What is an Over-the-Counter Drug?

Introduction

Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescription.

In many countries, OTC drugs are selected by a regulatory agency to ensure that they contain ingredients that are safe and effective when used without a physician’s care. OTC drugs are usually regulated according to their active pharmaceutical ingredient (API) rather than final products. By regulating APIs instead of specific drug formulations, governments allow manufacturers the freedom to formulate ingredients, or combinations of ingredients, into proprietary mixtures.

The term OTC refers to a medication that can be purchased without a medical prescription. In contrast, prescription drugs require a prescription from a doctor and should only be used by the prescribed individual. Some drugs may be legally classified as OTC (i.e. no prescription is required), but may only be dispensed by a pharmacist after an assessment of the patient’s needs or the provision of patient education. Regulations detailing the establishments where drugs may be sold, who is authorised to dispense them, and whether a prescription is required vary considerably from country to country.

Usage

As of 2011, around a third of older adults in the US reportedly used OTC drugs. By 2018, the prevalence of use by adults in the US as first-line treatment for minor illnesses had reached 81%.

Regulation by Country

Canada

In Canada, there are four drug schedules:

  • Schedule 1: Requires a prescription for sale and is provided to the public by a licensed pharmacist.
  • Schedule 2: Does not require a prescription but requires an assessment by a pharmacist prior to sale. These drugs are kept in an area of the pharmacy where there is no public access and may also be referred to as “behind-the-counter” drugs.
  • Schedule 3: Does not require a prescription but must be kept in an area under the supervision of a pharmacist. These drugs are kept in an area of the retail outlet where self-selection is possible, but a pharmacist must be available to assist in the self-selection of medication if required.
  • Unscheduled: Does not require a prescription and may be sold in any retail outlet.

All medications other than Schedule 1 may be considered an OTC drug, as they do not require prescriptions for sale. While the National Association of Pharmacy Regulatory Authorities provides recommendations on the scheduling of drugs for sale in Canada, each province may determine its own scheduling. The drugs found in each schedule may vary from province to province.

Indonesia or India

In November 2016, India’s Drug Consultative Committee announced it was embarking on establishing a definition of drugs which could be dispensed without a prescription. Prior to this, the general assumption was that any drug which did not fall into a prescription schedule could be purchased without a prescription. However, the needed definition had not been enacted by early 2018. The lack of a legal definition for OTC drugs has led to this US$4 billion market segment being effectively unregulated.

Netherlands

In the Netherlands, there are four categories:

  • UR (Uitsluitend Recept): prescription only.
  • UA (Uitsluitend Apotheek): pharmacist only.
  • UAD (Uitsluitend Apotheek of Drogist): pharmacist or drugstore only.
  • AV (Algemene Verkoop): may be sold in general stores.

A drug that is UA may be sold OTC but only by pharmacists. The drug can be on the shelves like any other product. Examples are domperidone, 400 mg ibuprofen up to 50 tablets and dextromethorphan. A drug that is UAD can also be sold at drugstores, stores where no prescription can be filed and there is only a relatively small selection of popular drugs like painkillers and cough medicine. The drugs are usually on the shelves, and the store also sells items like toys, gadgets, perfumes and homeopathic products. The drugs in this category have limited risk and addiction potential. Examples are naproxen and diclofenac in small amounts, cinnarizine, 400 mg ibuprofen up to 20 tablets and also 500 mg paracetamol up to 50 tablets. Drugs in the AV category can be sold at supermarkets, gas stations, etc. and include only drugs with minimal risk to the public, like paracetamol up to 20 tablets, 200 mg ibuprofen up to 10 tablets, cetirizine and loperamide.

United States

In the United States, the manufacture and sale of OTC substances are regulated by the Food and Drug Administration (FDA). The FDA requires that all “new drugs” obtain a New Drug Application (NDA) before entering interstate commerce, but the act exempts any drugs generally recognised as safe and effective (GRAS/E). To deal with the vast number of OTC drugs that were already on the market before the requirement that all drugs obtain an NDA, the FDA created the OTC monograph system to review classes of drugs and to categorise them as GRAS/E after review by expert panels. Certain classes of OTC drugs would not be required to obtain an NDA and could remain on the market if they conformed to the monograph guidelines for doses, labelling, and warnings finalized in the Code of Federal Regulations.

