MMP Handy Chart October 2011 V2

Handy charts
Handy charts to help people compare the medications for mental health conditions
17. Social anxiety (Social Phobia) Please • Also available: “Ask About Your
telephone the helpline for a large print Medicines”
version of any of these charts • For additional copies, please
Contents: contact the
1. Acute Psychiatric Emergency Medicines Management & Pharmacy
2. ADHD (Attention Deficit Hyperactivity Team
Each comparison chart has 2 pages; the first page
Disorder) Tel. 01785 221141
explains the background and the second page
3. Alcohol Dependence has a summary of the important comparative • Produced by Medicines
4. Alcohol Withdrawal information. The charts can only be a summary, Management & Pharmacy, St Chads
5. Alzheimer’s Disease and have thus been designed to be used in House, Stafford, ST16 3AG
6. Anxiety (Generalised Anxiety Disorder) conjunction with In addition,
7. Bipolar depression www.choiceandmedication.org.uk or www.choiceandmedication.org.uk has
www.southstaffsandshropshealthcareft.nhs.uk/, further details about each of the
8. Bipolar mania
where more explanations, details and information conditions listed e.g.
9. Bipolar mood disorder • What is the condition?
can be found.
10. Depression • What are the symptoms?
11. Insomnia • What are the alternatives to treat it?
12. OCD (Obsessive Compulsive Disorder) • Hospital Pharmacy Departments: (including non-medication treatments)
Stafford - 01785 221326
13. Panic Disorder What are the main medications?
Tamworth - 01827 263800 ext 8327
14. Psychosis and schizophrenia Lichfield - 01543 412904 • Is there an easy way to compare the
15. PTSD (Post Traumatic Stress Disorder) Burton Upon Trent - 01283 566333 Ext 5638 main medications? (ie these charts on-
16. Seasonal Affective Disorder Shelton Pharmacy, Shrewsbury - 01743 492150 line)
• If the medication is working, for how
long will I need to keep taking it?
• If the medication is not working, how long
will it be before a change is considered?
• How many medicines should I be taking
for my symptoms?
• Are there any guidelines I can look at?
• Where can I find out more information?
Edition 2, October 2011

Acute Psychiatric Emergency
A handy chart to help you compare the medicines to help the symptoms of an acute emergency
Please note: Everyone is unique and this is only a guide! How it can be given – these are the different forms of a medicine e.g. plain tablets, meltin-
This guide is different from the others in the series as it is not designed to the-mouth tablets, syrups or liquids, injections (this is almost always into the muscles; IM),
help people choose their medication, as in an acute emergency this will not suppositories or rectal tubules.
be appropriate. We have put this together to help relatives and carers to
know what the choices are, why certain medicines might be used, the usual
doses and what might then happen. There are many other ways that Top dose in 24hrs – this is the most that should usually be given to an adult in any 24
someone can be helped in an emergency and medication should be used to hours. This is not necessarily the same as in a day, because you could get lots one evening
help, not just to be the only treatment. It might also help if you putting and then more the next morning. Some people need higher doses, some need lower
together an Advance Directive. doses. Sometimes people need more than these doses, but this should only be done
carefully. The dose should usually be lower in older and younger people.
We hope you take this guide in the way in which it is intended i.e. an honest
attempt to inform, educate and help. How long for it to start to work – this is just a guide to how soon an effect from the medicine
starts to take an effect. This is usually quicker if given by injection.
What the sections in the table mean:

Peak effect – this is the time when the effect from a dose will be at its greatest.
Medicine – these are the main medicines used to help manage an acute
psychiatric emergency, and a few others that are sometimes used. How long it lasts for – this is how long the main effect of each dose often lasts for,
• These first medicines are those that NICE (National institute for Clinical although this will be different in different people.
Excellence) in England has included in their most recent guidelines
• We have listed them as their “generic name” (the name of the actual Some of the main side effects – these are just two of the main side effects. They are
drug). We have also mentioned the trade name where possible more marked at higher doses, and most wear off after a few days.
• This is only short guide. Please see the rest of our website for more ●●● = Most people will get this side effect
details ●● = Quite a few will get this side effect
● = Only a few people will get this side effect
What it does – some medicines are more useful for psychosis, some for o = This is very rare or not known The side
agitation and mania, and some for both. Some are better just at calming effects here are:
and reducing aggression or distress.  Drowsiness – feeling sleepy, sedated or doped up
 Muscle problems – can include muscle stiffness, muscles tightening up or going
into a spasm, restlessness (akathisia) There are many other possible side effects.
How we think it might work – this is how we think the medicine works in
Please see the website for more details of each of the medicines and side effects.
the brain to help an acute emergency. There is more about this on the
www.choiceandmedication.org/south-staffs www.southstaffshealthcare.nhs.uk
website. Taking two medicines with the same way of working doesn’t help
much. However, in an emergency, using two medicines that work in
Tips on how to get the best out of medication:
different ways often works much better e.g. quicker and with less side
• Read the website to make sure you know what each medicine is for, when and how it is
effects. An antipsychotic and a benzodiazepine together often give a
taken or given
quicker and better effect, and usually means lower doses of both can be
• Although medicines can help some of the symptoms, they are not always the only answer.
used.
In emergencies medication has to be the last resort – ways of calming (de-escalation)
should be used all the time.
V04 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org)

Indemnity applies only to subscribing organisations.
A handy chart to help you compare the medicines to help the symptoms in an
acute emergency
Main medicines What it does How we think it How it can be given Top dose in 24 How long Peak effect How long it Main side effects * Comment
probably works hours before it lasts for
Drowsiness Muscle
works
problems
NICE recommended
Haloperidol Antipsychotic & Blocks dopamine Tablets, syrup 30mg 1hr 2-6hrs 20hrs Often given with a
antimanic
Injection 18mg 30mins 15-60mins 4-6hrs
● ●●● benzodiazepine
Olanzapine Antipsychotic & Blocks dopamine Tablets, melt-in- A benzodiazepine

20mg 4hrs 5-8hrs 24hrs
(Zyprexa®) antimanic and calms themouth tabs must not be given
●●● ● within an hour
Injection 20mg 15mins 15-45mins 6-8hrs
Risperidone (e.g. Antipsychotic & Blocks dopamine Tablets, melt-in- ● ●● Often given with a
16mg 1hr 1-2hr 20hrs
Risperdal®) antimanic themouth tablets, syrup benzodiazepine
Benzodiazepines
Lorazepam Sedative and Tablets 4mg (up to 10mg) 30-45mins 2hrs 4-6hrs
calming
Boosts GABA, the
●●● o
Injection IM 8mg 30-45mins 60-90mins 4hrs
brain’s natural Often given with an
Diazepam Sedative and Tablets, syrup 30mg 30mins 1hr 4-8hrs
calming chemical antipsychotic
calming
messenger Injection IM 20mg? 15mins 15-30mins 4-8hrs ●●● o
Rectal 30mg 5-10mins 15mins 4-8hrs
Other medicines (usually only used where main medicines have not worked, or as an add-on)
Aripiprazole (Abilify®) Antipsychotic & Regulates Tablets, melt-in-
30mg 1-2hrs? 3-5hrs About 24hrs
antimanic dopamine themouth tablets, syrup ● ●
Injection 30mg 1hr 1-3hrs 24hrs
Quetiapine Antipsychotic & Blocks dopamine ●●● ●
Tablets 800mg 3-4hrs XL 6hrs About 12hrs
(Seroquel XL®) antimanic and calms
Often given with a
Chlorpromazine Antipsychotic Tablets, syrup 1000mg 1-2hrs 3hrs 6-8hrs benzodiazepine
Block dopamine and Injection 200mg 1hr? 1-4hrs 6-8hrs
●●● ●●
calms
Trifluoperazine Antipsychotic Tablets, syrup (20mg) 1hr 2-4hrs 24hrs ●●● ●●
Zuclopenthixol Antipsychotic Blocks dopamine 400mg over 2 ●● ●●●
Injection 12hrs? 36hrs 2-3 days
acetate (Acuphase®) weeks
Valproate Antimanic Calms, boosts
(e.g. Depakote®) GABA Tablets, syrup 2000mg or more 2hrs 3-5hrs 12hrs ●● o Better for mania
Antimanic Calms Tablets 2000mg 6hrs 12hrs 24hrs Better for mania
Carbamazepine (e.g. Syrup or chewtabs 2000mg 1-2hrs 2-6hrs 24hrs ●● o
Tegretol®) Suppositories 1000mg 3-6hrs 6hrs 24hrs
Promethazine Sedative and Antihistamine, Tablets, syrup 25mg 15-30mins 2-3hrs 6-12hrs
calming sedates Injection 100mg ? ? ?
●●● ●
Clonazepam Tablets 20mg 1hr 1-4hrs 30hrs
Boost GABA, the ●●● o
Sedative and Injection NK NK NK NK Often given with an
brain’s natural
calming antipsychotic
Midazolam calming agent Injection or mouth spray 5mg 15-30mins 30mins 2hrs ●●● o
V04 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org) * See other page for more advice
Indemnity applies only to subscribing organisations. about these side effects.
ADHD (attention deficit hyperactivity disorder)

