Treatment and intervention
Medicine
The main way these treatments work is biological and physical.
There is a lot of money available for research on medications, some of it from pharmaceutical companies and some from independent researchers who are not sponsored by pharmaceutical companies, so there is a lot of research into medications.
The medicines that treat psychosis are all part of a group of medicines that help to reduce or stop unusual and distressing thoughts and experiences.
All these medicines work in a similar way by trying to reduce unusual and distressing thoughts and experiences such as hearing and seeing things, or having strong upsetting beliefs.
They try to do this by changing the way that messages are transferred by the chemical messengers in your brain. There are lots of natural chemical messengers (neurotransmitters) in the brain. The main chemical that these medicines work on is called dopamine.
Others include serotonin, glutamate, acetylcholine and noradrenaline. Dopamine affects your ‘reward’ system, for example by influencing what you notice and pay attention to. In this way it affects your thinking, emotions, and behaviour. Too much dopamine in some parts of the brain means that there are too many confusing messages flying around or messages that make you notice and pay attention to unusual things. This can then be distressing and make you feel overwhelmed and anxious.
The medicines block some of the effects of dopamine, so that these chemical messages are gradually dampened down or even stopped. The medicine doesn’t change what you think, but people do find they often have a different perspective on their experiences after they’ve been taking medicine for a few weeks or months. People often also feel less worried or scared and better able to do the things they want to do.
Myth buster - i will be forced to take medicine
Generally speaking you don’t have to take medication, and someone will also talk to you about other things that might help, like talking therapies, support for getting back to school, college or work, help with money and housing, relationships and help with diet and exercise.Lots of studies have looked at whether these medicines work better than a sugar pill that doesn’t do anything (a placebo), and which of these medicines work better than the others.
There is lots of good quality evidence (from randomised controlled trials (RCTs) that these medicines reduce unusual and distressing experiences and particularly prevent them from coming back again (a relapse).
These medicines come in tablet, syrup, and long-acting injection form, though not all of them come as injections. They are different from some of the common medicines that you may have taken before like pain killers, because they don’t work immediately to affect your experiences. In fact, they generally take at least a few weeks and even a few months before you might notice any change at all in your experiences. For some people, the medicines will stop your unusual experiences and for other people they will only reduce them.
The sooner you take medicine after you develop unusual experiences the more likely the experiences are to go away completely, and the lower dose you might need – which is great as lower doses mean fewer side effects.
Some medicines will work for some people but not for others, and sometimes even when a medicine works, the experiences may come back occasionally, especially in times of stress. This is because they have to work quite hard to gradually, rebalance the chemical messages that are linked to upsetting experiences. After all our brains are pretty complex and powerful things! You may need to try a few medicines before you find the best one for you.
Again, unlike some common medicines, these medicines carry on working to rebalance or stop experiences all the time that you are taking them. This means that if you stop taking them, sometimes upsetting experiences come back again, gradually over a few weeks or months - but other times the experiences may have truly gone away.
It’s hard to know when is the best time to reduce, or stop medicine. Some doctors suggest that you should take it for at least a year after any upsetting experiences have gone away, and some suggest even longer. This gives the medicine time to work, and you time to get back to things you enjoyed doing before the experiences started.
Read more about how long you may take medication in the treatment choices booklet.
It’s really good not to have to remember to take tablets every day, although I don’t like having to go for injections once a month as I don’t like needles. I had some side effects, so I spoke to the doctor and I’ve changed medication.
Rob, aged 21
The main types of side effects are described below. Remember, different medicines have different chances of causing these side-effects and some have a lot fewer side effects than others.
I did take Olanzapine but it made me feel permanently jet-lagged. I couldn’t tolerate it and I found the risk of weight gain unacceptable.
Catherine, aged 31
The main types of side effects are described below. Remember, different medicines have different chances of causing these side-effects and some have a lot fewer side effects than others.
If you notice any of these side-effects then you should discuss them with your Care Co-ordinator, Pharmacist or Doctor:
- Weight gain – feeling more hungry and eating more so you might put on weight
- Metabolism changes – changes in how your body deals with sugars and fats
- Heart and circulation problems – changes in how your heart works such as odd/fast heartbeats or chest pain
- Hormone changes – changes with your sex drive, periods (women only), breast growth & milk production
- Movement changes – you may be more stiff, shaky or restless
- Stomach upset – you may feel sick, vomit or have diarrhoea initially
- Dizziness – especially when you stand up
- Blurred vision – don’t drive or cycle if you experience this
- Headaches
- Anxiety/agitation – worrying about lots of different things
- Tiredness
- Constipation – not being able to poo - this can be helped if you eat lots of fruit, vegetables and fibre
- Hypersalivation – too much saliva in your mouth
- Dry mouth – not enough saliva in your mouth.
There are lots of different medications.
The main ones that you may be offered include:
Click on the medication name to learn more about this type of medicine.
