A brief introduction to depot medication used in mental

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A brief introduction to depot medication used in
mental health

• The aims of the session are to provide
  information about
• Who might be prescribed depot medication and why?
• What are the main types of depot injection used?
• How does the medication work?
• What are the main side effects?
• What are typical and atypical medicines?
• How is Risperdal Consta different to other
  depots?
• What happens if people miss an appointment?
• Where can I find more information?

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Who might be prescribed depot medication?

• People who have at some point experienced
  symptoms of a psychotic illness. This could be
  schizophrenia, a bi-polar disorder or a
  schizoaffective disorder.
• Some of these symptoms might include hearing
  voices talking about them, to them or telling
  them to do things. They may believe that people
  are following them, watching them or trying to
  harm them or others around them.
• They may experience very strong false beliefs
  about the world, called delusions .These can be
  paranoid ideas, that people are spying on them or
  trying to harm them, or grandiose delusions,
  where they believe they are very famous or
  important.
• They may believe that the TV or articles in the
  news paper refer specifically to them, and tell
  the public all about them.They may think that
  people can read their thoughts, or that they can
  read other peoples. They might think that some
  other force is implanting thoughts into their own
  mind, or that they are able to do this.
• Imagine how vulnerable this must make you feel.
  Imagine how frightening these symptoms must be.

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How should the depot be given?

• Antipsychotic depot medications are all deep
  intra muscular injections, that should be given
  in the upper outer buttock. Some are also
  licensed to be given into a lateral thigh.
• It is recommended that Z tracking technique
  should be used to administer the injection.
• It is best practice that no more than 2 mls in
  volume should be given in any one site, at one
  time. This is to reduce patient discomfort and
  reduce localised reactions such as pain,
  irritation and the forming of nodules.
• Most depot preparations are stable in the
  vegetable oil they are suspended in. This means
  that you can mix different concentrations of the
  same drug if produced by the same manufacturer.

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What are the main types of depot medication used?

• Like other depot preparations, neuroleptic depots
  are generally made up of a drug suspended in
  vegetable oil, and are given intra-muscularly,
  for slow release over a given period of time.
• Depot medication has been used for many years,
  and was traditionally associated with people who
  could not manage to take their own medication
  regularly and effectively on a day to day basis.
  This is an outmoded way of thinking about depot
  medication, as some people simply find it more
  convenient.
• In recent years people are given much smaller
  doses of depot medication, which can help control
  their symptoms without giving them too many of
  the side effects.
• Some of the most common drug names are
• Flupentixol Decanoate(Psytixol/Depixol)
• Zuclopentixol Decanoate(Clopixol)
• Fluphenazine (Modecate),
• Pipothiazine (Piportil),
• Haliperidol Decanoate (Haldol)
• Risperidone Long Acting Injection
  (Risperdal Consta)

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How does the medication work?

• All depot antipsychotics work by effecting the
  amount of a particular neuro transmitter called
  dopamine, which used in the brain to pass
  messages between the nerves. They act by blocking
  the dopamine receptors in the brain.
• There is also some evidence that another
  neurotransmitter called serotonin interacts with
  the dopamine system, and can influence the way it
  functions.
• In people with mental illness, the chemical
  messaging systems do not always work in the way
  that they should.

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What are the side effects?

• Any drug carries the risk of anaphylaxic shock.
  People who will be coming to the Surgery will be
  well established on their medication, so this
  risk is very low.
• As with any drug, the severity of the side
  effects depends on the persons individual
  response to it and sometimes the dose given.
• The main side effects experienced by people
  taking depot medication can be quite unpleasant,
  and include symptoms categorised into three main
  groups Extra Pyramidal Side Effects (EPSE),
  anticholinergic reaction and prolactin elevation.
• EPSE include unusual body movements such as
  tremors similar to those in Parkinsons disease,
  a feeling of restlessness (this is sometimes
  called akathisia,) muscle stiffness (sometimes
  called dystonia), excessive production of saliva
  causing drooling, and repetitive movements of
  the head, face and neck (and occasionally limbs)
  which may occur gradually over time and can
  sometimes be irreversible (this is called tardive
  dyskinesia.)
• Anticholinergic reactions include blurred
  vision, confusion, increased or rapid heart rate,
  a dry mouth, difficulty passing urine and getting
  constipated. Generally a drying up of membranous
  tissues.