A handy chart to help you compare the medicines to help the symptoms of ADHD
Please note: You are unique and this is only a guide! Some of the main side effects – these are just a few of the main side effects. Many
This guide will be about right for most people, but not everyone. Some people are worse at higher doses, but most wear off after a few weeks.
may get better but some may stay the same. Some may improve quicker than ●●● = Most people will get this side effect
other people. Some may get all the side effects in the book, others none at all. ●● = Quite a few will get this side effect
What happens to you will depend on your unique brain and your genes. However, ● = Only a few people will get this side effect
this guide should help you to be able to choose between the many medicines. o = This is very rare or not known The side
There are many other ways you can be helped e.g. talking therapies, art therapy, effects here are:
help with coping with the symptoms, relaxation, and self-help.  Drowsiness – feeling sleepy or doped up
 Agitation – feeling tense, under pressure, fidgeting, anxious
No guide can be 100% unbiased, but we have tried hard to stick to the facts  Headache – can be mild
about medicines. We hope you take this guide in the way in which it is intended  Nausea – feeling sick, but not usually being sick
i.e. an honest attempt to inform, educate and help.  Muscle stiffness – can be stiffness or a slight shake or tremor There
are many other possible side effects.
Please see our website for more details of each of the medicines and side effects.
How long you could or should take it for - how long you take any medicine for will
Medicine – these are the main medicines to help treat the symptoms of ADHD, be up to you. Taking a medicine means remembering every day and may be also
and a few others that are sometimes used. getting some side effects. It also often means you get well and stay well. You will
• These medicines are in no special order need to decide what helps you best and what helps you get on with your life.
• We have listed them as their “generic name” (the name of the actual
drug). We have also mentioned the trade name where possible
• This is only short guide. Please see the rest of our website for more details How to stop it – some medicines can be stopped quickly. Others should be stopped
• Not all these medicines work as well as each other. Your clinician may be slowly. It is best to try to stop all medicines slowly – it’s kinder on your brain.
able to help you choose which one (or ones) might be best for you.
Some of these medicines might not be used in your area Tips on how to get the best out of medication:
• Read the website to make sure you know what the medicine is for, when and how to
take it and for how long to take it
Usual dose per day – this will depend on how well you do and what side effects
you get. Some people need higher, some need lower doses. It is usually best to • Try to get the best out of one medicine before trying another. Get the right dose for
start a drug slowly; it’s kinder to your brain. you, try taking it at different times, and try to cope with any side effects
• Take it regularly every day, unless it is meant to be taken only when required
(find ways to remember e.g. leave the pack by your bed, in the kitchen, next to your
How we think it might work – this is how we think the medicine works in the toothbrush, in your car if you have one, next to the TV or computer, but don’t forget to keep
brain. There is more on this on the website. Taking two medicines with the them out of the sight and reach of children)
same way of working doesn’t often help much. • Although medicines can help most people’s symptoms, they are not always the only
answer. Please see our website for ideas for self-help, and help from others
How long it takes to work – this is just a guide, as some people may get better
quicker or slower. But don’t give up too early.

A handy chart to compare the medicines to help the symptoms of ADHD
Medicine Usual dose per How we think it How long it Some of the main side effects * How long you How to stop it
day might work takes to work Drowsiness Agitation Headache Nausea Muscle could or should
(probably) stiffness take it for
Main medicines (licensed or which are proven to help)
Methylphenidate
(Ritalin®,
Up to about
40mg a day
Boosts dopamine
in areas of the
Within a few
hours or days.
o ●● ●●● ●● o Usually for several
years. Short gaps
Should be
stopped slowly
Medikinet®, (depends on your brain that May take a may help. Often over several
Concerta®, weight). Can be control few weeks for helps adults too weeks if taken for
Equasym®) up to 60100mg a concentration the full effect more than a few
day or more in months
adults
Atomoxetine
(Strattera®)
40-80mg a day in Boosts
children. Can be noradrenaline
Takes about 48
weeks to start
●●● o ● ●● o Usually for several
years. Short gaps
No problems
known
higher in adults working may help. Often
helps adults too
Dexamfetamine
(Dexadrine®)
Usually up to Boosts dopamine
20mg a day, a bit in areas of the
Within a few
hours or days.
o ●●● ●● ●● o Usually for several
years. Short gaps
Should be
stopped slowly
higher in adults brain that May take a may help. Often over several
control few weeks for helps adults too weeks if taken for
concentration the full effect more than a few
months
Other medicines (usually only used when the main medicines have not worked or as an add-on)
Risperidone up Can be regular
Antipsychotics
such as to about 4mg a
Decreases In a few days
dopamine in the for agitation
●● ● o o ●● but may also be
Should be no
problems
risperidone or day. alerting parts of useful if taken
olanzapine Olanzapine up to the brain and so when needed for
about 10mg a helps to calm the agitation
day brain
Clonidine
(Dixarit®,
50-300mcg
(0.05-0.3mg) a
Boosts the
regulation of
About 4 weeks ● o ●● ● o Sometimes for
several years.
Should be
stopped slowly
Catapres®) day, usually attention and Short gaps may over several
given 3-4 times a behaviour help. Often helps weeks if taken for
day. adults too more than a few
months
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Alcohol dependence
A handy chart to help you compare the medicines to help the symptoms of alcohol dependence
Please note: You are unique and this is only a guide! Some of the main side effects – these are just a few of the main side effects. Many are
This guide will be about right for most people, but not everyone. Some people worse at higher doses, but most wear off after a few weeks.
What happens to you will depend on your unique brain and your genes. ● = Only a few people will get this side effect
However, this guide should help you to be able to choose between the many o = This is very rare or not known The side
medicines. There are many other ways you can be helped e.g. talking therapies, effects here are:
art therapy, help with coping with the symptoms, relaxation, and self-help.  Drowsiness – feeling sleepy or doped up
 Nausea – feeling sick, but not usually being sick
No guide can be 100% unbiased, but we have tried hard to stick to the facts  Headache - where your head hurts
about medicines. We hope you take this guide in the way in which it is intended  Stomach upset and diarrhoea
i.e. an honest attempt to inform, educate and help.  Others – because these medicines are all quite different There are many
other possible side effects.
How long you could or should take it for - how long you take any medicine for will be
Medicine – these are the main medicines to help treat alcohol dependence, up to you. Taking a medicine means remembering every day and may be also getting
and a few others that are sometimes used. some side effects. It also often means you get well and stay well. You will need to
• These medicines are in no special order decide what helps you best and what helps you get on with your life.
• This is only short guide please see the rest of our website for more details How to stop it – some medicines can be stopped quickly. Others should be stopped
Usual dose per day – this will depend on how well you do and what side
• Try to get the best out of one medicine before trying another. Get the right dose for you,
effects you get. Some people need higher, some need lower doses. It is
try taking it at different times, and try to cope with any side effects
usually best to start a drug slowly; it’s kinder to your brain.
How we think it might work – this is how we think the medicine works in the (find ways to remember e.g. leave the pack by your bed, in the kitchen, next to your
brain. There is more on this on the website. Taking two medicines with the toothbrush, in your car if you have one, next to the TV or computer, but don’t forget to keep
same way of working doesn’t often help much. them out of the sight and reach of children)
• Although medicines can help most people’s symptoms, they are not always the only
How long it takes to work – this is just a guide as some people may get
better quicker or slower. But don’t give up too early.

A handy chart to help you compare the medicines to help the symptoms of alcohol dependence
Medicine Usual dose What it does How we think it How long it Some of the main side effects * How long you How to stop it
per day might work takes to work Drowsiness Headache Nausea Stomach Other side could or should
(probably) upset & effects take it for
the runs
Acamprosate 666mg Reduces Blocks the A week or O ●● o ●● Diarrhoea 1 year No problems
three reward and effect of so but builds
times a craving glutamate and over the
day boosts GABA next month
Disulfiram 200500mg “Adversive” – Blocks the A few hours ●● o ●● o Halitosis For as long as you No problems
a day makes you enzyme that Being need, probably for
ill if you drink breaks down short of at least 6 months
alcohol alcohol breath
dehydrogenase
Thiamine and 50100mg Protects the Replaces Can be O o o o About a month to No problems
other vitamins a day brain from missing vitamins fairly quick start with, can be
damage longer if needed
Other medicines (usually only where the main medicines have not worked or as an add-on)
Naltrexone 50mg Reduces Blocks reward About an O ●● ●●● ●● Poor For as long as you No problems
reward and receptors hour but sleep need, maybe 3
craving the effect Thirst months or longer
will build for Sweating
days and
weeks
Antidepressants, See other Help treat some of the reasons May take For as long as Depends on the
anxiolytics Handy people may drink too much several needed treatment
See other handy charts
Charts e.g. anxiety, social phobia, weeks or
depression longer
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(www.choiceandmedication.org) about these side effects.
Alcohol withdrawal
A handy chart to help you compare the medicines to help the symptoms of alcohol withdrawal
 Weight gain – feeling more hungry and putting on weight
No guide can be 100% unbiased, but we have tried hard to stick to the facts  Nausea – feeling sick, but not usually being sick
about medicines. We hope you take this guide in the way in which it is intended  Dry mouth etc – plus blurred vision, constipation, poor memory, difficulty passing
i.e. an honest attempt to inform, educate and help. urine (sometimes called “anticholinergic side effects”)
 Sexual problems – lack of desire, performance or pleasure There are many other
possible side effects.
Medicine – these are the main medicines to help treat the symptoms of How long you could or should take it for - how long you take any medicine for will be
alcohol withdrawal, and a few others that are sometimes used. up to you. Taking a medicine means remembering every day and may be also getting
• These medicines are in no special order some side effects. It also often means you get well and stay well. You will need to
• We have listed them as their “generic name” (the name of the actual decide what helps you best and what helps you get on with your life.
• This is only short guide. Please see the rest of our website for more details
• Not all these medicines work as well as each other. Your clinician may be How to stop it – some medicines can be stopped quickly. Others should be stopped slowly.
It is best to try to stop all medicines slowly – it’s kinder on your brain.
Some of these medicines might not be used in your area
• Read the website to make sure you know what the medicine is for, when and how to take
Usual dose per day – this will depend on how well you do and what side it and for how long to take it
effects you get. Some people need higher, some need lower doses. It is
usually best to start a drug slowly; it’s kinder to your brain.
How we think it might work – this is how we think the medicine works in the (find ways to remember e.g. leave the pack by your bed, in the kitchen, next to your toothbrush,
brain. There is more on this on the website. Taking two medicines with the in your car if you have one, next to the TV or computer, but don’t forget to keep them out of the
sight and reach of children)
same way of working doesn’t often help much.
V04 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org) Indemnity

