Challenges & Choices: Finding mental health services in Ontario
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There tend to be strong and conflicting views on taking medication. Many people are happy to find a pill that decreases their suffering and improves their quality of life. Others do not find medication helpful at all. They may be disturbed by side-effects that are unpleasant and even debilitating or unknown in the long-term. And they may not like the idea that the drug alters the way they think and feel. Some may view their need to take medication as a sign of weakness. Still others may be concerned about addiction. Or they may be discouraged because the drug isn't as effective as they had hoped.
Even those people who find that medication is useful may still experience side-effects that make it difficult for them to continue to take their prescriptions. Many people have to try two or more medications before they find one that they can tolerate (e.g., has few or no side-effects) and which is effective. This is because it is often difficult to predict which drug will work best for which person.
It is up to you to decide whether medication is right for you. Should you decide to take medication, your body may have to adjust to it before your doctor can assess how long you'll need to take it and the amount of the dose. The doctor's opinion may change, depending on how your body reacts to or absorbs the drug and as new research evolves.
A doctor may gradually increase the dose to figure out the amount needed to get the best effect from a drug. The drug will most likely come in a pill or tablet form. Liquids or injections (short- or long-acting) may be recommended for treating certain kinds of conditions.
Establish a relationship with one pharmacist you trust, particularly when you are taking several different medications. This way, the pharmacist will be aware of all the medications you've been prescribed and will be able to tell you about possible interactions. But don't rely just on your pharmacist for information: speak to other experts and read up on the medications.
Question: What if the medication doesn't work?
Answer: Not every medication works for every person. Unfortunately, doctors can't always predict which medication will work for you. But it's easier for them to choose the right drug if they have some details. Which medications have worked for you or a close relative in the past? What are your symptoms? What other medications are you taking?
Ask your health care provider when you'll see results from the medication. Some anti-anxiety medications can work within 30 minutes. Antidepressants can take from four to six weeks to become fully effective. Some antipsychotics can take even longer to help all symptoms. While it can be extremely frustrating to wait, you will have to give it some time. Find other ways to get support and care in the meantime.
If your medication is not working, your doctor can adjust the dose, prescribe another medication to complement the first or switch you to a different medication. Researchers are studying a number of new medications and treatments, which may be available in the future.
Remember that medication is only one tool to help treat mental health problems. You can also take medication in combination with psychotherapy, joining a support group, talking to friends and family or eating a well-balanced diet.
There are various types of psychiatric drugs:
Anti-anxiety medications, previously known as anxiolytics or minor tranquilizers, are used to help calm people and relieve anxiety. Commonly used anti-anxiety medications are diazepam (Valium®) and lorazepam (Ativan®).
Antidepressants are most commonly used to treat depression. They are also used to treat different forms of anxiety, severe premenstrual mood changes and bulimia. Commonly used antidepressants include fluoxetine (Prozac®), sertraline (Zoloft®) and venlafaxine (Effexor®).
Antipsychotics, also called neuroleptics, are used to treat symptoms of acute or chronic psychosis, including schizophrenia, mania and organic disorders. Some of the most common antipsychotics are risperidone (Risperdal®), olanzapine (Zyprexa®), haloperidol (Haldol®) and clozapine (Clozaril®).
Mood stabilizers are used to help control mood swings (extreme highs and lows) connected with bipolar disorder and prevent further episodes of this condition. Commonly used mood stabilizers are lithium (Lithane®, Duralith®) and divalproex (Epival®).
Please note that while some of the more common drugs are listed above, this does not imply that CAMH endorses the use of these particular medications over others.
Side-effects can be minor or serious, and vary greatly from person to person. Common side-effects include:
- minor stomach problems (nausea, constipation, diarrhea)
- sexual difficulties
- dry mouth
- blurred vision
- allergic reactions
- fatigue or difficulty getting to sleep
- twitching and trembling
- akathisia (restlessness, feeling like you have to move your legs, especially at night) and
- weight gain.
A particularly serious side-effect that can be caused by antipsychotics is tardive dyskinesia. This is an involuntary movement, usually of the tongue, lips, jaw or fingers, that can be permanent.
Which side-effects you experience depend on the drug and dose you are taking and how sensitive you are to the medication. In most cases, side-effects lessen as therapy continues. But it is also true that side-effects may not develop immediately. If you did not have certain symptoms before taking the medication, it's possible that they are a result of the medication.
If you do experience side-effects, do not stop or change your medication without first talking to your doctor, pharmacist, nurse or caseworker to find out how to cope with them. If the doctor dismisses your concerns, persist with your questions. Then consider getting a referral to someone else if you are not satisfied with the care you are receiving.
If the doctor's suggestions don't work, he or she can:
- prescribe another drug to counteract the unpleasant effects of the drug
- switch you to a different drug
- reduce the dose of the drug orgradually
- withdraw you from the drug.
Your doctor should continually monitor your medication. In some cases, he or she will test your blood to make sure your liver and other organs are functioning well and that the drug levels in your bloodstream are okay.
To find out about the effects of prescription and over-the-counter drugs as well as herbal products during pregnancy or while breastfeeding, call the Motherisk information line at (416) 813-6780 in Toronto. For information about the effects of alcohol, nicotine and drugs such as marijuana, cocaine and ecstasy during pregnancy or while breastfeeding, call Motherisk's toll-free Alcohol and Substance Use Helpline at 1-877-327-4636. Their Web site is www.motherisk.org
For health-related questions, call Telehealth Ontario, a free 24-hour confidential information line. Registered nurses, with support from pharmacists, will respond to your concerns. Their toll-free number is 1-866-797-0000 and TTY is 1-800-387-5559. Their Web site is www.gov.on.ca/health/
Question: I have heard that psychiatric medications have bad side-effects. Is this true?
