Medication Review

What is a medication review?

A medication review is a consultation with a psychiatrist with the main goal of finding out if your current medication regime can be optimised. Medication reviews can be an essential part of the treatment plan. A medication review is particularly relevant when the condition has not previously responded well to several different medications. 

Who carries out the medication review?

Typically, your psychiatrist will carry out a medication review in every consultation. 

If you or your psychiatrist feel that it would be helpful or appropriate to have another psychiatrist carrying out the medication review, this would involve a second opinion consultation. See our page on second opinions for more information.

This involves a review of your previous history and records and a long conversation with you. If you take multiple medications, the doctor will consider any possible interactions between them during your review. 

What happens during a medication review?

During a medication review, a psychiatrist will revisit all the medications you are taking including the dose and when you take them. A medication review is also an opportunity to ask any questions or voice any concerns you have about your medications so that you feel comfortable with your treatment plan. 

After a medication review, your psychiatrist will explain their clinical opinion and whether adjusting your medication could improve your symptoms or reduce side effects.

How do I know if my medication is working?

The initial answer is to ask whether you (and those around you) feel that the medication improves your symptoms and mental wellbeing. However, in the area of mental health and psychiatry, it can sometimes be difficult to answer this as it can be challenging to ascertain to what extent a certain medication may be helping. This can happen if you have taken it for a long period of time, or if you are taking several medications. 

For some medications, like sleeping tablets, we know that most people feel the effects (feeling sleepy or going to sleep) only 15-30 minutes after taking one pill. However, some medications prescribed in psychiatry don’t ‘kick in’ this quickly. Some of them can take several weeks to start working. For that reason, it’s important to take a systematic approach of reviewing each medication in order to ascertain whether it is necessary to continue on it or adjust or, in some situations, stop it. 

There are some nuances to finding out why a particular medication does not work. For example, people who smoke or vape nicotine may respond to some medications differently than non-smokers and their dose may have to be adjusted.

What is a medication or a symptom log?

A medication log is simply a way to record the medication and dose that you take every day for a period of time. Sometimes it is helpful to also record things such as your mood or quality of sleep. Your specialist will explain what is the best way to do this in your particular circumstances. 

You can record your medication log in a piece of paper, in a note on your smartphone or as a spreadsheet. Sometimes your specialist may give you a specific form for you to record your medication. 

There are also specific apps and questionnaires and other forms you could use to help you keep a daily log of how you are feeling.

When should I keep a medication or symptom log?

Keeping a log of what medication you take daily and including information about some of your symptoms (such as mood or anxiety levels) helps you and your psychiatrist understand better what effects your medication has on you. 

Medication and symptom logs are particularly helpful when you have had changes in your medication, such as starting a new medication or changing the dose. 

Keeping a medication or symptom log generally takes only a couple of minutes and will give you and your psychiatrist a very useful tool to improve decision-making about your care and medication

How do I know I should stay on my medication?

Please bear in mind that the information below is not intended to be a substitute for medical advice, and you must speak to your doctor before making any changes to your medication. 

Some factors to consider when you think you would like to stop taking a particular medication are:

• How much do you and other people close to you feel that it may be helping?
• Do you have any side effects?
• How long have you taken this medication, and what dose?
• Are there any potential long-term risks of taking this medication for a long time?
• Is the medication potentially helping to prevent a relapse of my condition? (this can happen in the case of antipsychotics, mood stabilisers or other medications for depression or anxiety)

How is medication for mental health conditions different from other medications?

The type of medicines used in psychiatry is sometimes  less straightforward compared with other medical disciplines. This is because most medications act on various different receptors in the brain, and it is more difficult to predict what the effects will be.

It is relatively common for two psychiatrists to prescribe different medications to the same patient in the same situation because of the wide variety of medications available.

There are multiple medications on offer in psychiatry, developed at different points following research discoveries. For instance, tricyclic antidepressants are much older medications than SSRIs (Selective serotonin reuptake inhibitors), and although the latter are not consistently proven to be more effective, they have been shown to have fewer troubling side effects and are often a first-choice medication for this reason. Lithium is yet another example, as it is one of the oldest psychiatric medications available and is still considered one of the most effective treatment options for Bipolar disorder.

What are the different types of psychiatric medications?