applies only to subscribing organisations.
A handy chart to help you compare the medicines to help the symptoms
of alcohol withdrawal
Medicine Usual dose What it does How we think it How long it Some of the main side effects * How long you How to stop it
per day might work takes to work Drowsiness Weight Nausea Dry mouth Sexual could or should
(probably) gain etc problems take it for
Chlordiazepoxide Starting at Anticonvulsant, A couple of ●●● o o o ● Usually no more Gradually over a
high dose stops fits or hours than 9 days week or so
(e.g. up to seizures Boosts GABA,
Diazepam
about the brain’s
●●● o o o ● Usually no more Gradually over a
than 9 days week or so
150mg a natural calming
day) then messenger
slowly
reducing
Clomethiazole Starting at Anticonvulsant, Calms the A couple of ●●● o ● ● ● Usually no more Gradually over a
(Heminevrin®) high dose stops fits or spread of hours than 9 days week or so
then seizures stimulating
reducing messages in
brain
Thiamine (and 50-100mg Protects brain Replaces Over a few o o o o ● For as long as No problem
other vitamins) from damage missing days or weeks needed
vitamins
Pabrinex® 2 ampoules Protects the Quickly replaces Over a few o o o o o Usually 3 days No problem
a day for 3 brain from more vital vitamins week or so,
days damage can be quicker
Carbamazepine 400- Anticonvulsant, Calms the A couple of ●● ● ●●● ● ●●● Usually only a Gradually over a
1000mg stops fits or spread of hours week or so week or so
seizures stimulating
messages in
brain
V04 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org) * See other page for more advice Indemnity applies only to
subscribing organisations. about these side effects.
Alzheimer’s Disease and dementia

A handy chart to help you compare the medicines to help the symptoms of Alzheimer’s Disease
medicines. There are many other ways you can be helped e.g. art therapy, and effects here are:
help with coping with the symptoms.  Drowsiness – feeling sleepy or doped up
No guide can be 100% unbiased, but we have tried hard to stick to the facts  Headache – can be mild
about medicines. We hope you take this guide in the way in which it is intended  Muscle stiffness – can be stiffness of the legs or arms
i.e. an honest attempt to inform, educate and help.  Tremor – a slight shake, usually the hands There are many other
Medicine – these are the main medicines to help treat the symptoms of up to you. Taking a medicine means remembering every day and may be also getting
Alzheimer’s Disease, and a few others that are sometimes used. some side effects. It also often means you get well and stay well. You will need to
How to stop it – some medicines can be stopped quickly. Others should be stopped
• This is only short guide. Please see the rest of our website for more details slowly. It is best to try to stop all medicines slowly – it’s kinder on your brain.
• Not all these medicines work as well as each other. Your clinician may be
Usual dose per day – this will depend on how well you do and what side • Try to get the best out of one medicine before trying another. Get the right dose for you,
effects you get. Some people need higher, some need lower doses. It is try taking it at different times, and try to cope with any side effects
usually best to start a drug slowly; it’s kinder to your brain. • Take it regularly every day, unless it is meant to be taken only when required
toothbrush, in your car if you have one, next to the TV or computer, but don’t forget to keep
How we think it might work – this is how we think the medicine works in the them out of the sight and reach of children)
brain. There is more on this on the website. Taking two medicines with the • Although medicines can help most people’s symptoms, they are not always the only
same way of working doesn’t often help much. answer. Please see our website for ideas for self-help, and help from others

A handy chart to help you compare the medicines to help the
symptoms of Alzheimer’s Disease
Medicine Usual dose per day How we think it How long it Some of the main side effects * How long you How to stop it
might work takes to work Drowsiness Nausea Headache Muscle Tremor could or should
(probably) stiffness take it for
Donepezil 5-10mg a day
Stops the
● ●● ●●● o o
(Aricept®)
breakdown of May get some
Galantamine Up to 24mg a day
acetylcholine, the improvement, ● ●● ●●● o o Should be no
(Reminyl®, or the person
brain’s chemical problem but the
Reminyl XL®) messenger for may stop
Usually life-long person usually gets
getting worse,
Rivastigmine 6-12mg a day memory
over several
● ●● ●●● o o worse when
(Exelon®) stopped
weeks or a
Memantine Up to 20mg a day Improves the flow
month or so ●● ● ●●● o o
(Ebixa®) of messages
around the brain
Others (these can help with some symptoms of dementia e.g. being
aggressive, irritable or not sleeping)
Risperidone 0.5mg to 2mg a May cause some ●● o o ●● ●● There should be no
(licensed) day for up to 6 sedation and can
problem.
weeks reduce agitation. Within a few
Quetiapine † Up to about May cause some days. Usually ●●● o o o o
(Seroquel®, 100mg a day sedation and only used if They should be
Seroquel XL®) reduces agitation. required or stopped every
Pericyazine up to These are usually regularly at a few weeks to
Other
only used when low dose to ●● o o ●● ●● check they are
antipsychotics† about 5mg a day. There should be no
Sulpiride up to required or help with not making
regularly at low behaviour things worse problem
200mg a day.
Amisulpride up to dose to help with problems or
200mg a day behaviour agitation.
problems or
agitation.
† Quetiapine or other antipsychotics should only be used with great care
Anxiety: a handy chart to help you compare the main medicines to help the symptoms of anxiety
As anxiety and depression often occur together, you might also want to look at the Handy Chart for depression
 Feeling strange – just not feeling right
about medicines. We hope you take this guide in the way in which it is intended  Dizziness – feeling a bit unsteady There are many other possible side
i.e. an honest attempt to inform, educate and help. effects.
Medicine – these are the main medicines to help treat the symptoms of How long you could or should take it for - how long you take any medicine for will be
anxiety, and a few others that are sometimes used. up to you. Taking a medicine means remembering every day and may be also getting
• This is only short guide. Please see the rest of our website for more details How to stop it – some medicines can be stopped quickly. Others should be stopped
Usual dose per day – this will depend on how well you do and what side take it and for how long to take it
effects you get. Some people need higher, some need lower doses. It is • Try to get the best out of one medicine before trying another. Get the right dose for you,
usually best to start a drug slowly; it’s kinder to your brain. try taking it at different times, and try to cope with any side effects
A handy chart to help you compare the main medicines to help the symptoms of anxiety
Medicine Usual dose per How we think it How long it takes to Some of the main side effects * How long you How to stop it
day might work work Drowsiness Nausea Feeling Dizziness could or should
(probably) strange take it for
SSRIs e.g. escitalopram Escitalopram Boosts serotonin ● ●●● o O
(Cipralex®), 10mg a day. Takes about 3-4
Paroxetine. Other Paroxetine weeks. The symptoms Stop gradually
SSRIs may also work 20mg a day may get a bit worse over a few weeks
As long as you
Venlafaxine 75mg a day
Boosts serotonin
in the first couple of ● ●●● o O want. Taking for if taken for more
(e.g. Efexor XL®) weeks before then at least 6 months than a few months
and getting better
Duloxetine 60mg a day noradrenaline ● ●●● o O reduces the
(Cymbalta®) chances of
getting unwell
Pregabalin Around 300mg Slows down A week or so, builds ●● ● ● ●●● again
No problem, best
(Lyrica®) excitatory over 3-4 weeks stopped over a few
messages days though
Buspirone 30mg Boosts serotonin 4 weeks at full dose ● o ●●● ● No problem
(e.g. Buspar®)
Benzodiazepines Lorazepam up to Boosts the effect A few hours ●●● o ● O
(shorter-acting e.g. 4mg. of GABA, the
lorazepam, oxazepam, Oxazepam up to brain’s natural Should be done
clonazepam) 30mg inhibitory or Usually for up to
slowly if taken for
calming a month or so,
Benzodiazepines more than a few
Up to about
chemical
A few hours to a few ●●● o ● O but can be longer
months
(longer-acting e.g. 15mg days
diazepam, messenger
chlordiazepoxide)
Beta-blockers e.g. Up to 120mg a Stops the heart A few hours o o ● ● As long as you Should be done
propranolol or day maximum beating too fast feel you want or slowly if taken for
oxprenolol and reduces need to more than a few
tremor months
Unlicensed (usually only where the main treatments have failed or as an add-on)
Other SSRIs (e.g. Fluoxetine & Boosts serotonin As paroxetine/ ● ●●● o O As SSRIs above As SSRIs above
fluoxetine, citalopram, citalopram 20mg escitalopram above
sertraline) a day
Antipsychotics e.g. Pericyazine Sedative and Within a few hours ●●● o o ●● Usually when No problem
pericyazine around 5-30mg calming required
Bipolar Depression
A handy chart to help you compare the medicines to help the symptoms of bipolar depression
You might also want to look at the Handy Charts for bipolar mood disorder and bipolar mania
help with coping with the symptoms, relaxation, and self-help. Drowsiness – feeling sleepy or doped up
Weight gain – feeling more hungry and putting on weight
No guide can be 100% unbiased, but we have tried hard to stick to the facts Nausea – feeling sick, but not usually being sick
about medicines. We hope you take this guide in the way in which it is intended Postural hypotension – can be stiffness or a slight shake or tremor
i.e. an honest attempt to inform, educate and help. Sexual problems – lack of desire or pleasure There are many other
Medicine – these are the main medicines to help treat the symptoms of bipolar up to you. Taking a medicine means remembering every day and may be also getting
depression, and a few others that are sometimes used. some side effects. It also often means you get well and stay well. You will need to
slowly. It is best to try to stop all medicines slowly – it’s kinder on your brain.
• Try to get the best out of one medicine before trying another. Get the right dose for
you get. Some people need higher, some need lower doses. It is usually best to
you, try taking it at different times, and try to cope with any side effects
start a drug slowly; it’s kinder to your brain.
How long it takes to work – this is just a guide as some people may get better
V03 ©Indemnity applies only to subscribing 2011 Mistura Enterprise Ltd (www.choiceandmedication.orgorganisations. )
A handy chart to help you compare the medicines to help the symptoms of bipolar depression
day might work takes to work Drowsiness Weight Nausea Postural Sexual could or should
(probably) gain hypotension problems take it for
Quetiapine 300mg a day We don’t really Probably up to ●●● ● ● ●●● o As long as you Should be no
(Seroquel XL®) know, but it about 4 weeks want, probably problem
Can help bipolar blocks dopamine for several years
depression when it
happens
Lamotrigine 50-200mg a day We don’t really May take many ●● ● ●● o o As long as you Should be no
(e.g. Lamictal®) know weeks, and want, probably problem
Can help stop must be started for several years
bipolar depression slowly
coming back
Other medicines (usually only where main medicines have not worked or as an add-on)
Antidepressants § Fluoxetine,
May take at ● ●● ●●● o ●●●
e.g. SSRIs citalopram It is best if all
least 4 weeks Best stopped
Low chance of and Boosts serotonin antidepressants are
sending you high for the full effect slowly after a
paroxetine stopped slowly.
but you may few months
20mg a day Paroxetine should
feel a bit better when the
be stopped
Mirtazapine 30mg a day after a few ●●● ●●● o o o depression has
gradually over
(e.g. Zispin®) § Boosts serotonin gone
Lowest chance of and noradrenaline several weeks
weeks
sending you high
Lithium Around We don’t really ● ●● ● o o Often many Must be done
(e.g. Camcolit®, 4001000mg a know, but it does May take several years, two years slowly over at least
Priadel®) day, depending a lot of different months is a minimum 4 weeks, if not over
things in the brain a longer time
on your blood
level
Olanzapine Around 10mg a We don’t really

