An Unintended Effect

Side Effects of Mental Health Drugs

Author: Mark Parkinson RPh:  President  AFC CE

Credit Hours 2.5- Approximate time required: 180 min

Educational Goal: 

Instruct about the side effects of common mental health drugs and how to manage them.

Educational Objectives:

1. Instruct how the body functions in regards to drugs

2. Explain where side effects come from

3. Explain about the complexity of mental health issues

4. Teach about the different classes of mental health drug

5. Tell how to manage common drug side effects

6. List precautions for special populations


1. Read the course materials.  2. Click on exam portal [Take Exam].  3. If you have not done so yet fill in Register form (username must be the name you want on your CE certificate).  4. Log in  5. Take exam.  6. Click on [Show Results] when done and follow the instructions that appear.  7. A score of 70% or better is considered passing and a Certificate of Completion will be generated for your records. 


 The information presented in this activity is not meant to serve as a guideline for patient management. All procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this article should not be used by care providers without evaluation of their patients’ Doctor. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication. Nutritional products discussed are not intended for the diagnosis, treatment, cure, or prevention of any disease.


Unintended Effects:

Side Effects of Mental Health Drugs



     When I was a 20-something year old, new caregiver in the relative new field of adult foster care, I have to admit I was pretty clueless. Back then, there were no basic training requirements and no continuing education lessons to take.   If it sounds like it was easier way back when- let me tell you, it wasn’t. Learning as you go, on the job training in health care definitely has its drawbacks. I didn’t even realize how clueless I was until after I started pharmacy school.  As I learned more and more about healthcare and medication effects, I kept telling myself I wish had known that when I started out as a caregiver.  I thought over and over again, “So that is why so and so acted so annoyingly. They couldn’t help it. It was a side effect of their medication. Maybe if I had known, I could have told the doctor and done something about it.”

  Of particular interest to me were mental health drugs. The very prescriptions I depended on to help my residents live normally actually caused some of the abnormalities. Because I was uninformed, my residents suffered, but you don’t have to be. Together, we can help you recognize the annoying side effects of medication in your residents sooner and, with their doctor’s help, do something about them.  


The Basics on the Body’s Behavior


     The human body and the way it behaves are controlled by a complex system of chemicals, hormones, and bodily functions. Our bodies take in food and drink and convert them into the basic chemicals we need to function. We utilize some of those basic elements to run the mechanics of our systems, like sodium and chlorine (salt) and glucose (simple sugars).  Other elements our bodies convert to more complex chemicals called hormones.  They are made to regulate more complex functioning that is not possible to produce from the basic materials we consume. Both of these types of chemicals float around in our bodies where ever our bodily fluid currents take them.  When a certain chemical floats passed an area that utilizes that particular material, it is taken in and produces the desired effect. 

     If it all sounds kind of random and based on luck, it isn’t. Our bodies are designed to take advantage of the shapes and properties of each chemical to produce the desired effect in the place it is needed. This is easier to understand if you think of this concept as a lock and a key. The key floats along until it reaches a certain keyhole that it fits in. When the key is inserted, the door is opened or the function is turned on or off. Only that certain chemical key shape will fit into that keyhole to produce that effect.  So if the body requires a certain function, it will produce that key until the desired effect is produced. When the function is produced, new keys are made that will fit into another certain keyhole that will turn off the production of the original chemical key. This is called the negative feedback effect. The variety of functions needed by the body are produced and controlled by this very, very complex system of chemical keys and key holes.

     Medical science has learned that it can manipulate bodily functions by producing chemicals (drugs) that are similar in shape to the chemical keys utilized by our bodies. The problem is we can’t copy the whole key/keyhole system exactly. It’s far too complicated. There is always some minute detail that we can’t replicate, don’t understand, or even know about.

     For example, we can make a chemical key (drug), but we can’t control where it goes after it gets into the body.  Let’s say we want to help a patient who is in pain. We produce an artificial chemical key that fits into the keyhole that turns on the pain-killing function of the brain. Unfortunately, that same chemical key also fits into the sleep-inducing keyhole and the nausea-producing keyhole of the brain. After the patient takes the pain killer drug, the pain is reduced but sleepiness and nausea are also experienced. That’s why drugs produce unintended effects known as adverse reactions or simply side effects.  


