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Antidepressants

Taking other medicines with antidepressant: sleeping tablets, medicines for anxiety, antipsychotics, mood stabilisers, and over-the-counter remedies

Some of the people we interviewed had been prescribed other medicines alongside an antidepressant, or in place of one. These included sleeping tablets, medicines to alleviate anxiety, antipsychotics, and mood stabilisers.
 
Sleeping tablets

It can be difficult to know sometimes whether difficulty sleeping is a side effect of antidepressant medicines, or a symptom of depression. Caroline’s depression is triggered ‘by not being able to sleep properly therefore not being able to cope very well’ while Sonia attributed her insomnia to the effects of fluoxetine.
 
Sleeping tablets (hypnotics) may sometimes be prescribed to help ease short-term insomnia. Doctors are cautious about prescribing sleeping tablets. They only help to initiate sleep and don't treat the cause of insomnia. People diagnosed with depression who are experiencing problems with sleep may be given an antidepressant which has drowsiness or sleepiness as a side effect but sometimes doctors may prescribe sleeping tablets for a short time to help establish a sleep routine. Doctors guidelines recommend prescribing the smallest effective dose possible for the shortest length of time necessary (for no longer than a week). In some cases, the GP may advise only taking the medicine two or three nights a week, rather than every night. Sleeping tablets can cause side effects such as feeling ‘hungover’ or drowsiness during the day (see 'Telling the difference between depression symptoms and antidepressant side effects').
 
There are two main groups of sleeping medicines, Benzodiazepines which include temazepam and loprazolam, and non- benzodiazepine hypnotics (also commonly known as Z drugs) which include zopliclone, zolpidem and zaleplon. However there is no firm evidence of differences in their effects and all three Z-drugs carry warnings about their potential to cause tolerance, dependence and withdrawal symptoms.
 
Some older people said they had been prescribed sleeping tablets over prolonged periods in the past. John who is now in his 80’s took a benzodiazepine medicine (Mogadon) for many years and he said they were prescribed freely when he was younger. Michael is in his 70’s and has taken antidepressants for a most of his adult life. Sometimes he has had trouble sleeping, but he avoids taking sleeping pills because he knows how addictive they can be. ‘I won’t take a sleeping tablet because next thing I’ll get hooked on them’.
 
When Dina first went to see a doctor some years ago complaining of insomnia her doctor prescribed sleeping tablets but looking back she thinks it was a symptom of depression. ‘I realised later on the, the sleep disturbance is part of [depression] it is interesting though, I don’t remember her going through and asking other questions to look at the whole picture’.
 
People who were prescribed sleeping tablets more recently had usually only taken them for short periods, or occasionally when needed. Hannah was prescribed zopiclone for a short while whilst she was in hospital but after a couple of weeks was put on an antidepressant that had a sedative effect instead. Olivia Y took temazapam for a few weeks when a relationship broke down and she couldn’t sleep. Most people we spoke to were aware that it is easy to become dependent on sleeping tablets and said their doctors were cautious about prescribing them. Usually doctors will only prescribe a small supply at one time. Thomas’s doctor prescribed zopiclone but due to an error it went on a repeat prescription, and Thomas took them regularly for a period of time. ‘They’re quite addictive. They build up a dependency and I’d gone through quite a rough withdrawal period. The withdrawal effects from zopiclone are terrible. There are people who are on them for years and years and years because GP’s don’t dare to take them off them’. Caroline was unhappy about taking sleeping tablets before she was prescribed one of the newer types. She did a lot of research on the internet to find out more about them. ‘Before I found these short acting ones… if I took one I would feel drowsy in the morning’. 
 

Emily’s doctor prescribed sleeping tablets for two weeks to...

Emily’s doctor prescribed sleeping tablets for two weeks to...

Age at interview: 28
Sex: Female
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I had a week to adjust and then I went back to work and in hindsight that was a big mistake going back to work after a week because, firstly because I was, I don’t know I was still very embarrassed about my behaviour at work, I hadn’t seen anyone since, I’d spoken to my manager who’d been very supportive but that was it, I was very embarrassed about going back to work and the side effects from the from citalopram were really, really quite bad at that point in that well effectively I had insomnia I was getting sort of fifteen twenty minutes sleep here and there and that was it.
 
And that had been going on for about a week before I went back to work so I, for a week I tried to go into work, I never did a full day and I was sitting there and realising an hour had gone by where I had just been staring and done nothing and don’t, didn’t really know what had happened in that hour. And so I went back to the doctor at the end of that week and that’s when I sort of explained it and he said to me you know, this is one of the side effects one of a potential massive list of side effects it is one of them what we need to do is break the cycle, get you sleeping again, so that’s when he diagnosed sleeping pills. He said ‘Try these for two weeks try and break the cycle and then come back again,’ and he also signed me off for another two weeks which was what I needed because I actually went back to my home town where my parents were and I moved in with them for a week and, I mean the sleeping pills they didn’t really.
 
