Managing the side effects of medication

If you are taking mental health medication, knowing how to manage the side effects of medicines can be very helpful.

Ciara Ni Dhubhlaing is the Chief Pharmacist here in St Patrick's Mental Health Services. Here, she shares some insights on what to expect when it comes to medication and its side effects, and how you can manage side effects if you do experience them.

Side effects of medication

A side effect of a medicine is an unintended or unwanted effect that the medicine has on you, alongside its expected and positive effects.

All medicines cause side effects. This is like anything you put into your body; if you normally have corn flakes for breakfast, but switch to porridge, you’re going to notice a change in your body. We’re looking for medicine to have a positive change but, because our bodies are complex, we’re potentially going to have some negative effects.

For many medicines used in mental health treatment, the benefits build up over time, but the side effects might be felt more immediately. This is because the side effects tend to have physical results in our body, whereas changes in our brain may take a little longer to kick in. Many side effects wear off over time, so knowing which ones do and don’t is important.

Patient information leaflets will have long lists of side effects. It is not recommended to do a general search online for these side effects or other effects of a medication, as you might get information that worries you. Instead, go to the independent Choice and Medication website, where you can not only find out the side effects, but also what you can do about them. This will give you perspective and information on what’s common, what will wear off, or what you might need to speak to your doctor or pharmacist about.

Remember that some side effects may be common, but that doesn’t mean you’ll experience them. In pharmacy, “very common” side effects means that between one in 10 and one in 100 people get them. 

If a medication has a serious side effect that you need to know about, your doctor will let you know to keep an eye out for it.

Bear in mind that you may even have no side effects at all.

Common side effects and how to manage them

Constipation

Constipation is very common. Keep an eye on your diet, making sure to include lots of fibre and fluids. Activity and exercise are really important: moving your body on the outside helps to move your body on the inside. You might be advised to take a mild laxative (a medicine that helps with bowel movements) if necessary; you can talk to your pharmacist about this.

Drowsiness

Consider the time of day you take your medication. If a medicine makes you drowsy, you might be better to take it in the evening or at night. Don’t drive when you have taken a medicine that makes you drowsy. Remember to still be careful if you are driving the day after taking a medicine in the evening, especially if you are taking a sleeping tablet: you might still have some effects the next morning.

Nausea and vomiting

Taking medicine with or just after food can help to avoid nausea and vomiting. Anti-nausea medication can also help, but it may be better to change the original medicine if you’re finding you need to take something else to reduce nausea caused by it.

Dry mouth

If you are finding your mouth is getting dry, take sips of water and suck on ice cubes. Sugar-free sweets, chewing gums and so on can help, but be careful about having too many as they can have a laxative effect. You may also benefit from a saliva replacement product, which your pharmacist or doctor can advise on.

Restlessness

Restlessness is usually managed by reducing the dose of medication and/or going more slowly with dose increases to give your body more time to become used to the medication. There are other medications which can help too.

Stiffness and tremor

There are medicines which can help to treat stiffness and tremors if these are side effects of a medication you are taking. However, it is often preferred to switch you to a medication that doesn’t cause these side effects for you if possible.

Weight gain

Following a healthy diet and increasing physical activity can be helpful to deal with weight gain, as well as for mental health. For some people who may experience weight gain as a side effect, it may not be an option to take an alternative medicine to the one that causes weight gain, but it’s always important to ask the question. There are medicines that can be taken which reduce or sometimes reverse weight gain. It’s best to start them early on if you notice weight gain, as it’s easier to keep weight off than to lose it later.

Sexual dysfunction

There can be many reasons for sexual dysfunction: it can be a hormonal or physical issue and is strongly linked to mood also. Changing the dosage of a medicine or switching to taking it at a different time of day can be helpful. It might also be possible to switch to a different medication.

Alcohol and medication

Most medication information leaflets will strongly advise you not to drink alcohol when taking them. The reason for this is because the effects are very unpredictable.

For anyone who drinks alcohol, often, there can be nights where you have a few drinks and feel fine, and other nights where you feel the effects much more strongly. It’s hard to tell how you will react to alcohol at any given time; it can depend on the mood you’re in, how much you have eaten, the environment, and many other factors. When you add mental health medication to this, it does make things more difficult and uncertain.