Mental Health Drugs and Effects


     The brain is by far the most complex organ / function system in our body. Millions of cells with trillions of connections are covered with a whole host of chemical receptors surrounded by a chemical soup of neurotransmitters. Add to that the complex interaction between individuals and our environment. It’s a marvel that we can accomplish anything with such a complex system.  It is no wonder that things go haywire for some people resulting in mental illness. Sometimes there’s a problem with how the body is put together or how it functions (genetic). Sometimes it’s how we interact with our surroundings or what we take into our bodies (environmental). The end result is that those individuals can’t mentally function normally.

     The medical community recognizes the need for help, and we try to manipulate the mental functions of the patient with drugs and other therapies to bring that person back to normal functioning. Medications that are used for this purpose are generally called psychiatric, psychotropic, or psychotherapeutic drugs. They are not intended to cure the patient but are designed to treat the symptoms of the mental illness so the patient can feel better and continue with their lives. With these treatments, there is always the chance of unintended effects. It can’t be helped.  Caregivers must learn to look for and help the patient manage the side effects that may arise.   


Information leaflet

    Medical science, drug companies, the government, and caregivers have put a lot of effort into producing predictable results while minimizing the side effects that can occur with any therapy. Only a small percentage of drugs are approved for human use. Those that are approved are extensively studied. All possible effects of each drug have been dutifully recorded. That information is required by law to be given to the consumer whenever that drug is dispensed. The information is supposed to help patients and caregivers anticipate the drug’s what is supposed to happen. It is also helps you be better prepared for what actually does happen, intended and unintended. A caregiver should always read a new drug information leaflet. 


Classes of Psychiatric Drugs

     Everyone is different, so it is easy to see that medication works differently for different people. The prescriber usually has a variety of prescription choices to try to alleviate a specific set of symptoms. If one medication either doesn’t work, doesn’t work well enough, stops working, or has side effects that are too bothersome, the doctor can use another drug for the same purpose. We generally group medications with similar effects into different classes


Antipsychotic /Schizophrenia Drugs


     Psychosis is a symptom of mental illness where the patient has an impairment of their perception of reality. It can radically change their personality and cause difficulty in living normally. Symptoms’ severity can range from a mild case of dementia or visual hallucinations to a major case of schizophrenia that requires hospitalization.


     Older medications used for psychosis are called “Typical” antipsychotic drugs. Some of the more commonly used are:

·        Chlorpromazine (Thorazine)

·        Haloperidol (Haldol)

·        Trifluoperzine (Stelazine)

·        Thioridazine (Mellaril)

·        Perphenazine

·        Fluphenazine

     Newer antipsychotic medications are called “atypical” antipsychotic drugs. Some of the more commonly used are:

·        Risperidone (Risperdal)

·        Olanzapine (Zyprexa)

·        Quetiapine (Seroquel)

·        Ziprasidone (Geodon)

·        Aripiprazole (Abilify)

·        Paliperidone (Invega)

·        Clozapine (Clozaril)

Extrapyramidal Side Effects

     A major side effect concern with “typical” antipsychotics, especially in long-term use, are the extrapyramidal side effects. The extrapyramidal system (EPS) is a part of our nervous system that controls voluntary movement. “Typical” antipsychotics can interfere with dopamine, a major neurotransmitter chemical of this system. The EPS side effects are usually reversible. If nothing is done, though, the unintended effects may become permanent.  If any of the following side effects occur, notify the doctor immediately. EPS side effects include:

·        Acute Dystonia: Sustained muscle spasms frequently in the neck and head. It can cause twisting and repetitive movements or abnormal posture. It nearly always develops after the first few weeks of therapy or after a significant change of therapy. It can be painful and life threatening if it interferes with breathing.

·        Hypokenesia:  Reduced muscle movements. It can cause an expressionless face, short shuffling steps, and difficulty in starting to walk. Signs usually develop within three months.

·        Diskenesia: Involuntary muscle movements. It can cause repetitive grimacing, tongue rolling/thrusting, chewing, lip smacking, puckering, rapid eye movement, twitching, and rocking back and forth.

·        Tarive Dyskinesia: If left unresolved, dyskinesia effects become permanent and are then called tardive dyskinesia (TD). Elderly women and diabetics seem to be at the greatest risk. About 5 percent of patients who chronically take typical antipsychotics develop TD.

