What are the ethical aspects of prescribing?

As in any other form of treatment the individual is required to give “informed consent”. This means agreeing to accept the medication after all aspects are discussed. The basis of ethical prescribing is the psychiatrist’s comprehensive knowledge of risk and benefits of psychiatric medications which is based on adequate training and experience in evidence-based practice. Any fears or doubts about prescribed medication should be discussed with the psychiatrist unreservedly. A collaborative doctor-patient relationship is essential for necessary exchange of information and joint decision making. The therapeutic partnership between the individual and the psychiatrist gives the best framework for medication management.

When are medications used?

Psychiatrists consider the long term and short term risks and benefits, as well as alternative treatments and therapies before prescribing or changing medications. A lot of research, trialling and data gathering from practical use have gone into developing evidence based guidelines in prescribing these medications. Psychiatrists make use of these internationally accepted guidelines and personal skill and experience to decide what to prescribe. The choice of a particular medication for a particular person will depend on many factors such as the diagnosis, medication history, previous response and side effects, current life circumstances, physical condition and any other medication taken concurrently.

How are doses decided and optimised?

Based on comprehensive assessment and diagnosis, doses are decided based on clinical guidelines and experience of the Psychiatrist. Careful dose titration is essential to achieve the best balance of benefit with minimum side effects. After stabilisation of acute symptoms, the aim is to maintain the relief from distress and improve functionality and quality of life. Response to medications, side effects and interaction with other medication need to be monitored regularly. A plethora of factors affect response to treatment. In general earlier initiation of treatment by medication &/or therapy predicts better outcome and quality of life

What about side effects?

As in any other form of treatment, psychiatric medications have undesirable effects which need to be minimised. This is done by careful assessment and skilful prescribing. It is important for the individual to talk to his or her Psychiatrist about how they feel on any particular medication and if they are having side effects so this can be looked into. As psychiatric medications work on various groups of receptors in the brain and body, side effects arise due to them affecting many other receptors co-laterally apart from the beneficial ones. It is important that medications produce enough improvement in symptoms and general well being to warrant the unpleasant side effects that may occur. Each person is unique in the distribution and density of neuro-receptors in the brain and body, so the extent of side effects from medications is different for each person. Many individuals experience no side effect or minor tolerable side effects in exchange of immense benefit.

What are the types of medications in psychiatry?

Medications in psychiatry are commonly grouped under antidepressants, mood stabilisers, antipsychotics, anxiolytics, hypnotics, stimulants and cognitive enhancers, though many medications have multiple indications and use. Each class of medication predominantly works on certain set of receptors and have unique action profile and side effects. For effective treatment psychiatric medications need to be taken regularly to achieve therapeutic levels in the body, cross the blood brain barrier and effectively target areas in brain for benefit.

Why am I not benefiting from medications?

A number of factors can contribute to poor response to treatment. First of all the need for and the effectiveness of medication needs to be reviewed! Are you prescribed the right combination of medication at the right dosage for you? Taking medications everyday is a chore and requires dedication, but taking them regularly is important in maintaining adequate levels in the body. Other issues that need looking at are concurrent stressful social and interpersonal circumstances, alcohol and substance use, personality factors and physical health. Many a times there are issues from the past which still affect people and do not allow them to relax, have rewarding relationships and sometimes even to go about day to day life. There are excellent therapies to address these psychological aspects of treatment in psychiatry and can be combined with medications to provide relief from distress and improve quality of life


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