Medicines and Medical Treatment

Chemistry as care, not a verdict

Medicines support recovery. They are not magic and not a character flaw.

15.1 Why medicines are used

Mental disorders involve real changes in brain circuits, neurotransmitters, hormones, and body systems. For many people, especially with moderate to severe conditions, medicines are an important part of treatment.

Medicines do not change personality or create dependency when used correctly. They aim to:

• Reduce symptoms (low mood, anxiety, psychosis, mania, obsessions, panic).
• Restore balance in brain chemicals and body systems.
• Improve sleep, appetite, energy, and concentration.
• Enable the person to benefit more from therapy, lifestyle changes, and social support.
• Prevent relapse and hospitalisation.

WHO and psychiatric guidelines recognise medicines as effective treatments for many mental disorders when prescribed and monitored by qualified professionals.

15.2 Who can prescribe

• Psychiatrists: medical doctors (MBBS/MD or equivalent) with specialised training. They can diagnose, prescribe, and monitor all psychiatric medicines.
• Other doctors: primary-care physicians, neurologists, and some other specialists may prescribe common psychiatric medicines, especially where psychiatrists are few.
• Psychologists and counsellors: generally cannot prescribe (except in a few countries with special additional training and legal provisions).

Always consult a qualified doctor for starting, changing, or stopping psychiatric medicines.

15.3 Antidepressants

Used for depression; anxiety disorders (GAD, panic, social anxiety, OCD, PTSD); some chronic pain and sleep problems (certain types).

• SSRIs: fluoxetine, sertraline, escitalopram, paroxetine. Increase serotonin availability. Often first-line for depression and anxiety.
• SNRIs: venlafaxine, duloxetine. Affect serotonin and norepinephrine.
• Other: bupropion (dopamine and norepinephrine); mirtazapine (can help sleep and appetite); TCAs and MAOIs (older classes, used less often due to side effects).

Important: usually take 2–6 weeks to show noticeable effect. Common side effects (often temporary): nausea, headache, sleep changes, sexual side effects, weight changes. Should not be stopped abruptly; tapering is needed.

15.4 Anti-anxiety medicines

• Benzodiazepines: lorazepam, clonazepam, alprazolam, diazepam. Fast-acting; reduce anxiety, panic, and muscle tension. Short-term or crisis use because of dependence, sedation, and cognitive side effects.
• Buspirone: non-sedating; takes a few weeks; used for generalised anxiety.
• Beta-blockers: propranolol. Reduce tremor and palpitations. Often used for performance anxiety.

15.5 Mood stabilisers

Used primarily for bipolar disorder (to prevent or treat mania and depression); sometimes for impulse control or mood instability in other conditions.

• Lithium: classic mood stabiliser; reduces suicide risk in bipolar disorder; requires regular blood tests for levels and kidney/thyroid function.
• Anticonvulsants: valproate, lamotrigine, carbamazepine. Also used for epilepsy; affect brain excitability.
• Some atypical antipsychotics also have mood-stabilising properties.

Mood stabilisers often need long-term use and regular monitoring.

15.6 Antipsychotics

Used for schizophrenia and schizoaffective disorder; bipolar mania and sometimes bipolar depression; severe depression with psychotic features; sometimes carefully and short-term for severe anxiety, OCD, or behavioural symptoms in dementia.

• First-generation (typical): haloperidol, chlorpromazine. Effective but higher risk of movement side effects (stiffness, tremor, restlessness).
• Second-generation (atypical): risperidone, olanzapine, quetiapine, aripiprazole, clozapine. Often preferred for lower movement side effects, but can cause weight gain, metabolic changes, and sedation.

Can be life-changing for psychosis and mania. Need regular monitoring of weight, blood sugar, lipids, and sometimes heart and blood parameters (especially clozapine). Should not be stopped suddenly because of relapse risk.

15.7 ADHD, sleep, and substance-use medicines

ADHD

Stimulants: methylphenidate, amphetamine-based medicines. Improve attention, focus, and impulse control. Controlled substances; careful prescribing and monitoring. Non-stimulants: atomoxetine, guanfacine — alternatives when stimulants are not suitable. Used mainly with a clear ADHD diagnosis.

Sleep

Sedative antidepressants in low dose (trazodone, mirtazapine). Z-drugs (zolpidem, zopiclone) — short-term; risk of dependence. Melatonin — sleep-wake regulation in certain cases under medical advice. Sleep medicines should generally be short-term while underlying causes are addressed.

Substance use

Alcohol: disulfiram, naltrexone, acamprosate. Opioid: methadone, buprenorphine (substitution therapy), naltrexone. Used as part of comprehensive treatment including counselling and social support.