·        Rigidity: The patient has troubles moving their limbs.

·        Paraesthesias: A sensation of numbness or tingling that can lead to seizures.

·        Neuroleptic Malignant Syndrome: A rare and potentially fatal condition that can happen shortly after taking a drug. Watch for fever, rigidity, rapid breathing, sweating, and confusion. If left unchecked, comma, seizure, and death can occur.


Agranulocytosis/ Weight Gain-Diabetes

     The second generation of antipsychotics is called “atypical.” They have a greatly reduced chance of EPS side effects but have their own unintended effects to be aware of.

·        Agranulocytosis: Loss of white blood cells. Without white blood cells, the body is susceptible to life-threatening infections. Clozapine causes this to occur the most and requires a blood test every one to two weeks.

·        Weight Gain: Changes in a person’s metabolism can lead to major weight gains. Weight gain can lead to other health concerns.

·        Diabetes: “Atypicals” cause trouble with glucose and lipid processing that can lead to diabetes.  Olanzapine and Clozapine seem to have the highest occurrence. Risperidone and Quetiapine have only moderate occurrence.


Less serious side effects

     Patients who take either “Typical” or “Atypical” antipsychotics can experience less serious side effects. Most go away by themselves after a few days or are easily managed. Driving or operating machinery would be unwise until the patient figures out how the new medication affects them. If a patient is already unsteady on their feet, they should receive extra monitoring and assistance when starting or changing any antipsychotic.  The side effects are:

·        Drowsiness

·        Dizziness when standing or changing positions (Hypotension)

·        Blurred vision

·        Rapid heartbeat

·        Sensitivity to the sun

·        Skin rashes

·        Menstrual problems

·        Dry mouth (reduction in saliva production, not an increase in thirst)

·        Constipation

·        Nausea

     A special note that can be quite problematic for elderly care workers: The FDA issued a Public Health Advisory for atypical antipsychotic medications. They determined that death rates are higher for elderly people with dementia when taking this medication. A review of data has found a risk with conventional antipsychotics as well. Antipsychotic medications are not FDA-approved for the treatment of behavioral disorders in patients with dementia. If a patient starts to develop signs of dementia by hallucinating or having delusions, the doctor may be reluctant to prescribe antipsychotic medications for treatment.

Antidepressant Drugs


     Depression is defined by being in a state of sadness, unhappiness, or hopelessness. Many things can cause or contribute to depression, including, medications, experiencing loss, old age, and emotional and economic problems.  A major contributing factor to clinical depression is an imbalance of neurotransmitters, which can be treated with medication.

     There is a wide variety of antidepressant drugs. The most commonly used classes are:

 1. Selective serotonin reuptake inhibitors (SSRI)

·        Fluoxetine (Prozac)

·        Citalopram (Celexa)

·        Sertraline (Zoloft)

·        Paroxetine (Paxil)

·        Escitalopram (Lexapro)

2. Serotonin and norepinephrine reuptake inhibitors (SNRIs).

 ·        Venlafaxine (Effexor)

 ·        Duloxetine (Cymbalta)

     Each medication has its own set of side effects, and individual reactions can vary significantly from patient to patient with any drug. Looked at collectively, users of SSRI and SNRIs have reported insomnia (trouble sleeping or change of sleeping patterns), agitation, or feeling jittery, headaches, and nausea.

The tricyclic antidepressants are an older class of medications and include:

·        Amitrptyline (Elavil)

·        Imipramine (Tofranil)

·        Nortriptyline (Pamelor)

·        Clomipramine

·        Doxepin

     The side effects in this class of medication are sedation, dry mouth, constipation, blurred vision, and bladder retention problems. Older men with prostate problems may have more problems with urination.

Other noteworthy antidepressants are:

·        Trazadone - a tetracyclic antidepressant. It has a significant drowsiness effect. Many doctors take advantage of this effect and use it as a sleeping aid. Users have also reported blurred vision, confusion, and dizziness.

·        Mirtazapine (Remeron) - a tetracyclic antidepressant. More common side effects are constipation, dizziness, dry mouth, increased appetite that leads to weight gain.  It might be wise for care providers to monitor the patient’s weight.