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What are the side effects? Continued

• Raised prolactin symptoms include erectile
  problems and decreased libido, difficulty
  reaching orgasm, general dissatisfaction with
  sex, enlargement and tenderness of breasts,
  lactation, irregular periods or periods that
  stop, infertility, reduced bone mineral density
  that could potentially lead to osteoporosis.
• Weight gain is a frequently experienced side
  effect of antipsychotic medication
• There is strong evidence linking people with
  schizophrenia with Type II diabetes but there is
  not enough conclusive evidence to say that this
  is caused by the medication.
• In a survey conducted by Rethink, called Just one
  percent, most people said that their priority in
  the development of new drugs was to find one with
  fewer side effects.
• Its hardly surprising that experiencing side
  effects, can be enough to discourage people from
  remaining concordant with the medication they are
  prescribed to help manage their symptoms.
• Some clients report discomfort at the injections
  site, and odeoma, pruritus and the forming of
  nodules under the skin are other localised
  reactions

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What are the similarities and differences in
typical and atypical depot injections?

• Typical or traditional antipsychotic drugs are
  usually associated with giving people more EPSE
  side effects. Atypical antipsychotic drugs are
  the newer, drugs which offer a different profile
  in terms of side effects, with a reduced
  likelihood of EPSE, but may still cause weight
  gain and other side effets.
• There are quite few oral atypical antipsychotic
  drugs, but currently only one long acting
  injection that is an atypical antipsychotic drug.
  This is called Risperdal Consta and is a long
  acting injection of an oral drug called
  Risperidone.
• Risperdal Consta can only be giving fortnightly,
  as one of three pre specified doses. Other
  typical depot medications can be given at
  intervals negotiated by the doctor and the patient

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How is Risperdal Consta different to other depots?

• Other depot preparations consist of a drug
  suspended in vegetable oil, and the amount of
  drug is stable throughout the total volume of the
  ampoule.
• Risperdal Consta is made up of a encapsulated
  micro-spheres (which looks like a powder), which
  are then carried in a special solution that you
  mix with it, to allow injection.
• The amount of drug is not stable in the solution.
  This is why there are only pre-set doses (25mg,
  37.5mg and 50mg) and a special pack is provided
  to give the drug
• It is a refrigerated item.
• The company provide a teflon coated needle to
  administer the injection with. Its important not
  to use a normal IM needle, as the micro-spheres
  would stick to the inside, and so the patient
  would not get the total dose of medication.
• The needle provided is rather long, this simply
  is because the trials were carried out in the USA
  where there is a greater population of obese
  people.
• It should ideally be prepared 20 minutes before
  being given to the patient.
• If the medication is left out of the fridge for
  20 min, its shelf life is then reduced to 7 days,
  this is important to remember when considering
  the cold chain of transportation of the drug,
  from the point of ordering to point of receipt.

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What happens if people miss an appointment?

• Its best to book people in for their next
  appointment when you see them for their
  injection. Some people are very organised and
  will remember this appointment, others may write
  it in their diary, whilst for some people,
  offering to write the appointment down for them
  is helpful. Some people have injection cards.
• If some one does not attend for their depot
  appointment, it may be for one of several
  reasons. The primary reason might not be that
  they do not wish to have their treatment. Please
  try to remember this!
• Its a good idea to ring the person to check
  whether they had remembered, and to establish
  another time that they can come to the surgery to
  receive their injection.
• The impact of missing their appointment is
  likely to vary depending on the stability of
  their current health, and the interval at which
  they have their medication, so missing it by a
  week is more significant for someone who had
  their depot every fortnight, than for some one
  who has it every four weeks.
• Most people who are having their depot at their
  GP surgery will have had fairly stable mental
  health for a number of years and have found
  having their depot a useful way of staying well.
  These people will be motivated by this to attend
  the surgery.
• If some did not come for their injection after
  two appointments the GP would need to liaise with
  the consultant psychiatrist who discharged the
  person to their care.
• Most people would take a number of months to
  relapse after stopping depot medication. This is
  because it remains in the system for a long time.

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Where can I find more information?

• www.sussexpartnership.nhs.uk/services-and-informat
  ion/medication/
• www.bnf.org
• www.rcpsych.ac.uk/mentalhealthinformation.aspx
• www.mentalhealthshop.org/products/rethink_publicat
  ions/only_the_best.html