Answer: Most side-effects from psychiatric medications are mild and temporary. However, some have serious, long-term effects that you should know about. Tell your health care providers about any side-effects. Don't worry about bothering them. If you don't tell them you are having a problem, they can't help you solve it. Ask family members to help. Explain the signs of a serious side-effect, so they can watch for them. It is also important to discuss the risks and benefits of taking or not taking the medication with your doctor.
If you have questions about your medication, bring them up with your health care providers. It's a good idea to write down questions so you will remember to ask them at your next appointment.
Your doctor, pharmacist or other health care provider can help you deal with these side-effects. For instance, if a drug makes you drowsy, they may suggest that you take it at night. If a drug nauseates you, they may recommend that you take it with food.
Mixing medication with other substances
Tell your doctor or pharmacist about any over-the-counter medication, vitamins, herbal products, illegal drugs or homeopathic remedies that you are taking. This is important because they may interact with the prescription drug. Ask about caffeine, alcohol and grapefruit juice, too. Grapefruit juice does not interact with all medications, but can cause serious side-effects and even be toxic with some.
If you want to go off your medication, first consult with your doctor. If you suddenly stop taking your medication, you could experience withdrawal symptoms or the return of the symptoms you were originally being treated for (e.g., insomnia after stopping to take a sleeping pill). You may also experience other symptoms, such as nausea, headaches and dizziness.
Withdrawal symptoms usually start within hours or a day or two of stopping a medication. Sometimes even missing two consecutive doses can cause withdrawal. Recurrence or return of the original problems can occur within a few days, but can also happen weeks or months later. It can sometimes be difficult to tell the difference between withdrawal and recurrence of the original problem.
If you decide with your doctor to go off your medication or switch to another drug, your current dose will be tapered. This means that the amount of medication you are taking will be slowly reduced. This happens over a few days to several weeks, decreasing your chances of withdrawal. The severity of withdrawal symptoms you may experience depends on the type of medication you've been taking, how long you've been taking it and your dose.
Question: Will I have to be on medication for the rest of my life?
Answer: Not necessarily. The length of time you will stay on a medication depends on many different factors:
the type of mental health problem
what symptoms you have and how long you've had them
how many relapses (recurrence of the symptoms) you have experienced
how severe your symptoms have been and
what other supports you have in your life.
Some people can be treated for a mental health problem over a short period, and recover fully. However, some problems are longer term and require indefinite treatment. Certain medications, such as sleeping pills and anti-anxiety medication, should be used for only a short time while you are learning new techniques and skills for coping.
For a first episode of depression, antidepressants should be taken for about one year. Antidepressants can be taken longer or indefinitely if you have more than two relapses or the symptoms in your first episode were very serious. Mood stabilizers and antipsychotics are usually taken indefinitely, because both bipolar disorder and schizophrenia, for which they are prescribed, are long-term problems.
Talk to your doctor about how long you will need to take the medication. Ask about how effective the medication is compared to psychotherapy. You may also want to discuss your feelings about taking medication. The most common mistake people make is stopping their medication when they feel better. While some medications are intended to treat only serious conditions, most psychiatric medications are meant to prevent further relapses. It is possible that your dose of medication can be lowered, or that you can gradually go off the medication, but be sure to speak to your doctor first. In many instances, a combination of medication and therapy is the most effective approach.
Questions to ask about medication
- What are the generic and trade names of my medication?
- What dose should I take?
- Why am I taking this medication and what is it supposed to do?
- How and when do I take this medication? (e.g., Do I need to take it at the same time each day, with food?)
- What are the most common side-effects, and how can they be treated?
- What are the signs of a more serious drug reaction that I should contact my doctor about?
- Which drugs, food and alcohol interact with this medication?
- What should I do if I miss a dose?
How long will I be taking this medication?
- When can I expect the drug to start working?
- Can I get addicted to the medication?
- What research is there about the drug I'm being prescribed (e.g., its effectiveness, risks, recommended dose)?
- What would be involved in going off the medication?
- What are the long-term effects of being on the medication?
Question: Is this medication addictive?
Answer: Most psychiatric medications are not addictive. Many are intended to be taken for a long time or indefinitely, but that does not mean they are addictive. Mental health problems involve a chemical imbalance, and just like other non-psychiatric problems, they often need long-term treatment.
Some psychiatric medications, such as anti-anxiety medications and stimulants used to treat attention-deficit/hyperactivity disorder, can become addictive, even when they are taken as prescribed. If you have any concerns about this, don't hesitate to speak to your doctor, pharmacist or health care provider. Tell your doctor if you know you have problems with addiction, so the doctor can be careful about the types of medication he or she prescribes.
Electroconvulsive therapy (ECT) is most commonly used for people who have severe depression for whom other treatments have not worked. ECT can be very effective for these people; however, it remains highly controversial.
The client is given an anaesthetic and a muscle relaxant. Then an electric charge is applied to the brain that induces a small seizure. Almost all people who are treated with ECT experience some memory loss of what happened immediately before or during the treatment. In some cases, clients lose the memory of significant periods in their lives.
Like other treatments for mental health problems, it is important to get all the facts about ECT and its potential side-effects before you decide whether this treatment is right for you.
Challenges & Choices: Finding Mental Health Services in Ontario