·        Bupropion (Wellbutrin/ Zyban) - an antidepressant that can also be helpful for smoking cessation. The more common side effects are dry mouth, agitation and trouble sleeping.

Antidepressant concerns

     All antidepressants have a slow onset of action. Weeks may pass before any effects are noticed. There will not be any sensation of euphoria, just a gradual feeling of being normal. Unfortunately, side effects can be seen as early as the first dose. They are usually mild and go away by themselves.

     Many antidepressants carry a suicide warning, especially for teens and children. Caregivers should take seriously and act upon any suicide indications, even when it comes up in casual conversations or joking.

     Alcohol is a drug that causes extra problems. Other drugs can also interact with antidepressants. A potentially life-threatening interaction called serotonin syndrome may develop.

      Symptoms usually occur rapidly. Mild to moderate reactions include increased heart rate, shivering, sweating, dilated pupils, twitching or tremors, agitation, blood pressure changes, and fever.  Life-threatening signs are fever above 106 degrees Fahrenheit and seizures. Drugs to watch for are tramadol (Ultram), ADHD stimulants, migraine “tryptans,” the herbals 5HTP and St John’s Wort, lithium, and many others.  

Herbal remedies

     St John’s Wort and 5HTP have both been used for mild to moderate depression. There is not much scientific evidence that either work very well, but some patients insist on using them. There are several unintended drug interactions that can occur with other medications, so work closely with the doctor and pharmacist if these remedies are consumed.


Mood stabilizers


     Bipolar disorder or manic depression is classified as a mood disorder. The patient experiences uncontrolled swings from very high moods of mania to low periods of depression. Often mood-stabilizing drug are used first. Other medications are then added as needed to control other symptoms that may arise. For example, antidepressants used for low periods and antipsychotics used for hallucinations during periods of uncontrolled mania. 

     Lithium was the first mood stabilizer approved by the FDA in the 1970s. It is still extensively used today.  Lithium is a basic element. Not only can it be used to stabilize mood, but it can also interfere with the function of other basic elements like sodium and potassium. Some of these and other side effects can get quite serious. They are:

·        Loss of coordination

·        Excessive thirst

·        Frequent urination

·        Blackouts

·        Seizures

·        Slurred speech

·        Fast, slow, irregular, or pounding heartbeat

·        Hallucinations (seeing things or hearing voices that do not exist)

·        Changes in vision

·        Itching, rash

·        Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs.

     Medication therapy will most likely be long term. Those basic elements that can be affected by lithium can also affect its long-term use.  If one of your residents is on lithium, they should have their blood levels checked regularly by their doctor. The doctor should make sure the kidneys and the thyroid are working normally.


     Anti-seizure medications are designed to inhibit nerves from firing. As such, they also can be used for stabilizing moods. Seizure medications used for bipolar disorder are:

·        Divalproex sodium (Depakote)

·        Carbamazepine (Tegretol)

·        Lamotrigine (Lamictal)

·        Oxcarbazepine (Trileptal).

 The side effects of divalproex sodium or its precursor drug valproic acid are:

·        Changes in weight

·        Nausea

·        Stomach pain

·        Vomiting

·        Anorexia

·        Loss of appetite.

     Young girls and women on valproic acid may have their testosterone levels affected and may develop polycystic ovarian syndrome. If a resident’s menstrual cycle becomes irregular, you should notify the doctor.  Long-term use of valproic acid can damage the liver or pancreas so they should be checked periodically. The FDA has also issued suicide warnings for anticonvulsant medications. 

     It is very rare but lamotrigine (Lamictal) can cause a very serious and potentially lethal skin condition called Stevens Johnson Syndrome (SJS). SJS is a severe inflammatory eruption of the skin and mucus membranes that can permanently scar and even kill.  What caregivers should watch for is an initial flu-like period of fever, headache, and sore throat followed by skin lesions. If skin eruptions appear, notify the doctor right away.  


Anti-anxiety medications


     Anxiety is defined as an unpleasant state of inner turmoil and nervousness. In an increasingly difficult world and under changing circumstances, a high level of anxiety can often be felt. There are also mental illnesses where feelings of anxiety are not under the control of the patient. Anti-anxiety medication (anxiolytic) use is more prevalent in care homes than in the general population, because of their cliental and general environment of change. 