May take several ●●● ●●● ● o o As long as you
(Zyprexa®) day know, although it want, probably
months
blocks dopamine for several years Should be no
problem
Valproate Around 400-
Boosts GABA and May take several ● ● ● o o As long as you
(e.g. Depakote®, 1000mg a day want, probably
others months
Epilim®) for several years
§ Antidepressants may help “bipolar depression” in the short-term but may not be a good idea if taken for a long time. Please see our website for more help.
Bipolar Mania
A handy chart to help you compare the medicines to help bipolar mania
You might also want to look at the pages for bipolar mood disorder, acute psychiatric emergency and insomnia
There are many other ways you can be helped but medicines are usually the first effects here are:
choice. Drowsiness – feeling sleepy, sedated or doped up
Muscle stiffness – can be stiffness or a slight shake or tremor
No guide can be 100% unbiased, but we have tried hard to stick to the facts about Weight gain – feeling more hungry and putting on weight
medicines. We hope you take this guide in the way in which it is intended i.e. an Dry mouth, blurred vision – plus constipation, poor memory, difficulty passing
honest attempt to inform, educate and help. urine (sometimes called “anticholinergic side effects”) Sexual problems – lack of
desire or pleasure There are many other possible side effects.
Please see the website for more details of each of the medicines and side effects.
Medicine – these are the main medicines to help treat the symptoms of bipolar up to you. Taking a medicine means remembering every day and may be also getting
mania, and a few others that are sometimes used. some side effects. It also often means you get well and stay well. You will need to
slowly. It is best to try to stop all medicines slowly – it’s kinder on your brain.
you get. Some people need higher, some need lower doses. It is usually best to
answer. Please see the website for ideas for self-help, and help from others
A handy chart to help you compare the medicines to help bipolar mania
Medicine Some of the main side effects * How to
Usual dose How we think it How long it takes Drowsiness Muscle Weight Dry mouth, Sexual How long you stop it
per day might work to work stiffness gain blurred vision problems could or should
(probably) take it for
Valproate Up to Boosts the effect of Can be a couple of ●● O ● O O
semisodium 2000mg a GABA, the brain’s days at high dose
(e.g. day natural calming
Depakote®) chemical messenger
Risperidone 4-6mg a day ● ●● ●● ● ●●
All reduce the effect
Olanzapine Up to 20mg
of dopamine Can have a quick ●●● ● ●●● ● ●
(Zyprexa®) a day effect in a few
hours but the effect Should be
Quetiapine 600mg a day ●●● ● ●● ● ● Can be many
slowly over
(Seroquel XL®) should build over a years, as they can
few days or week help stop you a few
Aripiprazole 15-30mg a Regulates dopamine
or so ● ● ● O O
becoming ill again weeks. If
(Abilify®) day receptors
you stop
Asenapine 5-10mg Reduces the effect of ●●● ●● ● ● O any
(Sycrest®) twice a day dopamine quicker, it
might make
Carbamazepine Up to 1600 Calms the spread of Can take a few ●● O ● O O
you less
(eg Tegretol®) mg a day stimulating messages days
Lithium stable.
Can be up We don’t really Can take a week or ● ● ●● O ●
(e.g. to 1000mg known for sure as it two
Camcolit®, a day or does lots of things in
Priadel®) higher the brain
Haloperidol Up to 18mg Reduces the effect of Can have an effect ●● ●●● ●●● ●●● ●●● As above, but not
a day by dopamine in a few hours but usually used
injection or the effect should longterm
30mg by build over a few
mouth days or weeks
Benzodiazepines Lorazepam Boosts the effect of Should be quick ●●● o o o o Are usually used Slowly over
4mg a day GABA, the brain’s e.g. about an hour only for a few a week or
or higher natural calming days or until you so
messenger are stable
V04 ©2011 Mistura Enterprise Ltd * See other page for more advice
(www.choiceandmedication.org) Indemnity applies only to about these side effects.
subscribing organisations.
Bipolar Mood Disorder (manic-depression)

A handy chart to help you compare the medicines to help the symptoms of bipolar mood disorder
You might also want to look at the Handy Charts for bipolar depression and bipolar mania
This guide will be about right for most people, but not everyone. Some people may are worse at higher doses, but most wear off after a few weeks.
get better but some may stay the same. Some may improve quicker than other ●●● = Most people will get this side effect
people. Some may get all the side effects in the book, others none at all. What ●● = Quite a few will get this side effect
happens to you will depend on your unique brain and your genes. However, this ● = Only a few people will get this side effect
guide should help you to be able to choose between the many medicines. There are o = This is very rare or not known The side
many other ways you can be helped e.g. talking therapies, art therapy, help with effects here are:
coping with the symptoms, relaxation, and self-help.  Drowsiness – feeling sleepy or doped up
No guide can be 100% unbiased, but we have tried hard to stick to the facts about  Stomach upset – feeling sick, but not usually being sick There are
medicines. We hope you take this guide in the way in which it is intended i.e. an many other possible side effects.
honest attempt to inform, educate and help. Please see our website for more details of each of the medicines and side effects.
What the sections in the table mean: How long you could or should take it for - how long you take any medicine for will
be up to you. Taking a medicine means remembering every day and may be also
getting some side effects. It also often means you get well and stay well. You will
Medicine – these are the main medicines to help treat the symptoms of bipolar need to decide what helps you best and what helps you get on with your life.
mood disorder, and a few others that are sometimes used.
• These medicines are in no special order
• We have listed them as their “generic name” (the name of the actual drug). How to stop it – some medicines can be stopped quickly. Others should be stopped
We have also mentioned the trade name where possible slowly. It is best to try to stop all medicines slowly – it’s kinder on your brain.
• Not all these medicines work as well as each other. Your clinician may be able Tips on how to get the best out of medication:
to help you choose which one (or ones) might be best for you. Some of
these medicines might not be used in your area
Usual dose per day – this will depend on how well you do and what side effects • Try to get the best out of one medicine before trying another. Get the right dose for
you get. Some people need higher, some need lower doses. It is usually best to you, try taking it at different times, and try to cope with any side effects
start a drug slowly; it’s kinder to your brain. • Take it regularly every day, unless it is meant to be taken only when required
How we think it might work – this is how we think the medicine works in the them out of the sight and reach of children)
brain. There is more on this on the website. Taking two medicines with the same • Although medicines can help most people’s symptoms, they are not always the only
way of working doesn’t often help much. answer. Please see our website for ideas for self-help, and help from others

