Mental health medicines: resources to support clinical decisions

SPS resources

SPS has a variety of resources on mental health and illness which we recommend you check first.

Examples include:

• Choosing an antidepressant for people with epilepsy (SPS page)
• Choosing an antidepressant for people with coronary heart disease (SPS page)
• Prescribing and switching between modified-release methylphenidate (SPS page)
• Oral benzodiazepines and choosing equivalent doses (SPS page)
• Supporting lithium safety across the system (SPS page)
• Managing the risks associated with patients prescribed clozapine (SPS page)

We have a wealth of articles relating to antidepressant switching:

• Establishing if a person needs to switch their antidepressant (SPS page)
• Considerations when choosing an alternative antidepressant (SPS page)
• Monitoring a person during and after antidepressant switching (SPS page)
• Planning and agreeing an antidepressant switching strategy (SPS page)
• Advice on specific antidepressant switches (SPS page)

When prescribing for people with swallowing difficulties (SPS page), we have advice on suitable formulations of selective serotonin reuptake inhibitors (SSRIs) (SPS page) and clozapine (SPS page).

Our advice on safety in breastfeeding (SPS page) includes:

• Using antipsychotics during breastfeeding (SPS page)
• Using SSRI antidepressants during breastfeeding (SPS page)
• Using tricyclic antidepressants during breastfeeding (SPS page)
• Using certain antidepressants during breastfeeding (SPS page)
• Treating bipolar disorder during breastfeeding (SPS page)

Other resources

In addition to our own resources, we particularly recommend the following resources. They are free to access unless otherwise indicated.

Resources are listed in the likely order you may wish to use them. However, this depends on the nature of the question you are looking to answer.

Local formulary or guidelines

Your local Area Prescribing Committee, Medicines Management Group or similar body may have relevant guidelines or documents on their website. For example, prescribing guidelines and shared care protocols.

Local mental health services

Your local Mental Health Trust may have resources on their website for healthcare professionals such as, guidelines or patients (information on psychotropic medicines).

Some Mental Health Trusts provide advice lines for local primary care health professionals. If available locally, GP practices and PCNs would be informed.

It may be helpful to make contact with your local adult Community Mental Health Team (CMHT), Children and Young People’s Mental Health Service (CYPMHS) or Children and Adolescent Mental Health Service (CAMHS). Contact details should be available on your local Mental Health Trust website.

Clinical Knowledge Summaries

Clinical Knowledge Summaries (CKS) (CKS) provide advice on mental health for primary care practitioners. Topics include:

• depression
• antenatal and postnatal depression
• depression in children
• mental health in students
• bipolar disorder
• generalised anxiety disorder
• obsessive-compulsive disorder
• post-traumatic stress disorder
• psychosis and schizophrenia
• self-harm

British National Formulary

The British National Formulary (BNF) and BNF for Children (BNFC) have treatment summaries on some mental health topics. Summaries differ for management of children and adults. Relevant treatment summaries are:

• attention deficit hyperactivity disorder
• depression
• hypnotics and anxiolytics
• mania and hypomania
• psychoses and related disorders

The BNF also has a treatment summary for antidepressant drugs.

NICE Guidelines

NICE mental health guidelines include guidelines on specific conditions in adults or children and young people:

• common mental health conditions, such as depression and a range of social anxiety disorders
• severe mental health conditions, such as bipolar disorder, psychosis and schizophrenia
• personality and conduct disorders: such as antisocial behaviour and conduct disorder, and borderline personality disorder
• eating disorders
• self-harm and suicide prevention
• harmful sexual behaviour
• aggressive behaviour
• maternal mental health – antenatal and postnatal
• learning disabilities – mental health problems in people with learning disabilities

Maudsley Prescribing Guidelines

The Maudsley Prescribing Guidelines in Psychiatry eBook is freely available to healthcare professionals in England with an NHS England OpenAthens account. Register for an NHS England OpenAthens account.

The eBook is divided into sections covering:

• drug treatment of major psychiatric conditions
• drug treatment in special patient groups such as children, the elderly, in pregnancy and breastfeeding and in renal or hepatic impairment
• specialist conditions, including the drug treatment of psychiatric symptoms occurring in the context of other disorders
• other aspects of psychotropic drug use such as plasma level monitoring

Tips on using this resource

Each chapter of the website can be opened as a separate webpage or pdf document. It is helpful to first open the ‘Table of Contents’ section to see what is covered in each chapter and decide which you need.

You can also search within each webpage or pdf document.

Psychotropic Drug Directory

The Psychotropic Drug Directory is available to subscribers via Medicines Complete and provides information on:

• drug treatment options for psychiatric conditions
• drug treatment in special patient groups (such as patients with cardiovascular disease, diabetes, epilepsy, glaucoma, Parkinson’s disease, renal or hepatic impairment, and use after bariatric surgery)
• drug interactions with psychotropic medicines
• drug-induced psychiatric disorders
• management of side effects from psychotropic medicines

Choice and Medication

Choice and Medication (subscription required) provides patient information on mental health conditions, treatments and medications.

Mental Health Trusts in the UK provide free access for patients and carers via their websites; personal professional subscriptions are available for healthcare professionals in non-subscribing organisations.

Resources include printable leaflets such as patient information for medicines (available in many different languages), factsheets on various topics (starting and stopping medicines) and charts to help users compare medicines for a condition.

Training resources

If you would like more information on how to approach answering questions on mental health, we recommend:

Medicines Learning Portal

The Medicines Learning Portal is aimed at trainee hospital pharmacists but the content is also relevant to clinical primary care healthcare professionals. The portal includes a tutorial on mental health which provides advice on:

• questions to ask when considering questions relating to mental health medicines
• swapping between medicines
• stopping and restarting medicines
• choosing a medicine
• managing side effects
• talking to patients

CPPE

The Centre for Pharmacy Postgraduate Education (CPPE) has various learning resources on mental health. They are available to pharmacy professionals registered with GPhC and include:

• introduction to mental health and therapeutics
• fundamentals of mental health
• consulting with people with mental health problems

Further advice

If the information is not available on the SPS website or the information resources listed, or if your clinical scenario is complex, we would suggest you seek further advice from our Medicines Advice Service (SPS page).

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