Each psychiatric medication works in certain chemicals (neurotransmitters) in the brain (e.g. serotonin, dopamine). Therefore, each medication has its own possibility of benefits and side effects, and efficacy in certain conditions. For instance, SNRIs are useful in somatoform disorders, such as fibromyalgia, whereas SSRIs, such as Sertraline, can be effective for anxiety. Our doctors are highly experienced in psychopharmacology (psychiatric medications). They will be able to make informed decisions before prescribing a particular medication for you.

You may hear or read of medications being in one of the following categories:

• Antidepressants: fluoxetine, mirtazapine, bupropion
• Tricyclic antidepressants: clomipramine, amitriptyline
• Mood stabilisers: lamotrigine, Lithium, quetiapine
• Antipsychotics: risperidone, olanzapine
• Anti-anxiety: diazepam, lorazepam, pregabalin
• ADHD medication: methylphenidate, dexamfetamine

I have anxiety, why have I been prescribed an antidepressant?

‘Antidepressant’ is a historical term that has remained in use, even though it can create confusion. An antidepressant is a general term applied to psychiatric medications that may produce several beneficial effects in psychiatric disorders. For instance, the antidepressant clomipramine is often useful in obsessive-compulsive disorder (OCD) and is useful for depression. Moreover, Quetiapine is officially classified as an antipsychotic but is often used outside the realms of psychosis to greatly affect mood regulation for conditions such as borderline personality disorder, severe anxiety and low mood. Doctors often prescribe so-called ‘antidepressants’ not just to treat depression but also to treat some other problems such as anxiety or OCD. However, we keep calling these medications ‘antidepressant’ for historical reasons.

What can I expect from medication?

Unfortunately, finding the right medication for a given person is too often a case of trial and error. Our doctors are very familiar with the process of trying different medications until you find the right one for your symptoms. By working closely with one of our doctors, you will be able to safely try other medications out to find the best one for you.

Some of our psychiatrists are able to carry out a type of test called pharmacogenomic test. This test is done by using a simple saliva sample. In many cases, the results may help in understanding and predicting the response to medication by exploring the likelihood of adverse effects, efficacy and metabolism of individual medications.

Why did my medication stop working?

Some may experience partial or temporary improvement. This improvement could be for a number of reasons, the most common being:

• You are taking a dose that is too low for your condition
• You are not taking the right medication for you
• You have not been taking the medication for long enough (usually a few weeks minimum is needed to assess efficacy)
• Your condition is caused by something else that has not been investigated thoroughly, such as a hormone imbalance or a vitamin deficiency
• Your condition may respond more favourably to another form of intervention such as therapy, EMDR or rTMS

Certain medications are safe and appropriate to take long-term and are only effective if taken daily over weeks and months, such as antidepressants. Other medications are fast-acting and fast to wear off, such as diazepam. You may see these medications as being recommended on a ‘PRN’ basis, which simply means ‘take as needed.’ Your doctor will educate you about the differences between these medication types and how to use them appropriately.

Psychiatric medications are not equally effective for everyone, so it is important to keep expectations of medication realistic. We generally advise our patients to try not to rely on medication alone to treat their conditions and engage in some form of psychotherapy and other interventions and use medication.

Do I have to take medication?

Medication is a personal choice. Our ethos at the London Psychiatry Clinic is to foster a collaborative approach where you and your psychiatrist can discuss your treatment plan. Your treatment may or not include medication. We will weigh the pros and cons of using medication so you can make an informed decision.

What if I have not responded to medication in the past?

Because there are so many types of psychopharmaceutical drugs available, it’s common to try a number of different medications before finding the right one for you. It also isn’t uncommon for patients to report that they feel no improvement, or that they find the side effects outweigh any negligible improvements. This can be for a number of reasons, and there is a natural process of trial and error before finding the optimal dose and medication for you.

I don’t like my medication. Can I stop?

We advise that you shouldn't stop taking it abruptly or without medical guidance, even if you dislike your medication. Although we sympathise that the medication you are taking may not be the ideal one for you, there is a small risk of withdrawal. Withdrawal from antidepressant medication can be extremely uncomfortable and is avoidable if tapered appropriately and under the care of your doctor. If you speak to your doctor at LPC, they will be able to switch you to a better alternative medication or explain how you can safely taper.

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