A handy chart to help you compare the medicines to help the
symptoms of bipolar mood disorder
Medicine Usual dose per How we think it How long it Some of the main side effects * How long How to stop it
day might work takes to work Drowsiness Weight Stomach Other main side you could or
(probably) gain upset effects should take it
for
Lithium Around We don’t really May take several ● ●● ●● Tremor, passing lots Often many Must be done
(e.g. Camcolit®, 4001000mg a know, but it does months for the of urine, feeling years, and at slowly over at least
Priadel®) day, depends a lot of different full effect thirsty. You will need least two 4 weeks. It is
on blood level things in the brain a blood test every 3 years better stopped over
months or so. several months
Olanzapine * 10-20mg a day We don’t really May take several ●●● ●●● o Diabetes
(Zyprexa®) know but it blocks months
[for stopping mania the effect of
coming back] dopamine Should be no
problem
Aripiprazole * 15-30mg a day Regulates May take several ● o ● Constipation,
(Abilify®) dopamine months headache, poor sleep,
[for stopping mania tremor, feeling
coming back] restless
Quetiapine 300-600mg a We don’t really May take several ●● ● ● Hypotension (feeling
Often
Should be no
for problem
(Seroquel®, day know but it blocks months dizzy when you stand
Seroquel XL®) dopamine up) many years
receptors
Lamotrigine 50-200mg a day We don’t really May take many ●● ● o Headache, feeling Should be no
(e.g. Lamictal®) know months. It also dizzy or sick, skin problem
[for stopping needs to be rashes.
bipolar depression started slowly
coming back]
Carbamazepine 400-1000mg a Calms the spread May take several ●● o ●● Blurred vision, Best stopped slowly
(e.g. Tegretol®) day of stimulating months dizziness over several weeks
messages in brain
Valproate * Around 400- Boosts the action May take several ● ●● ●● Nausea Often for Should be no
(Depakote®, 1000mg a day of GABA and months many years problem
Epilim®) others
* These medicines are only licensed to prevent mania coming back, if you got better with that medicine when you were high.
Depression
A handy chart to help you compare the medicines to help the symptoms of depression
Anxiety and depression often occur together, you might also want to look at the Handy Chart for anxiety
other people. Some may get all the side effects in the book, others none at ●● = Quite a few will get this side effect
all. What happens to you will depend on your unique brain and your genes. ● = Only a few people will get this side effect
medicines. There are many other ways you can be helped e.g. talking effects here are:
therapies, art therapy, help with coping with the symptoms, relaxation, and  Drowsiness – feeling sleepy or doped up
self-help.  Weight gain – feeling more hungry and putting on weight
No guide can be 100% unbiased, but we have tried hard to stick to the facts  Dry mouth etc – plus blurred vision, constipation, poor memory, difficulty passing
about medicines. We hope you take this guide in the way in which it is urine (sometimes called “anticholinergic side effects”)
intended i.e. an honest attempt to inform, educate and help.  Sexual problems – lack of desire or pleasure
 Sleep problems – sleep not being as refreshing as usual There are many other
Medicine – these are the main medicines to help treat the symptoms of
How long you could or should take it for - how long you take any medicine for will be up
depression, and a few others that are sometimes used.
to you. Taking a medicine means remembering every day and may be also getting some
• These medicines are in no special order side effects. It also often means you get well and stay well. You will need to decide what
• We have listed them as their “generic name” (the name of the actual helps you best and what helps you get on with your life.
drug). We have also mentioned the trade name where possible How to stop it – some medicines can be stopped quickly. Others should be stopped slowly.
• This is only short guide. Please see the rest of our website for more It is best to try to stop all medicines slowly – it’s kinder on your brain.
details
• Not all these medicines work as well as each other. Your clinician may
be able to help you choose which one (or ones) might be best for you.
• Read the website to make sure you know what the medicine is for, when and how to take it
and for how long to take it
Usual dose per day – this will depend on how well you do and what side try taking it at different times, and try to cope with any side effects
effects you get. Some people need higher, some need lower doses. It is • Take it regularly every day, unless it is meant to be taken only when required
usually best to start a drug slowly; it’s kinder to your brain. (find ways to remember e.g. leave the pack by your bed, in the kitchen, next to your toothbrush, in
your car if you have one, next to the TV or computer, but don’t forget to keep them out of the sight
and reach of children)
How we think it might work – this is how we think the medicine works in • Although medicines can help most people’s symptoms, they are not always the only answer.
the brain. There is more on this on the website. Taking two medicines with Please see our website for ideas for self-help, and help from others
the same way of working doesn’t often help much.
A handy chart to help you compare the medicines to help the symptoms of depression
Medicine Usual dose per day How we think it How long it Some of the main side effects * How long you How to stop it
might work takes to Drowsi Weight Nausea Dry Sexual Sleep could or should
(probably) work -ness gain mouth problems problems take it for
Citalopram,
SSRIs : citalopram,
paroxetine and
● ● ●●● ● ●●● ● Taking an Stop paroxetine
escitalopram antidepressant slowly over
fluoxetine 20mg a for 6 months several weeks.
(Cipralex®), fluvox-
day. Boost serotonin
amine, paroxetine, after a first bout No big problems
Sertraline 50-100mg
sertraline, fluoxetine a day. Escitalopram of depression with the others
10mg a day. will really
reduce the
Venlafaxine 75-225mg each ● ● ●●● ●● ●●● ●●● chances of
Stop slowly over
(e.g. Efexor XL®) morning at least 4 weeks
They take becoming
Mirtazapine 30mg at bedtime
about 4 ●●● ●●● O O O ● depressed Should be no
(e.g. Zispin®) (15mg is too low) again. For a problems
weeks for
Tricyclics e.g. dosulepin, Usually 125150mg Boost the amount the full
●●● ●● ●● ●●● ●● ●●● second
lofepramine, a day. of serotonin and episode, 1-2
clomipramine,
effect. But
Lofepramine 140- nor-adrenaline years seems
imipramine, you should Stop slowly over
amitriptyline, 280mg a day start to feel best.
about 4 weeks
trimipramine a bit better
Duloxetine 60-120mg each after a week ● ● ●●● ●● ●●● ●●● For a third
(Cymbalta®) morning or two. episode or more
Agomelatine 25-50mg at Regulates O O O O O O of depression, No known
(Valdoxan®) bedtime melatonin, taking an problems
boosts antidepressant
noradrenaline for at least 3-5
and dopamine
years reduces
Trazodone 100-300mg at Boosts serotonin
●●● ● ●● O ● O the chance of Stop slowly over
bedtime relapse. You about 4 weeks
Reboxetine 8-12mg each Boosts O O O ●●● O ● might want to Should be no
(Edronax®) morning noradrenaline think about problems
MAOIs e.g. Tranylcypromine
and isocarboxazid
● ●●● ●● ●● ● ●●● taking an Stop slowly over
tranylcypromine, antidepressant about 4 weeks
Stop the
phenelzine, 30mg a day. life-long.
breakdown of
isocarboxazid (needs Phenelzine serotonin and
special diet) 4590mg a day. nor-adrenaline
Moclobemide 300-600mg a day ● ● ●● ●● ● ●●
Tryptophan 3-6g a day Increases O O O O O O Should be no
(Optimax®)only for serotonin problems
resistant depression production
Insomnia: a handy chart to help you compare the medicines to help insomnia
medicines. There are many other ways you can be helped e.g. relaxation, sleep effects here are:
hygiene and self-help.  Hangover – feeling sleepy the next morning
 Stomach upset – feeling a bit sick There are many other
No guide can be 100% unbiased, but we have tried hard to stick to the facts possible side effects.
about medicines. We hope you take this guide in the way in which it is intended Please see our website for more details of each of the medicines and side effects.
i.e. an honest attempt to inform, educate and help.
What the sections in the table mean: up to you. Taking a medicine means remembering every day and may be also getting
some side effects. It also often means you get well and stay well. You will need to
decide what helps you best and what helps you get on with your life.
Medicine – these are the main medicines to help treat the symptoms of
insomnia, and a few others that are sometimes used.
• These medicines are in no special order How to stop it – some medicines can be stopped quickly. Others should be stopped
• We have listed them as their “generic name” (the name of the actual slowly. It is best to try to stop all medicines slowly – it’s kinder on your brain.
• This is only short guide. Please see the rest of our website for more details Tips on how to get the best out of medication:
• Not all these medicines work as well as each other. Your clinician may be • Read the website to make sure you know what the medicine is for, when and how to
able to help you choose which one (or ones) might be best for you. take it and for how long to take it
Some of these medicines might not be used in your area • Try to get the best out of one medicine before trying another. Get the right dose for you,
Usual dose per day – this will depend on how well you do and what side
effects you get. Some people need higher, some need lower doses. It is toothbrush, in your car if you have one, next to the TV or computer, but don’t forget to keep
usually best to start a drug slowly; it’s kinder to your brain. them out of the sight and reach of children)
How we think it might work – this is how we think the medicine works in the answer. Please see our website for ideas for self-help, and help from others
brain. There is more on this on the website. Taking two medicines with the

