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Medication

Medication is often prescribed for people who are suffering with severe paranoid thoughts and many find it helps. Remember that psychologists and counsellors can't prescribe medication; only GPs and psychiatrists can do so. As part of the consultation, they'll want to investigate possible physical causes of the suspicious thoughts. For example, they may take a blood sample so they can check for infection and see how the liver, kidneys, and thyroid gland are functioning.

Two major categories of medication are given to combat paranoid thoughts:

Each of these two categories includes lots of different individual drugs. Finding out about these drugs can be a confusing business because they all have at least two names! Each drug has an official medical name (its generic name) and the trade name given by the company that makes it. For example, the drug fluoxetine is widely known by the trade name Prozac. We use the generic names here.

Everyone responds differently to particular drugs so it may take time to find the right medication and the right dose. Each drug also has its own set of potential side-effects and risks. Your doctor will discuss how a person is getting on with the medication they've prescribed and they may alter the dose or even the drug until the one that's most effective is found. Make sure the doctor explains:

Neuroleptics

As we've mentioned, neuroleptics are one of the two major types of drug prescribed for suspicious thoughts. They're sometimes called `anti-psychotics' or `major tranquillisers'. Neuroleptics are mainly prescribed for people with mental health problems such as schizophrenia or psychosis, but in smaller doses they're sometimes used to treat anxiety and agitation.

Neuroleptics take a few days or weeks to act. If one doesn't work, doctors often try one of the others. There are lots of neuroleptic medications now. The older ones include chlorpromazine, haloperidol, and trifluoperazine. Among the newer ones, often called 'atypical neuroleptics', are risperidone, amisulpride, olanzapine, and clozapine. If the doctor suggests a neuroleptic, it's likely to be a low dose of an atypical.

The downside of neuroleptics is the unpleasant and occasionally severe side-effects they can produce, including drowsiness, weight gain, reduced sexual desire, and diabetes.

Anti-depressants

The doctor may feel that suspicious thoughts will reduce if the person's mood is better. In this case, they'll probably prescribe an anti-depressant. There are various types of anti-depressants, but chances are a person would be given one of the newer SSRIs (or `selective serotonin reuptake inhibitors').

Commonly used SSRIs are fluoxetine, paroxetine, citalopram, and sertraline. As with neuroleptics, it may be a while before the SSRI starts working. However the side-effects (for example, stomach upset, agitation, rashes, reduced sexual desire) are usually less common and less severe than those caused by neuroleptics.

The other commonly prescribed type of anti-depressants is the tricyclics - examples include amitryptyline, imipramine, and clomipramine. SSRIs are thought to have fewer side-effects than the tricyclic medications.

The web site www.mentalhealthcare.org.uk offers you the chance to post questions about medication to the Maudsley Hospital Chief Pharmacist. The Maudsley Hospital also runs a Mental Health Medication Helpline (Tel. No. 0207 919 2999, weekdays 11am-5pm).


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