     The most commonly used anti-anxiety medications are the benzodiazepines. They include:

·        Clonazepam (Klonopin)

·        Lorazepam (Ativan)

·        Alprazolam (Xanax)

·        Chlordiapoxide (Librium)

·        Clorazepate (Tranxene)

     Benzodiazepines work by quickly reducing certain brain activities producing a temporary relaxing, calming effect. Their side effects are also related to the reduction of function of the central nervous system. They are:

·        Drowsiness

·        Dizziness

·        Blurred vision

·        Headache

·        Confusion

·        Grogginess

·        Nightmares.

     Unintended effects of benzodiazepines can be addiction, emotional blunting, and depression with long-term use. They are considered drugs of abuse.  Alcohol and other drugs of abuse are a major concern with benzodiazepines.


     Other anxiolytic medications are:

·        Buspirone (Buspar) who’s side effects are:

                    ·         Dizziness

                    ·         Headaches

                    ·         Nausea

                    ·         Nervousness

                    ·         Lightheadedness

                     ·         Excitement

                     ·         Trouble sleeping

·         Beta Blockers, which include propranolol (Inderal) and atenolol (tenormin). They are commonly used for high blood pressure. Their side effects are:

                     ·          Fatigue

                      ·         Cold hands

                      ·         Weakness

                      ·         Dizziness upon standing

·         Low blood pressure

     There are other concerns with anti-anxiety medication therapy. For most patients, therapy is supposed to be only temporary. Patients can become habituated to anti-anxiety medications. They lose the ability to adjust to life’s demands without their chemical-coping mechanisms. This can be an issue when new residents who are on tranquillizers move into your homes. After they get used to the change, they have a hard time giving up the medication. It is hard to tell the habituation effect from a true addiction.

      Long-term use also makes it easier for the drug to build up in the resident creating over-sedation.  They look and act drugged out and drunk. Falls and lack of responsiveness become a greater issue.  Long-term use in the elderly (who have a greater sensitivity to sedation) can cause confusion, amnesia, loss of balance, and cognitive impairment that looks like dementia. Over sedation and pseudo-dementia are serious problems for care homes

         Many well-meaning caregivers discontinue the medication too quickly creating withdrawal. Caregivers should look for extreme depression and fatigue, irritability, anxiety, flu-like symptoms, and insomnia. These symptoms will eventually go away by themselves. If they become an issue, counsel with the doctor about your observations.


Stimulants Used in ADHD


     Attention Deficit Hyperactive Disorder (ADHD) and the closely related Attention Deficit Disorder (ADD) are conditions where some of the control centers of the brain are not as active as they should be for proper functioning.  There are medications that can stimulate the brain so that its control center can function properly, helping sufferers lead more normal lives.

These stimulate medication are:

  • Methylphenidate (Ritalin, Metadate, Concerta, Daytrana)
  • Amphetamine Salts (Adderall)
  • Dextroamphetamine (Dexedrine, Dextrostat)
  • Lisdexamfetamine dimesylate (Vyvanse)

 Their side effects are:

·        Decreased appetite

·        Sleep problems

·        Jitteriness

·        Tics (sudden repetitive movements)

     Stimulant medication has been known to cause sudden cardiac death. Extra screening should be done if there is a history of heart problems, especially at the beginning of therapy.

     Psychiatric problems can be aggravated when stimulants are taken. Medication use can trigger or make the symptoms worse. Caregivers should watch for signs of hostility, aggression, anxiety, depression, and paranoia. Residents with prior mental health issues, especially mania or bipolar disorder, are at a particularly high risk. Caregivers should carefully monitor their mental health patients taking these prescriptions.

     Stimulants are drugs of abuse, but taken as directed long -term studies show virtually no problems of drug addiction. Controlled release versions of these medications should not be crushed or chewed. Too much drug will be released at one time, increasing the potential of overdose or abuse for the purposes of “getting a buzz” from the medication. 

     There have been some reports of patients trying to lose weight on the medication because of its effect on appetite. There is no evidence to support the sustained weight loss claims.

     Caregivers should remember that ADHD patients have a problem with remembering to take all the doses because of their increased distractibility. Long-acting medication can help reduce this problem by reducing the amount of times the medication needs to be taken. Abuse potential should be taken into consideration when considering switching to the long-acting forms of their prescription. 

