Medication is used for most serious problems: the evidence-base for the use of antipsychotics in psychosis, antidepressants in severe depression and mood stabilisers in bipolar disorder is robust.

  • Clozapine has been demonstrated to have increased effectiveness in the short to medium term in patients who have not responded to other antipsychotics
  • Drug treatment should not be used specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder26 although short-term use may be helpful during a crisis.
  • Side effects are a major issue and advocacy for greater service user choice about taking medication is emerging27.  This includes consideration of discontinuation strategies.
  • There do not appear to be robust differences in effectiveness between first and second generation antipsychotics28; side effect profiles differ however.
  • Use of poly-pharmacy (two or more drugs of same BNF category) and medication above BNF recommended levels remains high despite cautions raised about such practices29. For BNF Chapter 4 (Central Nervous System) including antipsychotics and antidepressants, the number of items dispensed increased by 8.9m items between 2010 and 2011, the largest increase of any chapter.
  • Measures to develop collaboration with medication have had mixed success – combinations of more convenient care, information, reminders, self-monitoring, reinforcement, counselling, family therapy, crisis intervention, manual telephone follow-up, and supportive care may be helpful30. However ‘Compliance therapy’ does not appear to be an effective intervention31, CBT may be so32 but the most important positive predictor is the quality of the therapeutic relationship33.
  • Use of community treatment orders (CTO) has exceeded expectations -the number of people on a CTO at 31 March 2011 increased by 29.1 per cent from 2010 to 4,291: evidence regarding their effectiveness is awaited.