or partial relief, or had no impact at all, and yet some still experienced side effects. When Tania was first depressed she tried lots of different medicines and “nothing worked”. Tranquilisers helped her feel calmer “for a few moments” and sleeping pills helped her sleep a little but she got steadily worse and was eventually admitted to hospital. 

Side effects
Side effects vary according to the type of drug and the individual, and are too many to list here. But common side effects include things like weight gain, dry mouth, anxiety, tremor, feeling constantly sleepy or tired (sedation and lethargy), lack of sex drive.

People we spoke to varied hugely in the way they responded to medication and the side effects they experienced from taking medication, and, sometimes, when they stopped taking them. Some reported no side effects or very mild or hardly noticeable side effects. Enid said she “is one of these people who [doesn’t] suffer side effects very readily.” Others reported noticeable or disturbing side effects. 

Catherine Y experienced a significant amount of weight gain on antidepressant medication. Kathleen gained up to twenty seven kilograms in weight as a result of various medications she had been on, as well as the experience of being inactive on an inpatient ward over 2-3 years. Suzanne felt that she had gained weight whilst on antipsychotics even though she was barely eating and thinks it was fluid building up. Tristan felt that antidepressants led to his wife’s weight gain. Although he felt they lessened her depression, he also felt they took away some of her ability to enjoy life.
 

Suzanne was given highly sedative medication whilst she was an inpatient. She remembers she didn’t have dreams for a long time and did not feel well rested.

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Suzanne was given highly sedative medication whilst she was an inpatient. She remembers she didn’t have dreams for a long time and did not feel well rested.

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Yes, Largactil. Yes, that’s what I was on at the beginning. Just for a couple of days or even a day or two. I’m not totally sure. But yes, I can remember that I didn’t have any dreams for a long time, that I was so medicated at night that by the time I had queued up for medication, walked back to my bed, got into bed, I’d be asleep. And I’d kind of wake up only moments later and it would feel like you hadn’t had any sleep at all in some ways, because you didn’t have time to process any of the day’s events. And it was kind of like “bang” and there you were there again, oh no waking up in hospital again and sort of feeling of yes, it was very frightening every morning waking up in the hospital thinking, “Oh God I’m here again.”
Some people took additional medication to reduce their side effects. Catherine Z said haloperidol made her shake and she was given procyclidine to counteract it, which made her mumble and dribble.
 

When Catherine Z’s son had depression she was very concerned about the high doses of drugs he was given. He had ECT when the drugs did not work.

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When Catherine Z’s son had depression she was very concerned about the high doses of drugs he was given. He had ECT when the drugs did not work.

Age at interview: 52
Sex: Female
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He was admitted to the hospital at the beginning of November and towards the end of December they finally said we think we need to try ECT because nothing is working, these drugs are not touching him it’s making no difference. 

Just as an aside, the drugs that he was taking did have an impact on his liver and it took two years for his liver to be normal again. All the time he was on these drugs we kept saying “Is his heart okay? Are his kidneys okay? Is his liver okay?” And we were always reassured that yes he’s fine he’s healthy he can take it. But in my mind giving him those high doses of drugs and them having no effect was slightly barbaric, all the time knowing that there was this other treatment that they could have given him much earlier which could have got him better. We felt that we constantly had to say “When are you going to do the ECT? When are you going to do it?”
For a few people the side effects were very serious and badly affected their health (such as causing osteoporosis, or damaging the liver), and some medication seemed to contribute to their mental illness.
 

After her husband left her, Cathy was coping “extremely well,” but after a change of medication became “incredibly anxious”. She eventually took an overdose. She has slowly recovered and still takes medication.

After her husband left her, Cathy was coping “extremely well,” but after a change of medication became “incredibly anxious”. She eventually took an overdose. She has slowly recovered and still takes medication.

Age at interview: 49
Sex: Female
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So we carried on like that for, well, for quite a while until the January of 2001. And then my husband decided that he was going to leave because he couldn’t cope with me and what was going on and the stress of it all. And he, so he left. We were living in a house that was owned by the farmer who he worked for, so I had to move out with [name], my son. And we went to live with my parents and lived with them for about three months until we moved here. My parents very kindly bought me this house to live in and we moved here and we’ve been here ever since. Yes, after that happened I think, well, for a little while I was, I coped extremely well. And then I suppose it all, and what happened then? I… that’s right, I was put on some medication which didn’t really agree with me and made me incredibly anxious and, to the point where I could hardly function, the anxiety was so bad. And the following year after my husband left I took a massive overdose and ended up in the intensive care in [name of town] on, well, nearly dying. And although that obviously was a terrible time and I was in hospital for months recovering from it, which, I mean some people said I shouldn’t have recovered at all really, but I did. And since then it’s been onward and upward. I’ve, you know, slowly, well, probably, you know, two or three steps forward, a step back, but it’s, I’ve gone from strength to strength. I still take quite a lot of medication and, but that seems to keep me just sort of ticking over.
 

Although ECT has side effects, Sunil said medication can also have “serious adverse effects”. He experienced side effects from the mood stabilisers Depakote and carbamazepine, such as osteoporosis.

Although ECT has side effects, Sunil said medication can also have “serious adverse effects”. He experienced side effects from the mood stabilisers Depakote and carbamazepine, such as osteoporosis.

Age at interview: 56
Sex: Male
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But going back to your question about the ECT I would say to the patients that actually ECT may have the side effect of interfering with your short term memory, but drugs are not without side effects either, and I have personal experience of developing a severe reaction in my mouth, a condition called ‘Lichen Planus’, which is probably attributed to previous treatment with carbamazepine and I have actually has osteoporosis with problems in my spine, all due to Depakote and I know that lithium didn’t do me any favours when I had under active thyroid either. So I mean I can quote at least three drugs that I have had which are used in bipolar to stabilise mood, all of which have had serious adverse effects for me.
Catherine Y heard from some doctors that the development of fibromyalgia (a condition which causes pain all over the body) might have been a response to taking antidepressants. Beattie, Suzanne and Helen had experienced strong psychological and sedative side effects of an old antipsychotic medication called chlorpromazine (brand name Largactil). Helen remembered feeling so sedated she could barely get out of bed.

Last reviewed January 2018.
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