I wouldn’t say they really worked straight away but by the end of those two weeks that I had off I was, I was sleeping better and I was feeling a little bit more positive.
 

Flora’s doctor was reluctant to prescribe sleeping pills...

Flora’s doctor was reluctant to prescribe sleeping pills...

Age at interview: 43
Sex: Female
Age at diagnosis: 21
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My father has been on a lot of medication in his life and changed a lot and has, he felt, a lot of experience and he was always saying, you know, try something else and don’t accept their dosage if you think you need more or less and at one point before I think I’d been to the doctor he actually I know this is not legal but he had actually supported me by giving me some medication he’d been on and one that actually was quite supportive which was trazodone which has a kind of as lightly sedative effect. So when I told my doctor that they actually did I think for a while include that because it was particularly helpful at night.
 
This was in addition to the antidepressants?
 
Yes in addition because it had a relaxant sedative effect and one of the big things about my depression at that time was I couldn’t sleep at all and I had this thing which they called, something about the leg it’s a leg that...
 
Restless leg?
 
Restless leg and I’d be awake for hours and very, very tired, constantly tired and feeling more hopeless and more depressed because I’m not getting enough sleep. So I wasn’t getting a lot better and after a couple of months, well during the first few months of that I had to keep going back and asking for sleeping pills because I felt that I wasn’t being given a chance because the sleep was depriving me of my ability to kind of get better and I wasn’t coping. But because now GP’s are so concerned I think and over concerned because of past abuses of sleeping tablets or people sort of stocking up on them or taking too many I was only given a few at a time and it really, really was unhelpful because I feel now again in hindsight if my sleep had been sorted out then I would have had a lot better chance to recover.
 
Even when I got better and I came home and I remember having a review a couple of months, a month or so to, and said things are better and I’m doing more and my life feels a lot better it’s probably three months down the line I said I’m still having problems sleeping and the answer to that that I was given was that’s usually the last thing to go with the depression and often symptoms they take a while to leave you even though you may be feeling better. So I still had some sleeping tablets that I could take if I needed to but because I wasn’t depressed in the same way it didn’t have as a debilitating effect on me not sleeping and the Stelazine he said you might want to take that at night because then that kind of relaxes you . And just actually as he said after a little while that just improved and it was just the last thing to go really.
 

Caroline takes citalopram on a regular basis, and occasionally...

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Caroline takes citalopram on a regular basis, and occasionally...

Age at interview: 60
Sex: Female
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You see you can take something at, if you wake up at 1’o’clock my rule is I do take a drug if I’m, to take them to help me sleep if I’m still awake after an hour… So if I, so if I get into bed I’m still awake after an hour… I’m still awake, that rarely happens but if it did then I could take… either zopiclone or zaleplon? Or something like that because there would be time for it to wear off by the morning. If I woke at 2 ‘o’ clock and then at 3.00 I’m still awake then that’s... that’s actually quite a short night if you don’t go back to sleep. On the other hand if you have to get up in the morning it’s too late to take a regular sleeping pill so it’s kind of in between.
 
I do think, I think because they’re very short acting then they’re much less likely to or they’re less likely to be addictive than ones that last are say for say eight hours or have a life of eight hours or ten but I’m sure they addictive if you take enough of them. 
Medicines for anxiety

Some benzodiazepines (including diazepam and lorazepam) can help ease the symptoms of anxiety but are only recommended for short term relief when someone is experiencing extreme distress. Although they can help with symptoms of anxiety, they should not be used for longer. This is because they can become addictive if used for longer than four weeks. After even this short time the body can become dependent on them and larger and larger doses may be needed to achieve the same effect. For these reasons, they are usually only prescribed to help people cope during a particularly severe period of anxiety. Benzodiazepines can cause side effects, including confusion, loss of balance, memory loss, drowsiness and light-headedness.
 
In the past people were often prescribed these medicines routinely before more was known about their addictive qualities. Older people we spoke to recalled being routinely prescribed Valium for long periods of time. John recalled taking it for some years before he realised that he had become dependent. ‘I stopped that medication altogether, it was, it was alright but I was beginning to feel that there wasn’t something right, you know, had I been taking too many tablets for too long a period?’ The withdrawal after long use must be planned carefully with the doctor as there are severe effects when these drugs are stopped the dose must be reduced slowly every 7-14 days, so the overall reduction can take many months. 
 

In the past John said doctors gave out Valium readily....

In the past John said doctors gave out Valium readily....