15.8 How they work, side effects, special groups

Antidepressants modulate serotonin, norepinephrine, dopamine. Antipsychotics block certain dopamine (and serotonin) receptors. Mood stabilisers affect ion channels and neurotransmitter release. Anti-anxiety medicines enhance GABA or reduce physical arousal. Most need weeks to show full effect. They are tools, not magic cures.

Common concerns

• Weight gain: some antidepressants, antipsychotics, mood stabilisers. Diet, exercise, sometimes changing medicine.
• Sexual side effects: especially SSRIs. Dose adjustment or change of medicine.
• Sedation or activation: timing of dose can be adjusted.
• Metabolic changes: blood sugar, cholesterol, weight with some antipsychotics. Regular monitoring.
• Movement side effects: stiffness, tremor, restlessness with some antipsychotics.
• Withdrawal: stopping antidepressants or benzodiazepines abruptly can cause dizziness, flu-like symptoms, anxiety, or insomnia. Always taper under supervision.

Special populations

• Children and adolescents: benefits must outweigh risks; lower doses; close follow-up (including antidepressant and suicidal-thought warnings).
• Pregnancy and breastfeeding: some medicines safer than others; untreated severe illness also carries risks; decide with psychiatrist and obstetrician.
• Older adults: more sensitive to falls, confusion, interactions; lower doses; review polypharmacy.
• Physical illnesses: liver, kidney, heart, or neurological conditions affect choice and dose; coordinate doctors.

15.9 Myths

Myth 1: Psychiatric medicines are always addictive. Fact: most antidepressants, mood stabilisers, and antipsychotics are not. Some anti-anxiety and sleep medicines can cause dependence if misused.

Myth 2: Medicines change your personality. Fact: they aim to reduce symptoms so the person can function better and be more like their true self.

Myth 3: Once started, I will need them forever. Fact: some people need long-term medication (bipolar disorder, schizophrenia); others take medicines for a limited period and taper under supervision. It depends on diagnosis and severity.

Myth 4: Medicines are the only treatment. Fact: best outcomes often combine medicines with therapy, lifestyle, and social support.

15.10 Working with your doctor

Share full history: past treatments, responses, side effects, other medicines, supplements, substance use, medical conditions.

Ask: What is this medicine for? How long will it take to work? What are common side effects? What if I miss a dose? How and when will we stop or change it?

Take medicines exactly as prescribed. Do not change dose or stop on your own. Report side effects early. Attend follow-up. Avoid alcohol and recreational drugs unless the doctor says otherwise.

15.11 When hospital treatment is needed

• High suicide risk or recent serious attempt.
• Severe self-harm or inability to care for self.
• Severe mania or psychosis with risk to self or others.
• Severe eating disorders with medical instability.
• Severe substance withdrawal needing medical management.
• Need for intensive treatment, observation, or procedures (for example, ECT in severe depression).

Hospital treatment can be life-saving. It is not a failure. ECT today, when used, is given with anaesthesia for severe stalled depression or catatonia, with informed consent — not as punishment.

15.12 Stopping medicines safely

Speak with your prescriber first. They will usually:

• Wait until you have been well for a sustained time
• Reduce the dose gradually over weeks to months
• Agree a plan to watch for early warning signs
• Offer to restart if symptoms return

Stopping quickly can cause withdrawal-like effects and raises the chance of relapse.

15.13 Overdose and emergencies

Seek emergency help at once if someone takes more than the prescribed amount, especially with deliberate intent, or shows signs such as severe drowsiness, confusion, fits, fast or irregular heartbeat, or trouble breathing. Contact emergency services or a poison control centre, and have the medicine package ready.

Seek urgent help for warning signs of rare but serious reactions, such as a high fever with muscle stiffness and confusion, a spreading skin rash, signs of lithium toxicity (severe vomiting, diarrhoea, tremor, confusion), or sudden swelling of the face or throat.

15.14 Evidence and honesty

Psychiatric medicines are tested in large clinical trials. They help many but not all people, and the size of benefit varies. Side effects are real. Good care involves shared decision-making: you and your prescriber weigh benefits and risks and review often. If a medicine is not working after an adequate trial, it should be changed, not just continued.

15.15 Alternatives and add-ons

• Therapy: often equal to or better than medicine for mild to moderate conditions.
• Exercise: shown to help depression and anxiety.
• Light therapy, brain stimulation (TMS), and ECT for severe or resistant illness.
• Lifestyle changes: sleep, alcohol reduction, nutrition, and social support.

15.16 A simple story

15.17 One companion verse

Reflection activity

1. What are your main thoughts or fears about psychiatric medicines? Where do these ideas come from?
2. If you or someone you know was prescribed a psychiatric medicine, what two questions would you ask the doctor?
3. How can you support someone starting psychiatric treatment?

This book is for education and general awareness. It does not replace diagnosis or treatment by a qualified professional. If anyone is in danger, contact your local emergency services.