Following these principles will help ensure the safe administration of medications for mental illness. These medications are generally safe but they are powerful and can have serious consequences for the patient if not safely prescribed or monitored correctly. It is therefore vital that they are used correctly.
Before prescribing medication
- Make a correct diagnosis or diagnoses.
- Consider psychosocial interventions.
- Assess the risks and benefits of any medicine.
- Review the success of previous medicines and other interventions.
- Get to know the medicine you prescribe. Never prescribe a medicine you know little about.
- Is the patient taking any drug which could affect metabolism or pharmacological action of the psychiatric medicine? E.g. Carbamazepine, Sodium Valproate, some HIV regimens.
- Advise the patient to avoid illicit drugs or alcohol.
- There is some evidence that a patient whose family members have responded to certain agents are likely to do the same. It’s worth a try.
- Check that the medicine prescribed is available in the patient’s community.
- Advise that the medicine is taken with water and food if possible.
- Always check about allergies.
- Medicine should not be used simply because the patient expects it.
Starting medication
- Start with the lowest possible dose and increase the dose slowly.
- Try to avoid using more than one medicine (polypharmacy).
- Target symptoms, for example use a more sedating agent if insomnia is a problem.
- Inform and involve the patient and their family in all decisions.
- Be aware when prescribing in these circumstances:
- Pregnancy and breastfeeding (some medicine should not be taken)
- Elderly (use lower doses – see section)
- Children (use lower doses – see section)
- HIV, renal or hepatic impairment (use lower doses or avoid some medicines)
Continuing medication
- Review the need for medicine at each appointment and make a plan to reduce and stop once the required length of treatment is complete, while monitoring for return of any symptoms.
- Ensure the patient takes the medicine at the appropriate time and for the duration of the course.
- If a patient does not improve after a course of medicine, it is important to check that the patient has been taking the right dose for the right length of time. It is also important to check if the patient is using alcohol or drugs as this can stop medicine from working properly. It is useful to check the diagnosis and ensure that the person does not have a physical illness that presents in a way similar to a mental illness.
Stopping medication
Avoid suddenly stopping medicine if possible; decrease the dose slowly. The longer the patient has been on the medicine; the more gradual the decrease.