Age at interview: 84
Sex: Male
Age at diagnosis: 37
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In the early days, it must have been in the 50’s or 60’s, I can’t remember….but I know I had this feeling of edginess, of anxiety, things weren’t right, I couldn’t work fast enough. Anyway, eventually I went to the doctor and he prescribed some tablets called Valium, and I took those, but it wasn’t until about the third week that I began to feel any benefits.
 
I don’t know how I felt in the first instance of taking them but it wasn’t awfully good as I remember but then like all tablets they kicked in, you know, and everything was alright. It took away this black cloud that was with me all the time and I think it made it better for, for my wife as well because I remember one day we sat down and I was moaning about something as usual and she said’ oh stop it’, she said ‘you’re not the only one here with problems’ and zunk I changed, I remember that. But I took them for about a long while, I had a mixture a right thingy of tablets I had Concordin (protryptline), Valium something else and something else, you know, it’s one of those...
 
Where they for other things that were?
 
No they called it, what did they call it in those days? They called it ‘anxiety’.
 
Right.
 
It was ages before they called it depression.
 
I didn’t know it was anxiety I knew something was happening, I’d forever got this black cloud with me and I thought this is odd. Anyway it got, it got pretty bad so I went to see the doctor.
 
How did the doctor respond in those days?
 
Oh, let’s see what tablets we’ve got’.
 
Yes and how did you feel about having tablets to help you with that problem?
 
I didn’t mind, didn’t mind at all. But they work because I felt a lot better after taking them.
 
And did you just take then regularly every day?
 
Yes I think I took 30 milligrams every day and somebody said to me once ‘you’re becoming a junkie you know, you want to watch it’. And eventually I cut down from 30 to 20 and 20 to 10 and then I cut the 10 down and it was only when I got down to five milligrams that ‘pow’ I realised I was losing this backup.
 
What did you start feeling unwell again?
 
Yes.
 
Really.
 
I went back.
 
Was it the doctor that helped you to step it down or did you decide to do that yourself?
 
No I decided to do it.
 
Were you concerned about it?
 
I was going to a meeting it was called Tranqs I think something like Tranqs and - coming off tranquilisers and I went there and I slowly but surely got down to one and then none and it was great but it was hard work.
 
And when you say hard work what does that mean?
 
Oh.
 
You got the shakes?
 
Yes everything’s alive in a, it’s like having a thundercloud carrying it about with you and even noises are sharp vision was sharp.
 
Was this during the time when you were stepping it down?
 
Yes.
 
So it was kind of like a withdrawal?
 
That’s right yes.
 

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Clare was prescribed Ativan (lorazepam) when she first...

Clare was prescribed Ativan (lorazepam) when she first...

Age at interview: 59
Sex: Female
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He listened to me and he said I was, I was clearly exhibiting the symptoms of quite a lot of anxiety and stress. He didn’t at that time diagnose depression but he was clearly saying that I wasn’t managing day to day living and I did what he then described and I’ve always used since he said ‘If you came to me with a broken leg you wouldn’t turn down a plaster cast,’ he said ‘So what I’m going to give you is I’m going to give you some tablets that are going to help you just to get over this kind of hump if you like.’
 
And I think he prescribed Ativan, but that may have been my GP in London that’s the bit I’m not terribly sure about however whatever he prescribed me I took reluctantly because I was full of anxiety around becoming addicted to them and there was the whole negative kind of connotation of taking anything that wasn’t, you know, an antibiotic or a Paracetamol or whatever. So however they did help and they helped me to find what I would call the equilibrium in that they helped me to get over the very difficult time that I was having and make some informed decisions about my future or our future. So that was really the first time that I had, I had been to a doctor about my mental health. I had I think gone to my GP in London, I actually think now that I think about it he had prescribed Ativan and it was remarkable as I lost a lot of weight and I thought ‘this is great’. So it was kind of like an upper, the Ativan I wrote it down and I can’t remember what that was for and I was only on it for a short while but it was remarkable because I lost a lot of weight which is obviously a bonus to be honest although horrible side effects because I didn’t eat.
 
The very first ones that I got that were fantastic I lost weight but I would never want to take them again because I think they’re now banned and I believe that’s what put me off subsequently when the doctor said have these tablets I was like no, no, no, because those were they were head, they messed with my mind.
 
Did they make you feel different?
 
