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The Royal College of Psychiatrists Improving the lives of people with mental illness

 

Depot Medication

 

What is antipsychotic medication?

It is a medication that is used for some types of mental distress or illness, known as psychotic illnesses, where you may hear voices, have difficulty controlling your thoughts or feel very agitated. This happens most often in bipolar disorder (otherwise known as 'manic depression') and schizophrenia.

 

What is depot antipsychotic medication?

It is a special preparation of the medication, which is given by injection. The medication is slowly released into the body over a number of weeks.

It is important to know that the medication going into your body by a depot injection is exactly the same as the medication going into your body in tablet form. The only difference is the route through which its enters. This means that the benefits and the side-effects of the depot injection are the same as they would be if you took the drug by mouth.

 

What happens when the nurse or doctor gives the depot injection?

  • You go into a private room with the nurse or doctor.
  • The injection is usually given into the buttock.
  • After each injection the medicine stays in your body for a few weeks.

How is it started?

  • The first time you have this treatment you will usually be given a small amount to check that it does not have any bad effects on you.
  • If you have no bad effects from the medication, you start regular injections after a few days.

Why is it usually given into the buttock?

Because the injection is quite thick, it needs to be given into a large muscle, so that there is less (or no) pain and swelling.

Where can you have the injections done?

You can usually decide yourself where to have the injections. The choices might be:

  • At your doctor's surgery 
  • At a community mental health centre
  • At an out-patient clinic
  • At your home.

How often do you have to have these injections?

Between once a week and once a month.

How long do the injections go on?

This will depend on your illness. You should discuss this with your doctor.

 

Trade name

Proper name

Dose/amount

How often

Modecate Fluphenazine decanoate up to 100 milligrams 1 injection every 2 to 5 weeks according to response and severity of condition
Depixol Flupenthixol decanoate up to 400 milligrams 1 injection every 2 to 4 weeks according to response and severity of condition
Haldol Haloperidol decanoate up to 300 milligrams 1 injection every 2 to 4 weeks according to response and severity of condition
Piportil Pipothiazine palmitate up to 200 milligrams 1 injection every 4 weeks
Clopixol Zuclopenthixol Decanoate up to 600 milligrams 1 injection every1 to 4 weeks
Risperdal Consta Risperidone up to 50 milligrams 1 injection every 2 weeks
Xepilon Paliperidone up to 150 milligrams 1 injection every 4 weeks
ZypAdhera Olanzapine embonate up to 405 milligrams 1 injection every 2 or 4 weeks

Which depot to choose should be a joint decision between you and your psychiatrist. All depots are broadly similar in how effective they are. There are some slight differences in some of the effects of the drugs. For example, Clopixol may be more suitable if you are highly agitated, while Depixol may be more suitable if you have a low mood associated with your illness.

There are also differences in the side-effects they may cause, and this will influence your choice of depot.

What's good about having depot injections?

  • You only have to have the medicine once a week or once a month. (Pills have to be taken every day)
  • You are less likely to forget your medicine, so less likely to get ill.
  • The medicine can reduce unpleasant experiences, like hearing voices. It can also help you to feel calmer and think more clearly.

What's bad about having depot injections?

  • Some people feel uncomfortable about having injections, perhaps due to anxiety about needles.
  • Some people experience pain from the injection which can last for a few days - this is usually mild.

Apart from these problems, the side-effects of the medication are the same as with the tablet version of the same drug.

Most depot medications belong to the older group of antipsychotics ('first generation' or 'typical' antipsychotics). This means they will commonly be associated with side-effects such as stiffness or shaking in your arms and legs.

Can anything be done to avoid these problems?

Yes. Although having regular injections can be uncomfortable and seem daunting to begin with, it is possible to get used to the process, and you will gradually feel more comfortable with it. Discussing any anxieties with your nurse or doctor can also help.

The physical discomfort of regular injections can also be reduced by alternating the injection site each time. Most depots can be given at different intervals such as weekly, every 2 weeks, every 3 months or monthly. Choosing a dose which allows for less frequent injections can also be helpful.

If you experience side-effects from your depot medication, having smaller amounts of the medicine can help, or you can take another medicine to reduce the side-effects. It is usually best to reduce the dose of medication to a level where these unpleasant effects do not happen.

Can you say 'no' to having these injections?

Yes you can, just the same as with any other medication. But, if you are kept in hospital under a section of the Mental Health Act, the doctors could make you have treatment (again, like any other medication) even if you don't want it. After 3 months, if you say still don’t want the treatment, the hospital has to ask an independent doctor from a different hospital to see you and decide if you need the medicine or not.

 

What happens if you miss an injection?

If you miss an injection, you should have another one as soon as you can. If you do not, over a few weeks or months the medicine will stop working and some of the old problems will come back, like hearing voices or feeling troubled or scared. You may start to feel worse than before you started the medicine if you keep missing the depot injections.

 

What if you are not happy about the injections?

Talk to your doctor, nurse or key worker. They might be able to help you feel OK about it, or suggest a different treatment. If you have any questions about your medicine or if you do not understand anything you have read here please ask your doctor, nurse or key worker. They want to help.

 

Warnings

Depot injections may make you feel sleepy, so:

  • Be careful with alcohol - it will make you even more sleepy
  • Don't drive a car or work any machinery if you are not fully awake or if you feel the medicine is affecting your concentration
  • Some other medicines, such as sleeping pills or hay fever pills may make you feel more sleepy when you have depot injections.
This leaflet was produced by the Royal College of Psychiatrists' Public Education Editorial Board
Series Editor: Dr Philip Timms.
Expert review: Dr Michael Yousif
 
Information about treatments can change rapidly and the College updates its mental health information leaflets regularly.
 
© March 2013. Due for review: March 2015. Royal College of Psychiatrists.
This leaflet may be downloaded, printed out, photocopied and distributed free of charge as long as the Royal College of Psychiatrists is properly credited and no profit gained from its use. Permission to reproduce it in any other way must be obtained from permissions@rcpsych.ac.uk. The College does not allow reposting of its leaflets on other sites, but allows them to be linked directly.
 
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