     With some patients, stimulant drug use is a concern if they have been ineffective. There are a few non-stimulant alternative treatments for ADHD. They are:

·        Atomoxetine (Straterra) whose common side effects are:

·        Changes in menstrual cycles

·        Changes in urination

·        Dry mouth

·        Palpations, increased heart rate

·        Kidney problems (contact doctor if skin or eyes turn yellow)

·        Constipation

·        Insomnia

·        Abnormal dreams

·        Increased aggression

·        Teen suicide warning


·        Alpha blockers, which include clonidine (Catapres) and gaufacine (Intuiv). These can also be used for high blood pressure. Notable side effects are:

·         Dry mouth

·        Sleepiness

·        Weakness  and or dizziness (check for low blood pressure)

·        Headache

·        Constipation

·        Abnormal dreams


Caregiver Notes


     It is useful to be informed of potential medication side effects, but if they appear, what are you going to do about it. The following information might help in your caregiving efforts.


Medication management steps


As a pharmacist, I recommend the following steps:

Step 1- Read the literature that comes with the medication. It may seem daunting at first, but you’ll soon notice patterns in the material and it will become easier and quicker the more you read.

Step 2- Observe and record. Monitor the patient and pay attention to what changes. Listen to complaints and see if they are consistent with any side effects. Don’t emphasize the printed side effects to the patient. You might accidently encourage the patient to develop side effects that don’t really exist.

     Record significant events then watch if the intensity reduces over time. Many bothersome side effects will go away by themselves as the patient’s body gets used to the new medication. Ask questions of others who are with the patient, like family members, teachers, job supervisors, and other caregivers.

Step 3- Report. Tell the prescriber about the side effects that occur. They want to know what is happening with their patient. They can’t be with the patient all the time but you can.  If the doctor hears nothing, they assume everything is going OK. Sometimes even if you report annoying side effects, the doctor will do nothing about it. If that occurs, the doctor might have decided that the desired effect outweighs the unintended effect.  If the side effect starts to be a problem for your caregiving efforts, it will be up to you to communicate effectively with the doctor. Make them understand the impact those annoying side effects are having upon you and your other residents.  Be professional not just a whiner, reputations are earned –both good and bad.


Managing Common Side Effects


     As you have read this course, you may have noticed several side effects mentioned over and over again. Here are a few helpful hints that will help you manage some of the common unintended effects that might appear.

·        Dry mouth- Often dry mouth caused by medication use is the result of the saliva glands being turned off, not from dehydration. Drinking water is good, but you will notice that it is only a temporary fix. A longer lasting solution would be to either turn the saliva gland back on by sucking on something tart like a lemon drop or lifesaver, or utilizing a long-lasting saliva substitute. There are several OTC products you can buy or you can make your own by mixing liquid glycerin, lemon juice, and honey.    

·        Upset stomach- Eating soda crackers works great on drug-induced nausea. Either eat some with the medication or eat them when drug-induced nausea occurs

·        Constipation- Except in patients in danger of fluid overload, doubling the amount of fluid intake is a good first-line therapy. You can also increase the intake of foods that cause diarrhea like prunes, prune juice, or large amounts of other fruits (except bananas and applesauce).

·       Sedation- Sleepiness from medication can actually be taken advantage of. It’s all about coordinating when the greatest drowsiness occurs and when the patient goes to bed. Work with the doctor on when to take the medication. Altering the dose to the lowest effective amount might also help.

·       Dizziness/Less alert- Any prescription that works on mental health has the potential of causing changes in alertness, even stimulants. Be extra vigilant when starting any new mental health drug. It would be wise to be there when a patient transfers from one position to another like getting out of bed or up from the table. It’s much easier to provide a balancing hand than to pick someone up off the floor.


Other concerns



      It is not fully understood why there is an increase in the suicide rate for some medications, especially in teens. One possible explanation is there was already a strong desire to commit suicide but the patient lacked the emotional energy to do so. Ironically, when the therapy starts to work, the patient now has the energy to follow through with their plans. So even if the medication appears to be helping, caregivers should remain vigilant for the following warning behaviors.