They made me, they were uppers you know and I’m a child of the sixties so there’s that whole ‘uppers and downers’ thing in the 1970’s when I got these uppers as they were I was euphoric, I was on a high, I didn’t eat I didn’t need to eat, I was awake like 18/20 hours a day I was “whoa”, you know, I don’t mean it was like party time but I was, you know, very happy but it was false because as soon as I came off them, you know, it was like oh right okay so I put on loads of weight and, you know, went back to normal so they were definitely I’m really glad they’re banned because they were obviously really horrible things. And people did become addicted to them that were on them long term so that; I think that’s kind of my story about antidepressants.
A few people we talked to had been prescribed benzodiazepines, usually diazepam, for short periods to cope with symptoms of anxiety, but on the whole people with these symptoms are more likely to be prescribed an antidepressant that that is known to help alleviate anxiety. Lucy Y’s depression was characterised by symptoms of anxiety, but she felt her antidepressant worked well to suppress those feelings. ‘It’s never been so bad that I’ve needed that... even so, if, even if the anxiety kicks and I started to have panic attack usually the antidepressants I’ve taken have sort of calmed that down quite considerably. What she [doctor] tends to prescribe when there’s a significant component of anxiety is citalopram... I was getting very, very anxious the last couple of weeks so she prescribed that and it’s been good’. In some patients, particularly with panic disorders, the anxiety may increase at the start of treatment with an SSRI but this should subside within the first two weeks. Taking a half dose initially may make it less likely to happen.
 
Antipsychotic medicines 

Antipsychotic medicines, also known as neuroleptics, may sometimes be prescribed in addition to, or instead of an antidepressant depending on the symptoms. They are not suitable or effective for everyone as side effects can affect people differently. Often people who are prescribed antipsychotic medicines have a complex medical history and may also have been diagnosed with other problems such as bipolar disorder, acute episodes of mania, hypomania, psychosis, or personality disorder. Antipsychotic medicines include risperidone, quetiapine and olanzapine. 
 

Thomas came off citalopram and was prescribed risperidone...

Thomas came off citalopram and was prescribed risperidone...

Age at interview: 34
Sex: Male
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I came off citalopram quite quickly really within a year of taking it in about 2002. And I was just treated thereon medicinally for what they would say is paranoia.
 
So I was treated them with some atypical antipsychotics. I was, I was treated first with risperidone, but I started to have huge weight gain problems with that, and then in 2003 I was prescribed another atypical antipsychotic called quetiapine which is known as Seroquel, the drug’s brand name, which I’ve been on ever since - 400 mgs and that’s been okay for me, but again I’m not sure if it really does anything for me whatsoever.
 
After the CBT and then you stopped taking Cipramil was there a gap where you didn’t have any medication at all?
 
It was not antidepressant medication. So it was antipsychotic medication I was taking.
 
So this is the Quetiapine?
 
Quetiapine.
 
Quetiapine. And how long ago did you start taking that one?
 
Well I was prescribed rispiradone for of all…
 
Right.
 
In 2002 I believe. Just a small dose. And then it got gradually increased by I started to have weight gain problems with it.
 
And did you take that in addition to the antidepressant that you were on at the time?
 
Yes. I did.
 
Right, so all it did for you was weight gain and you didn’t feel any…
 
Well no.
 
It was quite interesting. I had this huge problem, as I sort of said before, I was going in at night to the university, I was scared about people following me around –that kind of stuff, but the moment I started taking risperidone, for some reason it gave me the confidence really to walk through the front gates of the university. I have no idea why, but it did, and I walked through the front gates of the university and I walked out. The university that I went to, it had several entrances, it was a huge warren complex and I would go in through various routes and things. I would change my route every night. I went; I walked through the front gates of the university during the day in the full view of everyone. And so for me in my mind it was - this is good being able to do that and I linked it to my medication I was taking and so, and I, I didn’t really, although I had lots of weight gain I didn’t directly at the time, again I was quite naïve, I didn’t link it to the medication. I didn’t realise that the reason why I was gaining so much weight was because had this, again this thirst, this sugar thirst I would call it that only could be quenched by lots of sugary drinks, and lots of sugary drinks means lots of calories and lots of calories mean you put on weight. I didn’t make the link. It only came later. And I’ve got no explanation for why I didn’t make that link.
 
And I stopped taking risperidone because I was putting on so much weight and my psychiatrist agreed to replace it with quetiapine which has a lower weight gain profile. So okay same type of drug, less, it has less of a weight gain profile.
When Max was admitted to hospital after a breakdown he believes he was given an antipsychotic ‘to help calm me down’ but he didn’t know which one. Michael was prescribed risperidone when he experienced paranoia. Sonia has a complex medical history of severe depression, including eating disorders and self-harming. She takes fluoxetine and mirtazipine to help keep her mood stable, but her psychiatrist has also prescribed quetiapine, ‘to minimise my impulsive behaviour in terms of self-harm and to keep me calm’. Dina believed that olanzapine had interfered with her menstrual cycle. She feels doctors don’t give enough information about the medicines they prescribe. Janet felt that olanzapine left her feeling ‘zapped’ and although she didn’t want to take it, worried that without it she would feel even worse. ‘Do I take the olanzapine or do I not take it and feel frightened? Because the fear that I used to feel was terrible, I used to be frightened of the garden and the tree... I may grumble about not feeling very bright and alert but I know that really they probably do me more good and I would be worse if I didn’t have them, if I came off the olanzapine I would probably be terrified again of everything so I think they are a good thing.’ Olivia X had been sectioned when she refused to take medicines a psychiatrist recommended, and eventually was prescribed Seroquel (quetiapine). This was necessary to satisfy a judge that she was stable enough to regain custody of her children who had been removed from her care whilst she was in hospital.
 
