Mental health: Choosing a medicine

Last updated: Monday, April 29, 2024

You may be asked to help choose the right medicine to treat a mental health condition. The diverse range of unwanted effects that psychiatric drugs can have, and their potential to interact with other medicines, means that the choice is not always straightforward. 

Their side effect profile can make treatment choice difficult in many patient groups including those with heart disease and epilepsy, and in those who are pregnant or breastfeeding. The potential drug interactions are many; common scenarios include the use of antidepressants in patients taking serotonergic agents such as the triptans or tramadol, and combining medicines that are known to prolong the QT-interval. As with any long-term treatment, patients need to be aware of the perceived benefits and risks and should be involved in the decision-making process if they are able. Refer to the Information sources for treatment recommendations in all these special populations.

Case study

Lucy is a 27-year-old woman who experienced a stillbirth 6 months ago after unexpectedly falling pregnant. She sits and weeps for long periods of time and has been unable to talk to anyone about how she feels. Although her mother is alive and well, she lives 200 miles away. She currently lives with her husband. 

Lucy has from epilepsy and currently takes lamotrigine. Investigations suggest the lamotrigine was unlikely to have caused the stillbirth. 

Her appetite is poor, she has lost 2 stones in weight and she sleeps poorly, often waking at 4am thinking how cruel the world is and how she might as well end it all. She cannot cope with her job as a nursing assistant and is not looking after her home or doing any cooking. She constantly argues with her husband who thinks that enough time has passed now and she should be able to get back to work. 

1. What do you think might be Lucy's diagnosis?
2. What aspects of this story made you think this was her diagnosis?

Lucy visits her GP and is prescribed amitriptyline 25mg at night for a month. Four days later she is admitted to an acute psychiatric ward following an attempted overdose. She has no past psychiatric history. 

3. Comment on the appropriateness of the prescription.
4. Which antidepressant would you recommend for Lucy and why?
5. What events in her life may be causing or exacerbating her condition?
6. How might you encourage adherence with a new antidepressant treatment regimen?

When you’ve considered answers to these questions, click forward to the next page to see some suggested answers.