·        Acting more subdued or withdrawn than usual

·        Feeling helpless, hopeless, or worthless

·        New or worsening depression

·        Thinking or talking about hurting himself or herself

·        Extreme worry

·        Agitation

·        Panic attacks

·        Trouble sleeping

·        Irritability

·        Aggressive or violent behavior

·        Acting without thinking

·        Extreme increase in activity or talking

·        Frenzied, abnormal excitement

·        Any sudden or unusual changes in behavior


Opposite effects


      Some residents react differently than expected. They seem to be mentally wired backwards. Notify the doctor if the resident has new or worsening symptoms or changes in mood, thoughts, or behaviors. 




     Cooperating with instructions and staying on mental health drugs long term is a major concern in the management of mental illness. The side effects of a medication sometimes reduce the resident’s desire to continue to take their prescriptions.

The Right to Refuse

      Every resident has the right to refuse a medication, even if it will cause them harm. There are special rules governing a patient’s right to refuse treatment, but a discussion of these is beyond the focus of this CE course. Please talk to the case worker or government licensor for more information.  Often, though, if a resident doesn’t want take a medication, it is an indication of unwanted side effects.

·        Listen to complaints and find out the “Why’s” of refusal. Then address the issues complained about.

·        There are certain medications that should not be discontinued abruptly. It will actually make the resident feel worse. Reminding the resident of that fact, followed by an action plan to address their concerns is often all it takes to regain their cooperation.

·         Greater cooperation can be gained by avoiding simple yes and no questions. Instead of asking, “Do you want your meds now?” ask, “Would you like to take your medication in applesauce or chocolate pudding? …with water or juice? … now or in 15 minutes?”

Feeling Better and Non-compliance

      Mental health medications can be very effective, but they shouldn’t be thought of as a cure.  Medication can provide temporary relief or even sometimes long-term relief of symptoms, creating the illusion of a cure.  But medications rarely eliminate the underlying causes of the mental illness. Once the patient stops taking the drug, the mental illness symptoms often return in full force.  This yo-yo effect can be quite disheartening to the patient. Caregivers must communicate effectively with their residents the lifelong nature of their mental illness and the reality of what is happening to them to prevent the up and down return of their symptoms. 


Special Populations


     The very old, the very frail, and the young have a different metabolism than the average adult patient. Medication effects must be monitored more closely in these populations. Often it takes less medication to achieve the desired results or side effects occur more readily at normal doses.

     Pregnancy and medications are always a special concern. Sometimes though, it is actually more dangerous for the unborn child for the mother to be off of prescription therapy. Counsel with the doctor about the need to take medications during pregnancy. 

     After the baby is born, caregivers should watch for postpartum depression, especially if residents stopped taking their medication during pregnancy.  It is a very rare occurrence in care homes for a resident to breastfeed their child.  If a resident wants to breastfeed their child, the caregiver must warn that psychiatric medication can pass into the breast milk. However, the medication may or may not affect the baby. It depends on the medication and when it is taken. It is a proven fact that breast feeding is of benefit to the newborn, so patients and their caregivers must talk to the doctor about the potential risks and benefits of breastfeeding while on medications.




     Caregivers are responsible for the welfare of their residents. A large portion of the therapy that those residents are under is medication based. Mental health and medications are particularly interconnected and complicated. Caregivers must not only know when and what to give but also what the medication is supposed to do and what side effects are possible.  No matter how well the medication is tolerated, there is always the possibility of unintended, sometimes serious, effects that have to be monitored for.  Even if there are adverse effects, sometimes they can be managed and the medication will be continued. An informed caregiver is better prepared to handle any unintended medication effect that may arise so it is advisable to read the drug information material that comes with each mental health medication and all other prescriptions.     



1. Leonard Holmes, Tardive Diskinesia. Mental Health, 6/ 02/10

2. MedWatch: The FDA Safety Information and Adverse Event Reporting Program. Safety, FDA

3. Tardive Dyskinesia. Wikeperdia The free encyclopedia

4. Tardive  Dyskinesia. NAMI, National Alliance on Menatl Illness

5. Introduction: Mental Health Medications. Mental Health Medication, NIH, National Institutes of Health. NIH Publication No. 08-3929, Revised 2008.

6. Extrapyramdial Side effects. Wikipedia the free encylcopedia

7. Various drugs listed in article.


An Unintended Effect

Side Effects of Mental Health Drugs

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