 

Sonia has experienced side effects from antipsychotic medicines...

Sonia has experienced side effects from antipsychotic medicines...

Age at interview: 31
Sex: Female
Age at diagnosis: 17
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What about the antipsychotics how do they make you feel, do they have a different effect?
 
Yeah, they… they kind of, they make everything a bit fuzzy. You get used to it and I think it’s only when you come off them that you realise kind of that you’ve been, been living with the volume turned down a bit if that makes sense. But they do help, they, I think the ones that I’ve been on prior to the quetiapine which I think now haven’t really done much for me and I’ve always stopped taking them because I didn’t like them, didn’t like the way they made me feel. With the quetiapine she’s been.
 
Is that the risperidone?
 
Risperidone and chlorpromazine and Clopixol.
 
So when you say you didn’t like the way they made you feel was that that whole fuzzy?
 
Yeah and very, they do have a tendency to make your muscles spasm and I didn’t like that.
 
Was that in your legs mainly?
 
Yes and I really didn’t like it I couldn’t, it just, yeah I just didn’t like it at all.
 
And has it continued after you?
 
No with the quetiapine I’m quite lucky, that it hasn’t happened with this one. But with this one she’s kind of been quite persistent and she’s changed the dosages around, she’s changed the times that I take them.
 
So how, you said you take three times a day?
 
Yeah, so originally when I first started taking last year she had me on 25 milligrams once a day, soon ramped that up to 25 milligrams twice a day, then it became 50 milligrams twice a day, then she changed it so I was taking them twice, you know once in the morning, once at lunch time and once at night then she tried changing it to do it three times and were back to twice a day.
 
It’s a lot to remember isn’t it?
 
Yeah and so now, as of Monday, I’m now taking then morning, lunchtime, 5pm and then double dose at night.
 
Would you notice if you missed a dose?
 
Yes I think so.
 
What would happen?
 
I think that the agitation for me and also the desire to hurt myself, as much as it pains me to admit that she is right, it does help with the harm, the harm minimisation, it actually does. And I think it doesn’t, one of the reasons I don’t like and haven’t had liked antipsychotics in the past is because I’m very aware that it’s not that I don’t want to self-harm it’s that the drugs are making me not want to self-harm.
 
Right.
 
And for me that’s always been an issue it’s kind of like in my head I still want to self-harm but a drug is kind of stopping me from doing that and I didn’t, I’ve never liked that before.
 

Catherine was prescribed antipsychotics and antidepressants...

Catherine was prescribed antipsychotics and antidepressants...

Age at interview: 41
Sex: Female
Age at diagnosis: 14
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So the lofepramine I was on for about a year and a half but in the midst of that I also had another admission to the young people’s unit because I had additional symptoms of hearing voices and, and very much, kind of a lot of guilt, a lot of sort of paranoia and guilt so I did have another stay whilst still on antidepressants but also in addition to antipsychotics for a period of time as well which they felt would work well with the antidepressant.
 
Do you know what ones those were?
 
Sulpiride, was the antipsychotic.
 
Okay.
 
I didn’t see the back.
 
Oh well we can do that later that’s okay.
 
And they felt that that was still part of the depression, it just, it was just an addition to it and that I clearly still had a lot of struggles with, the really compounding factor was guilt and the guilt came about in the fact that I was scared that people were talking, that I was a bad person, you know, so all really, the, the depression cycle was about sort of blaming myself and I think that’s were there the kind of the psychosis came into it. And then I, after that admission and while still on antidepressants and then on the antipsychotic I went to supported accommodation.
 
I was on Prozac at the time, yes. I think my antipsychotic had been reduced and changed to Stelazine and I actually since experienced quite significant physical symptoms. I was experiencing very high, a lot of sweating a lot of anxiety in the stomach, a lot of stomach upset and mentally I was really feeling very unwell.
 
Did you attribute that to the antipsychotic drug?
 
Yeah, yeah, yes definitely the, unfortunately they, they didn’t agree with me.
 

Flora asked to be prescribed Stelazine (trifluoperazine) because...

Flora asked to be prescribed Stelazine (trifluoperazine) because...

Age at interview: 43
Sex: Female
Age at diagnosis: 21
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I kept saying I really wanted to also have another medication which was called Stelazine that’s the brand name, that‘s the trifluoperazine.
 
Yes.
 
