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Before starting a psychiatric medicine: understand your prescription

Sultan AlmuhasinMedical review: Tatmeen team8 min read
عبوة دواء ونشرة مطوية تحمل رموزًا، وخلفها كرسيان وطاولة قرب نافذة.
Article contents
  1. Start with the reason for the prescription and the alternatives
  2. Agree on an improvement you can notice
  3. The medicine's group does not tell the whole story
  4. Bring the relevant information and ask for clear instructions
  5. Know when your review is and how to get in touch before it
  6. When to seek help before your appointment
  7. A card to take to your appointment
  8. Frequently Asked Questions
  9. Sources and references
  10. Writer and reviewer

Before you start a medicine, it helps to understand why it is being offered, what you can expect from it, and how its benefits and side effects will be reviewed. A simple place to start is: “Why are you suggesting this medicine for me, and what are we hoping will improve?” Its name, or someone else's experience of taking it, cannot tell you everything you need to know about your prescription.

Benefits depend on the medicine, the condition it is prescribed for, your health and your previous treatment. Talking through the options with your doctor helps you take part in the decision. Choosing the medicine and deciding how to use it require an assessment and prescription for you.

Start with the reason for the prescription and the alternatives

Your doctor considers your symptoms and their effect on daily life, the possible diagnosis, previous treatments, physical health and other medicines. The aim may be to relieve current symptoms, maintain an improvement or reduce the likelihood of further episodes5 in some conditions. Find out which of these goals applies to you.

Seeking mental health support does not always mean needing medication. For less severe depression, for example, NICE does not usually recommend antidepressants as the first treatment1 unless they are the person's informed preference. Psychological treatment, structured monitoring or a combination of medication and psychological treatment may be appropriate. Treating conditions such as mania or psychosis involves different decisions. The options should fit your condition, rather than someone else's experience.

Ask about suitable alternatives, the benefits and risks of each, and what might happen if the proposed treatment is delayed. Mention anything that could make the plan difficult to follow, such as cost, medicine availability or appointment times. These details help your doctor discuss an option that fits your life.

Agree on an improvement you can notice

“I want to feel better” makes sense, but it is a broad goal. Work with your doctor to identify a change that matters to you. Would fewer panic attacks make a difference? Are particular thoughts or experiences disrupting your day? Is concentration your main difficulty? These are goals to discuss in relation to your condition, not promised results from a medicine.

Agree when benefit can be assessed and what the next step will be if the expected improvement does not occur. People respond differently5, and a doctor may need to adjust the plan. Some side effects can appear before you notice a benefit, so find out what to monitor and when to call early. One day cannot establish whether treatment has succeeded or failed.

Tell your doctor what matters in your daily life. You might say: “I drive in the morning. Could this affect my alertness?” or “Sexual side effects matter to me. How would we deal with them if they occur?” You can ask about a possible problem before it happens.

The medicine's group does not tell the whole story

One medicine may be used for several conditions. A label such as “antidepressant” or “antipsychotic” does not establish a diagnosis on its own. These examples show how the discussion differs by medicine; they are not a list of treatments to choose from:

Example Why might it be prescribed? A question about your prescription
Sertraline Depression and conditions such as OCD or panic disorder Which symptoms are we targeting, and what alternatives are suitable?
Risperidone Conditions such as schizophrenia or manic symptoms in bipolar disorder What improvement do we expect, and how will we monitor sleepiness, movement and weight?
Lithium Mood conditions, including bipolar disorder Why have we chosen it, and what blood tests and monitoring do I need?

The NHS explains the uses of sertraline2, risperidone3 and lithium4. These examples do not cover every medicine or use, and do not mean any of them is suitable for you.

Bring the relevant information and ask for clear instructions

Write down the names of medicines, supplements and herbal products you use, including those bought without a prescription, and bring the list. Tell your doctor about allergies, previous experiences with medicines, physical conditions, pregnancy or plans for pregnancy2, and breastfeeding. Mention any past periods of unusually high activity or impulsiveness10 with less need for sleep. This information can affect treatment choice.

When describing previous treatment, explain what happened rather than only saying, “It did not suit me.” For example: “I felt sleepy at work, and I am worried that will happen again.” Give the medicine’s name and how long you took it if you remember; say which details you do not remember instead of guessing.

Before leaving, ask for written instructions about taking the medicine, missed doses, interactions, any tests needed and driving. A pharmacist can explain the leaflet and answer questions about taking it. Follow your own prescription; do not use someone else's or change yours because of an experience you have heard about. If sleepiness or dizziness affects your ability to drive, do not drive and seek advice.