A handy chart to help you compare the medicines to help insomnia (poor sleep)
Medicine Usual dose at How we think it How long it takes Duration of effect Some main side effects * How long you How to stop it
night might work to work Hangover Stomach could or should
(probably) upset take it for
Zopiclone 7.5mg About an hour or Lasts about 4-8 hours ● O
(e.g. Zimovane®) so
Zolpidem 5mg About 1520mins Lasts about 2 hours O O
(e.g. Stilnoct®)
Boost the effect
Zaleplon (e.g. Sonata®) 10mg
of GABA, the
15-20mins Lasts about 2-4 hours O O
These medicines
brain’s natural
Benzodiazepines, Loprazolam 1-2mg
Lormetazepam
About an hour or
calming chemical so
Lasts about 4-6 hours, ● O can sometimes A low dose for a few
shorter-acting but may be longer in tend to lose their days may help, as you
(e.g. loprazolam, temaz- 0.5-1.5mg messenger older people
pam, lormetazepam) Temazepam10mg
effect in some can get “rebound
people over a few insomnia” (ie sleep
Benzodiazepines, Nitrazepam 5mg About an hour or Lasts about 6-8 hours, ●●● O months. So, it is gets worse for a few
longer-acting so but may be longer in best not to take days) if you stop
(e.g. nitrazepam) older people them every night suddenly
Promethazine 10-25mg Antihistamine and About an hour Lasts about 4-8 hours ●● O for a long time.
(e.g. Phenergan®) sedative
Chloral hydrate and Chloral hydrate Sedative About an hour Lasts about 4-8 hours ●● ●●●
cloral betaine up to 1g
Clomethiazole 192mg (resistant
insomnia only)
Sedative About an hour Lasts about 4-8 hours ●● ●
(Heminevrin®)
Melatonin 2mg at night in Boosts melatonin, About an hour Lasts for a few hours ● O 3-13 weeks can There should be no
(Circadin PR®) people aged 55 the brain’s help get a sleep problems at the end
or over, for up to natural sleep pattern back to of the course
13 weeks regulator normal
Sedative Mirtazapine ● O These may lose A lower dose for a
antidepressants (e.g. 1530mg Antihistamine and some of their few days may help, as
mirtazapine, sedative effect over several you can get “rebound
trazodone)
Trazodone ● ● months. Best not insomnia”
50150mg
Antipsychotics or Promethazine 10- Antihistamine and About an hour Lasts about 4-8 hours ● O to take them (i.e. sleep gets worse
antihistamines at low 25mg sedative every night for a for a few days) if you
dose long time. stop suddenly
OCD (obsessive-compulsive disorder)

A handy chart to help you compare the medicines to help the symptoms of OCD
about medicines. We hope you take this guide in the way in which it is intended  Dry mouth etc – plus blurred vision, constipation, poor memory, difficulty passing
i.e. an honest attempt to inform, educate and help. urine (sometimes called “anticholinergic side effects”)
Medicine – these are the main medicines to help treat the symptoms of OCD,
and a few others that are sometimes used.
up to you. Taking a medicine means remembering every day and may be also getting
• Not all these medicines work as well as each other. Your clinician may be How to stop it – some medicines can be stopped quickly. Others should be stopped slowly.
able to help you choose which one (or ones) might be best for you. It is best to try to stop all medicines slowly – it’s kinder on your brain.
Usual dose per day – this will depend on how well you do and what side • Read the website to make sure you know what the medicine is for, when and how to take
effects you get. Some people need higher, some need lower doses. It is it and for how long to take it
usually best to start a drug slowly; it’s kinder to your brain. • Try to get the best out of one medicine before trying another. Get the right dose for you,
How we think it might work – this is how we think the medicine works in the (find ways to remember e.g. leave the pack by your bed, in the kitchen, next to your toothbrush,
brain. There is more on this on the website. Taking two medicines with the in your car if you have one, next to the TV or computer, but don’t forget to keep them out of the
same way of working doesn’t often help much. sight and reach of children)

A handy chart to help you compare the medicines to help the symptoms of obsessive-compulsive disorder
Medicine Usual dose per How we think How long it takes Some of the main side effects * How long you could How to stop it
day it might work to work Drowsiness Weight Nausea Dry mouth Sexual or should take it for
(probably) gain etc problems
SSRIs e.g. Citalopram, Boost ● ● ●●● ● ●●● These should best be
citalopram, fluoxetine and serotonin stopped slowly over at
escitalopram, paroxetine least 4 weeks,
fluvoxamine, 2060mg a If the medicine has especially with higher
Takes about 10-
paroxetine, day. helped, it seems that doses. Paroxetine
12 weeks
sertraline, Sertraline if you keep taking it should be stopped
for full effect.
fluoxetine 50200mg a day. for at least 1-2 years gradually over at least
Some symptoms
Escitalopram it will reduce the 4 weeks or more
may begin to
10-20mg a day. chances of the
improve after a
symptoms coming
Tricyclics e.g. May need higher Boosts few weeks
●●● ●● ●● ●●● ●● back Should be slowly over
clomipramine doses e.g. 150- serotonin at least 4 weeks
(other tricyclics 300mg a day
do not work)
Venlafaxine Usually Boosts the Takes about 10- ● ● ●●● ●● ●●● If the medicine has Should be slowly over
(e.g. Efexor 75225mg a day amount of 12 weeks helped, it seems that at least 4 weeks,
XL®) or possibly serotonin and for full effect. keeping taking it for possibly longer
higher noradrenaline Some symptoms at least 1-2 years
may begin to will reduce
improve after a the chances of the
few weeks symptoms coming
back
Antipsychotics Risperidone up Partly Within a few ●● ● o ● ●● Often for a few
Should be no problems
e.g. risperidone to about 14mg sedation and days, but takes a but over a few weeks is
months just to help
used with SSRIs a day bit longer for the a good idea
Antipsychotics Olanzapine up partly calming full effect to kick ●●● ●●● o ● o the worst symptoms,
e.g. olanzapine to about 10mg used the mind in but can be longer.
with SSRIs a day
Panic Disorder
A handy chart to help you compare the medicines to help the symptoms of panic disorder
No guide can be 100% unbiased, but we have tried hard to stick to the facts about  Nausea – feeling sick, but not usually being sick
medicines. We hope you take this guide in the way in which it is intended i.e. an  Dry mouth, blurred vision – plus constipation, poor memory, difficulty passing
honest attempt to inform, educate and help. urine (sometimes called “anticholinergic side effects”)
 Sexual problems – lack of desire, performance or pleasure There are many
Medicine – these are the main medicines to help treat the symptoms of panic be up to you. Taking a medicine means remembering every day and may be also
disorder, and a few others that are sometimes used. getting some side effects. It also often means you get well and stay well. You will
• Not all these medicines work as well as each other. Your clinician may be Tips on how to get the best out of medication:
able to help you choose which one (or ones) might be best for you. Some • Read the website to make sure you know what the medicine is for, when and how to
of these medicines might not be used in your area take it and for how long to take it
you get. Some people need higher, some need lower doses. It is usually best to • Take it regularly every day, unless it is meant to be taken only when required
them out of the sight and reach of children)
How we think it might work – this is how we think the medicine works in the • Although medicines can help most people’s symptoms, they are not always the only
brain. There is more on this on the website. Taking two medicines with the answer. Please see our website for ideas for self-help, and help from others

A handy chart to help you compare the medicines to help the symptoms of panic disorder
Medicine Usual dose per How we think it How long it Some of the main side effects * How long you could How to stop it
day might work takes to work Drowsiness Weight Nausea Dry mouth, Sexual or should take it for
(probably) gain blurred vision problems