Which is old again an old style what they call antipsychotic but it’s helpful in cases of anxiety and again they.
 
How did you know about that one, again from your relatives?
 
Yes, family who had used it in the past in fact my grandmother is still on it and she’s been on it for 30 years and they’re saying that she wouldn’t be able to manage without it and it’s just one little pill and she’s an extremely anxious person but it takes, it just means that she can kind of get on with life. And there were side effects to that, there still are quite serious side effects to that and it’s not one that they generally like to prescribe, they say they prefer to prescribe newer drugs that have replaced those like Kitapen (quetiapine)?
 
I don’t know that one.
 
I don’t know how to say it. And the reason being is that it can produce Parkinsonian type...
 
Shakes?
 
Yes and motor reflexes that you can’t control in your mouth for example so your mouth will quiver or drop and it could possibly I think effect part of your body but it definitely tends to be the face. And only apparently 50% of the people who stop taking it recover from that so, you know, there’s a 50% chance that you’re left with this side effect, so that’s why they generally don’t recommend it. But my psychiatrist gave me all the information and just said wanted me to know everything and I said well you know my grandmother has been on it all this time and she’s perfectly okay and he said well you're grandmothers very lucky, you know, but that’s not something you should base your decision on. but he also said that it’s, it’s something we’re if it’s being given long term there’s a long term build up in the body but if it’s taken short term or for brief periods it’s unlikely to have that kind of effect.
 
After about I don’t know some months, six months maybe, maybe longer I gradually reduced the dosage of the trifluoperazine to the point where it’s been now nearly I think two years and the last sort of six months or so the psychiatrist said well you know look at it as that you have a tool box and here’s a set of your tools and, you know, when you find you need them then you’ve got them there but you don’t have to take them all the time so the trifluoperazine he said he was happy for me to take as and when if I was going through, you know, difficult circumstances or I wasn’t sleeping so well for a few weeks and feel I might like to take one a day, the highest dose I was taking of that was about three at that time so one a day was quite, was the minimum dose.
 
And you didn’t get those side effects that you mentioned using that drug, the shakes?
 
No, no and I did go back with reviews, asked is there any alternative to just find out whether there was actually an alternative and he kind of talked me through the other ones and said that they, you’ve tried one or two of them and said they’re all kind of similar really and although I said that I was worried he did say if you’re not taking it on a regular basis and large doses you’re unlikely to have that problem. So, you know, if you feel it suits you and you want to take it on an occasional basis then don’t worry too much that’s probably fine.
(More information can be found in our Experiences of psychosis section).
 
Mood stabilisers

Lithium may sometimes be prescribed as a mood stabilising medicine when a person has been diagnosed with bipolar disorder. People with bipolar disorder have a chemical disturbance in the brain which causes alternate periods of very high and very low mood, over periods of weeks or months. Sometimes these mood swings go in only one direction - either high or low - and this is called "unipolar disorder". Lithium can help some people who experience serious downward swings into depression, whether or not these lows are followed by highs. It is usually prescribed for a minimum of six months but people often need to continue taking it on a long term basis. The dose needs to be closely monitored to help prevent side effects, such as diarrhoea and vomiting. People taking lithium should have regular blood tests (at least once every three months) to check that levels of lithium are not too high or too low. Kidney and thyroid function will also need to be checked regularly. Janet had problems with increased calcium levels and is now monitored closely ‘If it goes, my calcium level goes up to three, that’s the dangerous area, I’m alright as long as my calcium’s below three’. Although she expects to continue taking lithium, she thinks if her calcium levels change her doctor may need to prescribe an alternative.
 
Dina had tried many different combinations of antidepressant and other medicines over several years but never found anything helped her to feel better until she began taking lithium. ‘The first time that I sensed any difference from a medication was when I started lithium’. Janet said it helped stabilise her mood but ‘you don’t really feel anything it’s just that it stops you going high... I felt that it masked things, you know, the edge was taken off, all the edges. I did feel that it took away... it masks your emotions but you don’t actually feel anything other than that’. 
 

Dina found lithium worked really well and feels it’s the one...

Dina found lithium worked really well and feels it’s the one...

Age at interview: 46
Sex: Female
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It was a very, very distinct effect that lithium had when I started taking it and it was kind of quick as well.
 
Can you describe that effect?
 
You know, a lot like my mood being lifted.
 
Okay.
 
You know, but on the other hand though at the same time I had spent some time at the mental health arts project, I’d started thinking that I want to go back to work, you know, it was like a combination of things.
 
So you mean it’s hard to pin down exactly what the mood change?
 
Yes but I do think because it was so dramatic that, you know, although I mean from my reading I understand that, you know, they don’t really know how lithium works or they don’t really know how any of these drugs work and why …. I think the lithium was an important factor I mean that was what my psychiatrist says and I probably believe it and he says that without being somebody who is very much kind of a ‘medical model’ person because I mean you know, he was very much psychologically minded.
 