Remember that alcohol is a depressant that can affect mood negatively at the time and for a few days afterwards.

Be very cautious around alcohol, and keep it to a minimum. Family, friends and loved ones can help you in this. If, for example, you are at a celebration and would like to have a drink, have a plan around this; do it carefully and with people around you who know that you are taking medication and can mind you if necessary.

Driving and medication

Mental health medications act on our brains. Some may make you feel sleepy, or less alert; dizzy; less coordinated; or slower to respond. These kinds of effects may affect your ability to drive.

If you are taking sleeping tablets or medicines that cause drowsiness, be particularly careful around driving, especially the morning after taking them. While you might not feel drowsy, your reaction times are likely to be slowed.

Some medicines can cause effects with vision, particularly blurred vision. If you notice this, speak to your pharmacist or optician about eye drops, or consider with your team if a change of medication is required.

Do bear in mind that, sometimes, medicines are essential to help us drive safely. For example, a person living with bipolar disorder once gave the example that they can be more likely to take risks, such as breaking a red light or parking illegally, when they are having an episode of elated mood or a ‘high’. Taking medication which stabilises mood can help them to reduce this kind of risk-tasking behaviour. It's helpful to remember that having medicine which supports your mental health and helps you to stay well may also improve your concentration and safe driving.

Whatever medication you are taking, it is important to be aware that there are laws in place around drug driving, which changed in recent years. It is now possible for An Garda Síochána to test drivers for drug use, including prescription drugs, such as benzodiazepines, a common type of anti-anxiety medicine. Under the law, having a prescription from your doctor for these drugs does not remove your personal responsibility; be sure to think about whether you feel safe to drive or are in a good state to be behind the wheel before you drive.

Remembering to take medication

Remembering to take your medications and doing so in a planned way gives the highest chances for the medicines to work best for you. If there are unexpected or unplanned changes to your medication for any reason, it’s important to manage these too.

Try to take your medication at the same time each day; timing may matter, depending on what the drug is, so check with your pharmacist or prescriber about that.

If you find it difficult to remember to take your medicines, you might find it helpful to link it with something else you do as part of your daily routine, such as taking it at mealtimes, or when you’re going to brush your teeth in the morning. Tablet organisers, reminders on your phone, a medicines list, or prompts from family might also help.

Some medicines are available as injections every month or every few months, instead of daily tablets. These may be a better option if you find it hard to remember to take tablets regularly.

It can often happen that you might miss a dose of your medication. In this case, don’t double up on your next dose to catch up with it. Check the patient information leaflet that comes with your medicine; there is always a section in these leaflets on what to do if you miss a dose. If you are unsure, check with your pharmacist or prescriber.

Safe use and storage of medication

Taking medication while standing or sitting up and with a full glass of water can help with the drug absorption.

It’s best to shake a bottle of liquid medicine before taking it. Don’t use a teaspoon for measuring as they hold different quantities – use a proper medicine spoon or a medicine cup. Your pharmacy can provide one if you don’t have one.

Always keep medication out of the reach of children, and don’t hoard medicines or keep them piling up. For example, if you have stopped taking a medicine you have been prescribed but are finding it difficult to tell your doctor, don’t keep collecting the prescription and bringing the medicine home. It can be a risk to yourself and to other people to have a stockpile of medicines or out-of-date medication around.

Don’t put medicines in the bin or down the sink, as this can be damaging to the environment. Return them to your pharmacy, where they can be safely destroyed.

Stopping medication

It is not recommended to stop medication without support, even when you feel well. It is best to stop medication as slowly as you can and with the right help.

For some medicines, if you stop taking them suddenly or too early, the original symptoms can return, there can be withdrawal symptoms, or there can be a risk of mental health relapse.

If you want to come off medication, start by discussing it with your doctor or multidisciplinary team (MDT).

Assess the risk of stopping medication for yourself. For example, there is a questionnaire on the Choice and Medication website which can help you to explore and understand the risk of relapse if you were to stop medication. It can be a really useful tool for anyone, even if you’re not thinking about stopping medication, because it can help you to see where you might need to boost your supports to increase the likelihood of staying well.

Remember that mental health medication works with our brains’ chemicals, and that our brains are extremely complex. When making the decision to stop medication, it’s about being kind to our brains and stopping in a safe, planned way to give them time to adjust.