Ask about changing treatment from the outset: “Could reducing or stopping this medicine cause symptoms? How would we discuss a change if I need one?” Some medicines, including antidepressants, can cause withdrawal symptoms6. Withdrawal alone does not prove addiction. Some medicines also need a discussion about dependence or addiction risks7. Agree to review changes with your doctor rather than make your own dosing plan.

Know when your review is and how to get in touch before it

Write down your first review date and how to contact the team if a problem occurs beforehand. Assessing benefit and checking safety do not necessarily happen at the same time. You may need an early review after starting treatment or changing a dose, particularly if there are concerns about self-harm.

For adult depression, NICE recommends reviewing suicide risk1 one week after starting an antidepressant or increasing its dose for people aged 18 to 25, or when there is particular concern about increased risk. This is an early safety review, not a deadline for judging full benefit or a timetable for every medicine and condition. Agree on the review appropriate to your plan, and do not wait for it if your condition worsens.

When to seek help before your appointment

If you develop unusually high activity or impulsiveness with less need for sleep10 after starting, contact your doctor urgently2; do not assume it is simply improvement.

Seek an urgent assessment for new or increasing thoughts of self-harm. If you might harm yourself now or cannot keep yourself safe, call an ambulance or go to an emergency department. Difficulty breathing, a swollen tongue or throat, a seizure, or a suspected overdose also need immediate medical help2. Do not wait to confirm the cause or for every symptom to appear. Tell the team the medicine's name and follow their instructions about it.

In Saudi Arabia, the ambulance number is 997. For health advice when you need guidance and there is no emergency, the Ministry of Health provides 937 around the clock9.

A card to take to your appointment

Copy the parts you need to your phone or a sheet of paper, leaving room for your doctor's answers. If time is limited, start with what you most want to understand:

Medicine and why it has been chosen for me: …
The improvement we will monitor and when to assess it: …
Alternatives and my priorities: …
Instructions, missed doses and tests needed: …
Side effects to call about, and emergency warning signs: …
Could reducing or stopping cause symptoms? How would we discuss a change? …
Review date and how to contact the team beforehand: …

If you already take a medicine, read about preparing to review its benefits and risks over time.

Frequently Asked Questions

What should I ask my doctor before starting a psychiatric medicine?

Start with: “Why are you suggesting this medicine for me, and what are we hoping will improve?” Then ask about suitable alternatives, the benefits and risks of each, when benefit can be assessed and what the next step will be if the expected improvement does not occur. Before leaving, ask for written instructions about taking the medicine, missed doses, interactions, any tests needed and driving.

Does seeking mental health support mean I will need medication?

Not always. For less severe depression, for example, NICE does not usually recommend antidepressants as the first treatment unless they are the person's informed preference. Psychological treatment, structured monitoring or a combination of medication and psychological treatment may be appropriate. Treating conditions such as mania or psychosis involves different decisions, and the options should fit your condition rather than someone else's experience.

How long does a psychiatric medicine take to work?

People respond differently, so agree with your doctor when benefit can be assessed and what the next step will be if the expected improvement does not occur. Some side effects can appear before you notice a benefit, so find out what to monitor and when to call early. One day cannot establish whether treatment has succeeded or failed.

Do withdrawal symptoms mean I am addicted to my medicine?

Withdrawal alone does not prove addiction. Some medicines, including antidepressants, can cause withdrawal symptoms, and some medicines also need a discussion about dependence or addiction risks. Ask from the outset: “Could reducing or stopping this medicine cause symptoms?” Then agree to review any change with your doctor rather than make your own dosing plan.

When should I get urgent help after starting a psychiatric medicine?

Seek an urgent assessment for new or increasing thoughts of self-harm. If you might harm yourself now or cannot keep yourself safe, call an ambulance on 997 or go to an emergency department. Difficulty breathing, a swollen tongue or throat, a seizure, or a suspected overdose also need immediate medical help; do not wait to confirm the cause or for every symptom to appear. Tell the team the medicine's name and follow their instructions. Contact your doctor urgently about unusually high activity or impulsiveness with less need for sleep; do not assume it is simply improvement.

Writing and article review

Sultan AlmuhasinWritten bySultan Almuhasin

Content writer and researcher at Tatmeen, working on Arabic and English articles across mental health and everyday life topics, including relationships, stress, work, habits, and family.

Tatmeen teamMedical reviewTatmeen team

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