With the lithium of course it’s the toxicity of it like, you know, I have to go and have blood tests every few months you know this is a very toxic drug, I mean a very good drug apparently but it’s a very toxic drug.
 
That’s the lithium?
 
The lithium, yes. So you know it has to be monitored and, you know, I mean I don’t know whether I have to be on this, you know, for the rest of my life or I guess I’ll have to kind of negotiate with the psychiatrist.
Some people had strong feelings against taking lithium, because they believed it was ‘dangerous’ or ‘toxic’. Sonia said her doctor wanted her to take it but she refused. When Janet’s doctor first suggested it she said she’d prefer the option of an antidepressant. Michael rarely questioned the medicines he was prescribed but had not liked the side effects he got from taking lithium ‘I always believe, if they tell me to do something I’ll do it, the only one I’ve objected to is lithium’. 
 

Michael didn’t like taking lithium because of concerns that...

Michael didn’t like taking lithium because of concerns that...

Age at interview: 72
Sex: Male
Age at diagnosis: 26
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I was taking risperidone, paroxetine and lithium and I took that for six months and that’s quite dangerous taking lithium, damage your kidneys and all kinds of things and it makes you fat as well, I always blame this on, on lithium and I thought when I stopped taking it, it would go away but it doesn’t, you have to exercise to get rid of it. and I fought to come off that, I was determined to come off it and I kept going to psychiatrists every time I saw them can I come off lithium.
 
And that was because you felt it wasn’t doing you any good?
 
It wasn’t doing me any good.
 
Did you know about all the sort of dangers?
 
Oh yeah they tell you, you have to have a card and all kinds of things yeah.
 
Right, so that was the one drug that you were not happy to.
 
I’m not happy to take it, no.
 
Whereas all the others you’ve been kind of quite.
 
Just accepting yes.
 
Yes.
 
Yeah, yeah, yeah.
 
So you were worried about the kind of concerns that you would have if you were going to resist taking one would be to do with safety and health?
 
Health yeah.
 
And other health reasons?
 
Yeah, yeah, yeah. But they do always check my liver and kidneys because Risperidone has some effects as well.
 

When Sonia’s doctor wanted her to take lithium she said...

When Sonia’s doctor wanted her to take lithium she said...

Age at interview: 31
Sex: Female
Age at diagnosis: 17
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I think, was it last year or the year before when I was told she wasn’t going to change by antidepressants unless I changed to lithium I think perhaps five years ago I would have just gone yes just give it to me and I didn’t I said just ‘Do you know what, no, there’s no chance in hell that I’m ever taking that’.
 
What was your objection to that had you looked that up or?
 
Lithium is a very dangerous on overdose and I tried to stay away from drugs for medications that are dangerous on overdose because as much as I know there are times that I will want to try and kill myself I try and limit the risks and I try to, sorry, eliminate the risks so having the drug in the house, a supplying the drug in the house that I know could kill me, I wasn’t really prepared to do that.
Olivia X (below) had been taken to see a psychiatrist when her mood became erratic and her parents were worried about her. The psychiatrist diagnosed bipolar disorder and wanted her to take lithium, but she disagreed and refused to take it. She was unhappy with the way the psychiatrist had spent so little time with her before suggesting such a powerful drug. 
 

Olivia X was taken aback when the psychiatrist...

Olivia X was taken aback when the psychiatrist...

Age at interview: 45
Sex: Female
Age at diagnosis: 40
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The psychiatrist that I saw I was quite resistant to and I thought that he was making some snap decisions he initially thought I had, well he, I was definitely emotionally dysfunctional so he initially said bipolar disorder but I was, couldn’t accept that as a diagnosis, I just said ‘No I’ve got the divorce, I’ve got this shitty situation at work, it’s not that - it’s the situation I’m in, it’s not me - it’s all these things I’m having to deal with,’ and so he wanted me to go on olanzapine and lithium and I have a friend who’s on lithium clinical trial and I didn’t want to touch the stuff so I said no because I want to look at what the toxicological l issues are, I want to look at the side effects, you’ve not taken my blood pressure, I’m feeling quite wired and tense, I probably have got high blood pressure, you know. There’s all these physical things you haven’t, nobody’s looked at and also I had had no periods for like two months so I said maybe this is menopause, nobody’s looking into this. and I had also had my breasts were making milk a little bit as I had a three year old, my son was three at the time but I had stopped breast feeding at six months so it was all a bit peculiar that my breasts were making milk. So I said all of these things should be looked at because I could be physically ill or it could be a hormonal thing. And so I was bit challenging to the psychiatrist which I think he didn’t really appreciate.
 