SSRIs e.g. Paroxetine 20mg Boost ● ● ●●● ● ●●● Stop paroxetine slowly
citalopram, a day. serotonin over several weeks.
escitalopram, Sertraline Usually no problems
paroxetine 50100mg a day. If the medicine has with others
Take about 812
Escitalopram helped, it seems that
weeks for the
10mg a day keeping taking it for
full effect but
6-12 months at least
Tricyclics Usually Boost you may start ●●● ●● ●● ●●● ●● Should be slowly over
will reduce the
e.g. amitriptyline, 125150mg a serotonin and to feel about 4 weeks
clomipramine, day chances of the
noradrenaline better after a
dosulepin, symptoms coming
Lofepramine few weeks
doxepin, back
140-210mg a
imipramine,
day
lofepramine,
trimipramine
Benzodiazepines Clonazepam 0.5- Boost GABA, Should get ●●● o o o o Usually only for a few Should be slowly over
e.g. 2mg a day. the brain’s some effect in weeks or months, or a few weeks
clonazepam, Diazepam natural calming a few days longer if only taken
diazepam, 210mg a day. messenger “if needed”
lorazepam Lorazepam 14mg
a day.
Other medicines (usually only where main medicines have not worked or as an add-on)
Beta-blockers Up to 120mg a Stops the Should get o o o o o Often just used as Should be stopped
e.g. propranolol day heart beating some effect in an “if needed” slowly if taken for more
or oxprenolol too fast and a few hours medicine than a few months
reduces tremor
V03 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org) * See other page for more advice Indemnity applies only to
subscribing organisations. about these side effects.
Psychosis
A handy chart to help you compare the medicines to help the symptoms of psychosis and schizophrenia
There are many other ways you can be helped e.g. talking and family therapies, effects here are:
art therapy, help with coping with the symptoms, relaxation, and self-help.  Drowsiness – feeling sleep, sedated or doped up
 Muscle stiffness – can be stiffness or a slight shake or tremor
No guide can be 100% unbiased, but we have tried hard to stick to the facts about  Weight gain – feeling more hungry and putting on weight
medicines. We hope you take this guide in the way in which it is intended i.e. an  Dry mouth etc – plus blurred vision, constipation, poor memory, difficulty
honest attempt to inform, educate and help. passing urine (sometimes called “anticholinergic side effects”)
 Sexual problems – lack of desire, performance or pleasure There are many
Medicine – these are the main medicines to help treat the symptoms of be up to you. Taking a medicine means remembering every day and may be also getting
psychosis and schizophrenia, and a few others that are sometimes used. some side effects. It also often means you get well and stay well. You will need to decide
• These medicines are in no special order what helps you best and what helps you get on with your life.

A handy chart to help you compare
the medicines to help the symptoms of psychosis
Medicine Usual dose per How we think How long it Some of the main side effects * How long you could How to stop it
day it might work takes to work Drowsiness Muscle Weight Dry mouth Sexual or should take it for
(probably) stiffness gain etc problems
Newer ones (atypicals, second generation)
Risperidone 4-6mg a day Mainly blocks ● ●● ●● ● ●●
(e.g. dopamine
Usually there If taking one of
Risperdal®) receptors may be an effect these medicines for
Paliperidone 6mg a day in a few days, ● ●● ●● ● ●● a first episode of
(Invega®) with the effect psychosis or possible
building over 3-4 schizophrenia,
Olanzapine 10-20mg a Blocks ●●● ● ●●● ● ● taking it for at least
(Zyprexa®) day dopamine weeks
and other 2 years will reduce
Quetiapine Around
receptors
●●● ● ●● ● ● the chances of the Should be no
(Seroquel XL®) 600mg a day symptoms coming problem but we
Aripiprazole 10-30mg a Regulates As above but ● ● O O O back. suggest that
(Abilify®) day dopamine you might get a stopping it gently
bit more If taking it for over several
agitated before schizophrenia that weeks or months
getting better keeps coming back, is the safest way
then taking it for at
Clozapine Usually Blocks a wide Usually there ●●● ● ●●● ●●● ● least 5 years will much
(Clozaril®, around 300- range of may be an effect
Denzapine®, 600mg a day receptors in a few days, reduce the
chances of the
Zaponex®) with the effect
symptoms come
- only for building over 3-4
back.
resistant weeks. Can be
schizophrenia up to 6 months
If for symptoms of
for clozapine
psychosis, then it
Other antipsychotics may only be needed
for a few weeks or
Haloperidol 5-20mg a day ● ●●● ●● ● ●●● months
Should be no
problem but
Amisulpride 400-800mg/d ● ●● ●● ● ●●● stopping it gently
Sulpiride 400- Block Usually there ● ●● ●● ● ●●● over several
1600mg/d dopamine may be an effect weeks or months
receptors in a few days, is the safest way
Zuclopenthixol 10-25mg a
with the effect
●● ●● ●●● ●● ●●●
day
building over 3-4
weeks
* See other page for more advice
V04 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org) about these side effects.
Medicine Usual dose How we How long it Some of the main side effects * How long you How to stop it
think it might takes to work Drowsiness Muscle Weight Dry mouth Sexual could or should
work stiffness gain etc problems take it for
(probably)
Phenothiazines
Chlorpromazine 75-300mg/d Blocks ●●● ●● ●● ●● ●●● Should be no great
dopamine problem but we
Levomepromazine 100-200mg/d receptors, Usually have an ●●● ●● ●●● ●● ●● suggest that
some effect in a few stopping it gently
Pericyazine 75-300mg/d
serotonin and days, with the ●●● ● ●●● ●●● ●● over several weeks
many other effect building or months is the
Perphenazine 12-24mg a day
receptors over 3-4 weeks ●● ●●● ●● ● ●●● safest way
If taking one of
Trifluoperazine 5-15mg a day ● ●●● ●● ● ●●● these medicines
Depot and longer-acting injections for a first episode
of psychosis or
Risperidone
(Risperdal Consta®)
25-50mg every
two weeks
Mainly blocks
dopamine
At least 4
weeks before
● ●● ●● ● ●● possible Risperidone
carries on being
schizophrenia,
receptors any effect, but taking it for at released for
will then build least 2 years will another 5-7 weeks
over several reduce the after the last
weeks chances of the injection
Paliperidone symptoms coming
50-150mg once Mainly blocks
palmitate (Xeplion®, a month
● ●● ●● ● ●● back.
dopamine
receptors If taking it for
Invega Sustenna )®
schizophrenia that
Olanzapine pamoate 210-405mg ●●● ● ●●● ● ● keeps coming
(Zypadhera®) every two or back, then taking it
four weeks Because the
for at least 5 years medicine is
Block will much reduce
Zuclopenthixol 200-500mg
dopamine and ●● ●● ●●● ●● ●●● the chances of the
released from a
decanoate (e.g. every two “depot” over
many other symptoms come
Clopixol®) weeks Usually takes a several weeks,
receptors back.
Flupentixol 20-200mg week or so
before it begins
● ●● ●● ●● ●●● If for symptoms of
stopping is not a
problem as the
decanoate (e.g. every two
psychosis, then it
Depixol®) weeks to work medication slowly
may only be
reduces. The main
Haloperidol
decanoate (e.g.
50-200mg a
four weeks
Blocks
dopamine
● ●●● ●● ● ●●● needed for a few
problem is
weeks or months
Haldol Decanoate®) receptors symptoms coming
back.
Fluphenazine
decanoate (e.g.
25-100mg
every two
Block
dopamine,
● ●●● ●● ●● ●●●
Modecate®) weeks serotonin and www.choiceandmedication.org/south-staffs www.southstaffshealthcare.nhs.uk
many other
Pipothiazine 25-50mg every
receptors ● ●● ●● ●● ●●●
palmitate (Piportil®) two weeks
* See other page for more advice
V04 ©2011 Mistura Enterprise Ltd about these side effects.
(www.choiceandmedication.org) Indemnity applies only to
PTSD (post-traumatic stress disorder)

A handy chart to help you compare the medicines to help the symptoms of PTSD
medicines. We hope you take this guide in the way in which it is intended i.e. an  Dry mouth etc – plus blurred vision, constipation, poor memory, difficulty passing
What the sections in the table mean: possible side effects.
Medicine – these are the main medicines to help treat the symptoms of PTSD, up to you. Taking a medicine means remembering every day and may be also getting
and a few others that are sometimes used. some side effects. It also often means you get well and stay well. You will need to
able to help you choose which one (or ones) might be best for you. Some • Read the website to make sure you know what the medicine is for, when and how to take
of these medicines might not be used in your area it and for how long to take it
Usual dose per day – this will depend on how well you do and what side effects try taking it at different times, and try to cope with any side effects
start a drug slowly; it’s kinder to your brain. (find ways to remember e.g. leave the pack by your bed, in the kitchen, next to your toothbrush,
in your car if you have one, next to the TV or computer, but don’t forget to keep them out of the
sight and reach of children)