I would have liked a proper psychiatric consultation because it was literally within ten minutes he told me I was bipolar. And in fact to say that is a little bit like taking the rug from under your feet because you’re basically saying I think you’re loopy, you know. And I think that’s appalling I think you couldn’t just suddenly say to someone you’re got cancer, you couldn’t suddenly just say, you know, and he didn’t have a check list or anything that he was going through in a methodical manner, it was just purely on my behaviour. Now if he said look I’m going to be judging your behaviour I would have gone in and I could have been as nice as pie and then he would have had no behaviour to judge whatsoever, I just went in very relaxed and myself and a bit over the top probably.
 
And he couldn’t make anything of it so?
 
And he just thought you’re wild… wild equals bipolar, bipolar equals olanzapine and lithium.
 
So really within ten minutes or so of speaking to him he was offering you lithium?
 
Yes.
 
Without any other tests or diagnosis?
 
Yes, yes.
Over-the-counter remedies 

Herbal remedies such as St John’s wort are not prescribed by doctors, but can be bought over the counter. They may help relieve low mood and anxiety. However, these remedies may not be suitable for everyone, and some people should not take them. In particular they should not be taken alongside an antidepressant and many other medicines, such as those for HIV, epilepsy, bipolar disorder and oral contraceptives. This is because it affects the liver. It’s very important to check with the doctor or pharmacist before taking any herbal or over the counter remedies if you take other medicines. Emma had heard about St John’s wort but hadn’t taken it. I have considered it but because I was on medication the St John’s Wort would react with it so you can’t... I just sort of stuck to what the doctor has prescribed’. Janet had tried Evening Primrose Oil in the past but was sceptical about herbal remedies. ‘I don’t have a lot of faith in these natural remedies, they’re not strong enough for some people, they’re alright for some people’. Thomas takes a sedating antihistamine to help with insomnia. 
 

Rachel has tried herbal remedies when she has been ‘in...

Rachel has tried herbal remedies when she has been ‘in...

Age at interview: 51
Sex: Female
Age at diagnosis: 11
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Have you taken any over the counter remedies or anything like that?
 
St John’s Wort.
 
And how do you find that, you’re not meant to take that if you’re taking?
 
No, I take that particularly when they first started sort of going St John’s Wort works for moderate depression you know, mild to moderate depression. and I did, I did I thought it was, I thought it was okay as and I also… sort of things like in between other medications, I’ve had things like Quiet Life tablets and stuff like that and natural remedies.
 
Do you feel that there is an effect from those?
 
I think so, I think so yes. I mean particularly things that, you know, with the ones which have got valerian in and hops those things definitely have a soporific effect and sometimes…. but in quite a gentle way which I can cope with. Because if something it’s not very magical but if something makes you, makes you a bit more sort of sleepy and laid back, you can’t physically be so anxious. I mean they help more with anxiety than depression.
Olivia Y (below) stopped taking citalopram and now takes a supplement that she buys in the health store, called 5HTP (hydroxytryptophan). It is an amino acid that occurs naturally in the body, and is thought to help alleviate symptoms of depression and anxiety, although more evidence on safety and effectiveness is needed before any strong conclusions can be made. It may cause side effects such as dizziness, nausea and diarrhoea. 
 

Olivia Y takes 5HTP...

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Olivia Y takes 5HTP...

Age at interview: 33
Sex: Female
Age at diagnosis: 16
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I’d heard reports of 5HTP, do you know 5HTP, you might want to look this up 5HTP it seems to be a better, it’s not St John’s Wort it’s significantly better it’s a sort of herbal antidepressant/ antianxiety helps you sleep, it contains a hydroxytryptophan, tryptophan.
 
Is this on prescription or?
 
No health food shops, health food shops and as I came off my citalopram it’s, it’s apparently so successful that on the label you don’t take it with antidepressants so I didn’t. And then when I came off my antidepressants I started taking this and I’ve been on that since March and I feel pretty good.
 
Did you speak to your GP about that?
 
I think I remember asking him yes I’m pretty sure I told him about this and I think he said, I think his words were ‘if you can buy it in the shops then you’re not buying anything bad’ and yes.
 
Is there any evidence base on that do you know?
 
I didn’t do an academic search but I did Google search it and I’ve just been taking that.
 
Is that something you take on a daily basis?
 
Yes I take it; I take one capsule at night time yes.
 
And does it have?
 
It’s an amino acid.
 
Okay. Does it have any noticeable effect or do you think it just?
 
Noticeable effects or the ones that it claims to have?
 
Noticeable side effects or the ones that it claims?
 
Side effects not one, not one. The benefits that are from various people are it combats anxiety, combats depression.
(See also ‘Treatment in hospital’ and our sections on ‘Experiences of psychosis’ and ‘Depression’).

Last reviewed June 2016.
​Last updated June 2016.
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