A handy chart to help you compare the medicines to help the symptoms of post-traumatic stress disorder (PTSD)
Medicine Usual dose per How we think it How long it Some of the main side effects * How long you could or How to stop it
day might work takes to work Drowsiness Weight Nausea Dry mouth Sexual should take it for
(probably) gain etc problems
SSRIs; paroxetine, Paroxetine 40- Boost serotonin Takes about 12 ● ● ●●● ● ●●● May need to be for a Should be slowly
and sertraline 50mg a day. weeks for long time e.g. 1-2 over several
(although Sertraline full effect years at least, as weeks,
sertraline is only around there is a high chance preferably longer
licensed for 150mg a day of the
women) symptoms coming
back if you stop
Other SSRIs e.g. Citalopram Boost serotonin ● ● ●●● ● ●●● Should be slowly
citalopram, and over several
escitalopram, fluoxetine 20- weeks, better if
fluoxetine 60mg a day. even slower
May need to be for a
Escitalopram
Takes about 12 long time e.g. 1-2
10-20mg a
weeks for years at least as
day.
full effect there is a high chance
of the
Venlafaxine 150-225mg a Boosts serotonin ● ● ●●● ●● ●●● symptoms coming Should be slowly
(e.g. Efexor day and back if you stop over at least 4
XL®) noradrenaline weeks, possibly
longer
Antipsychotics Risperidone Partly sedation ●● ● o ● ●●
e.g. risperidone 1-4mg a day and partly Takes a few Often for a few Should be no
used with SSRIs calming the mind weeks to help months just to help problems but
if used with the some of the the worst symptoms, over a few weeks
Antipsychotics Olanzapine ●●● ●●● o ● o
e.g. olanzapine about 10mg a SSRIs or symptoms but can be longer is a good idea
used with SSRIs day venlafaxine.
SAD (Seasonal Affective Disorder)
A handy chart to help you compare the medicines to help the depressive symptoms of SAD
medicines. We hope you take this guide in the way in which it is intended i.e. an  Dry mouth, blurred vision – plus constipation, poor memory, difficulty passing
 Sexual problems – lack of desire or pleasure There are many other possible
side effects.
Medicine – these are the main medicines to help treat the symptoms of be up to you. Taking a medicine means remembering every day and may be also
Seasonal Affective Disorder, and a few others that are sometimes used. getting some side effects. It also often means you get well and stay well. You will

A handy chart to help you compare the medicines to help the depressive symptoms of seasonal affective disorder
day might work takes to work Drowsiness Weight Nausea Dry mouth, Sexual could or should
(probably) gain blurred vision problems take it for
Unlicensed (there are no licensed treatments in the UK or RoI)
Sertraline, 50-200mg a Boosts ● ● ●●● ● ●●● Should be no

an SSRI day serotonin great problem but
slowly over a week
Although other Takes about 4 or so is a good
SSRIs can be idea
weeks for full Can be for
used, the best
evidence is for effect but you shorter courses
sertraline may feel better e.g. 3 months
after a few but may be
weeks. Can be better to take for
Other SSRIs e.g. Citalopram, Boosts ● ● ●●● ● ●●● Stop paroxetine
started for about 4-6
citalopram, paroxetine serotonin slowly over several
winter months
escitalopram and fluoxetine weeks. No
depression in
(Cipralex®), 20mg a day. problems with
autumn before
paroxetine, Escitalopram others
your mood
fluoxetine 10mg a day
drops
Bupropion 150-300mg a Boosts o o ● ● o Should be no

(Zyban®) day dopamine great problem but
- licensed in slowly over a week
USA or so is a good
idea
Social Anxiety or Social Phobia

A handy chart to help you compare the medicine treatments to help the symptoms of social anxiety
You might also want to look at the Handy Chart for anxiety
Please note: You are unique and this is only a guide!
This guide will be about right for most people, but not everyone. Some people
may get better but some may stay the same. Some may improve quicker than Some of the main side effects – these are just a few of the main side effects. Many are
other people. Some may get all the side effects in the book, others none at all. worse at higher doses, but most wear off after a few weeks.
What happens to you will depend on your unique brain and your genes. ●●● = Most people will get this side effect
However, this guide should help you to be able to choose between the many ●● = Quite a few will get this side effect
medicines. There are many other ways you can be helped e.g. talking therapies, ● = Only a few people will get this side effect
art therapy, help with coping with the symptoms, relaxation, and self-help. o = This is very rare or not known The side
effects here are:
 Drowsiness – feeling sleepy or doped up
No guide can be 100% unbiased, but we have tried hard to stick to the facts  Weight gain – feeling more hungry and putting on weight
about medicines. We hope you take this guide in the way in which it is intended
i.e. an honest attempt to inform, educate and help.
 Dry mouth, blurred vision – plus constipation, poor memory, difficulty passing
urine (sometimes called “anticholinergic side effects”)
What the sections in the table mean:  Sexual problems – lack of desire, performance or pleasure There are many
Medicine – these are the main medicines to help treat the symptoms of social
phobia, and a few others that are sometimes used.
• These medicines are in no special order How long you could or should take it for - how long you take any medicine for will be
• We have listed them as their “generic name” (the name of the actual up to you. Taking a medicine means remembering every day and may be also getting
drug). We have also mentioned the trade name where possible some side effects. It also often means you get well and stay well. You will need to
• This is only short guide. Please see the rest of our website for more details decide what helps you best and what helps you get on with your life.
able to help you choose which one (or ones) might be best for you. How to stop it – some medicines can be stopped quickly. Others should be stopped
Some of these medicines might not be used in your area slowly. It is best to try to stop all medicines slowly – it’s kinder on your brain.
Usual dose per day – this will depend on how well you do and what side Tips on how to get the best out of medication:
effects you get. Some people need higher, some need lower doses. It is • Read the website to make sure you know what the medicine is for, when and how to
usually best to start a drug slowly; it’s kinder to your brain. take it and for how long to take it
How we think it might work – this is how we think the medicine works in the try taking it at different times, and try to cope with any side effects
brain. There is more on this on the website. Taking two medicines with the • Take it regularly every day, unless it is meant to be taken only when required
same way of working doesn’t often help much. (find ways to remember e.g. leave the pack by your bed, in the kitchen, next to your toothbrush, in your car
if you have one, next to the TV or computer, but don’t forget to keep them out of the sight and reach of
children)
How long it takes to work – this is just a guide as some people may get • Although medicines can help most people’s symptoms, they are not always the only
better quicker or slower. But don’t give up too early. answer. Please see our website for ideas for self-help, and help from others
A handy chart to help you compare the medicines to help the symptoms of social anxiety
You might also want to look at the Handy Chart for anxiety
day might work takes to work Drows- Weight Nausea Dry mouth, Sexual could or should
(probably) iness gain blurred vision problems take it for
Escitalopram 10mg a day ● ● ●●● ● ●●● Should be no great
(Cipralex®) problem but slowly
- other SSRIs may Takes at least over a week or so is
be effective, but 12 weeks for May need to take a good idea
unlicensed Boosts full effect but for at least six
serotonin may begin to
Paroxetine 20mg a day
feel better after
● ● ●●● ● ●●● months or more Should be stopped
(e.g. Seroxat®) or the symptoms slowly over several
- other SSRIs may be a few weeks may come back. weeks
effective, but are
not licensed
Other medicines (usually only where the main medicines have not worked or as an addon)
Venlafaxine (e.g. 75-150mg a Boosts ● ● ●●● ●● ●●● Should be stopped

Efexor XL®) day serotonin and Takes up to 12 May need to take slowly over several
noradrenaline weeks for full for at least six weeks
Fluoxetine & effect but you months or
Other SSRIs e.g. Boosts
may begin to
● ● ●●● ● ●●● more or the
Should be no great
fluoxetine, citalopram serotonin problem but slowly
citalopram and 20mg a day. feel better after symptoms may over a week or two
sertraline Sertraline a few weeks come back. is a good idea
50mg a day
Benzodiazepines Lorazepam up Boosts GABA, Quick, can be a ●●● o o O o Best just used If taken regularly
to 4mg a day the brain’s few hours or for short-term every day should
natural calming less help when probably be stopped
messenger needed, rather slowly over a couple
than regularly of weeks
Beta-blockers e.g. Up to 120mg a Slows the Should get o o o o o Often just used Should be stopped
propranolol or day, usually heart, reduces some effect in as an “if needed” slowly if taken for
oxprenolol much less tremor a few hours or medicine more than a few
so months
V03 ©2011 Mistura Enterprise Ltd

(www.choiceandmedication.org) Indemnity applies only to
* See other page for more advice about these side effects.
No such guide can be entirely bias-free. No matter how hard someone tries, training
and background will always influence your outlook. We have, however, tried to
eliminate bias, and we hope you take these charts in the spirit in which they are
provided i.e. a genuine attempt to inform, educate and support.
See also www.choiceandmedication.org.uk or
www.southstaffsandshropshealthcareft.nhs.uk/
Produced by Medicines Management & Pharmacy Team,
St Chads House, Stafford, ST16 3AG
October 2011

MMP Handy Chart October 2011 V2

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MMP Handy Chart October 2011 V2

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Handy charts

Edition 2, October 2011

What the sections in the table mean:

V04 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org)

Olanzapine Antipsychotic & Blocks dopamine Tablets, melt-in- A benzodiazepine

ADHD (attention deficit hyperactivity disorder)

V04 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org)

A handy chart to compare the medicines to help the symptoms of ADHD

V03 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org)

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Alzheimer’s Disease and dementia

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Olanzapine Around 10mg a We don’t really

Bipolar Mood Disorder (manic-depression)

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OCD (obsessive-compulsive disorder)

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V03 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org)

Main medicines (licensed or which are proven to help)

V04 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org) Indemnity

PTSD (post-traumatic stress disorder)

V03 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org) Indemnity

V03 ©2011 Mistura Enterprise Ltd (www.choiceandmedication.org) Indemnity

Sertraline, 50-200mg a Boosts ● ● ●●● ● ●●● Should be no

Bupropion 150-300mg a Boosts o o ● ● o Should be no

Social Anxiety or Social Phobia

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Venlafaxine (e.g. 75-150mg a Boosts ● ● ●●● ●● ●●● Should be stopped

V03 ©2011 Mistura Enterprise Ltd

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