Thus, an OTC drug product is allowed to be marketed either (1) pursuant to an FDA monograph or (2) pursuant to an NDA for products that do not fit within a specific monograph. There is also the possibility that certain OTC drug products are marketed under the grandfathering provisions of the Federal Food, Drug, and Cosmetic Act, but the FDA has never formally acknowledged that any legitimate grandfathered OTC drug exists.

Examples of OTC substances approved in the United States are sunscreens, anti-microbial and anti-fungal products, external and internal analgesics such as lidocaine and aspirin, psoriasis and eczema topical treatments, anti-dandruff shampoos containing coal tar, and other topical products with a therapeutic effect.

The Federal Trade Commission regulates advertising of OTC products, in contrast to prescription drug advertising, which is regulated by the FDA.

The FDA requires OTC products to be labelled with an approved “Drug Facts” label to educate consumers about their medications. The labels comply to a standard format and are intended to be easy for typical consumers to understand. Drug Facts labels include information on the product’s active ingredient(s), indications and purpose, safety warnings, directions for use, and inactive ingredients.

The 2020 Coronavirus Aid, Relief, and Economic Security Act (CARES Act) includes reforms that modernise the way certain OTC drugs are regulated in the United States. Many OTC monographs need to be updated but updating or changing an OTC monograph requires the slow and burdensome notice-and-comment rulemaking process. The CARES Act includes OTC monograph reform provisions that replace the rulemaking process with an administrative order process.

Restricted Over-the-Counter Substances (US)

An ill-defined third category of substances is products having over-the-counter status from the FDA while being simultaneously subject to other restrictions on sale. While they are legally classified as OTC drugs, they are typically stored behind the counter and are sold only in stores that are registered with their state. They may be unavailable in convenience and grocery stores that stock other non-restricted OTC medications.

For example, many drugstores have moved products containing pseudoephedrine, an OTC product, into locations where customers must ask a pharmacist for them. A prescription is not required; the change has been made in an effort to reduce methamphetamine production. Since the passage of the Illinois Methamphetamine Precursor Control Act and the subsequent federal Combat Methamphetamine Epidemic Act of 2005, the purchase of pseudoephedrine is restricted. Sellers of pseudoephedrine must obtain and record the identity of the purchaser and enforce quantity restrictions. Some states may have more stringent requirements (such as Oregon, where a medical prescription is required to purchase any quantity of pseudoephedrine). After initial attempts to control methamphetamine use (by requiring documentation of sale with government issued ID as well as limits on the quantity an individual could purchase) failed to realise meaningful reductions in methamphetamine use and production, Mississippi passed House Bill 512 in the State Senate on February 2, 2010 “to require a prescription from a licensed medical professional to purchase over-the-counter medicines with pseudoephedrine, ephedrine, or any other precursor chemical that can readily and illicitly be converted into methamphetamine, Methcathinone or any active/scheduled analogues of Phenylethylamines/ amphetamine.” However, products containing the substance are still OTC in most states, since no prescription is required.

A similar regulation once applied to some forms of emergency contraception. However, on 25 February 2014, the FDA approved generic one-pill emergency contraception products for unrestricted sale on the shelf. There is no age limit or need for ID to purchase.

Furthermore, some Schedule V controlled substances may be classified as OTC products in certain states. Such drugs are sold without a prescription but are subject to record-keeping rules and quantity and/or age restrictions, and they must be dispensed by a pharmacy. Finally, pharmacies frequently require a prescription for Schedule V drugs as a matter of policy, despite their OTC status according to applicable laws and regulations.

United Kingdom

In the United Kingdom, medication is governed by the Medicines Regulations 2012. Medication falls into one of three categories:

  • Prescription Only Medication (POM), which are legally available only with a valid prescription from a prescriber.
    • A pharmacist has to be on the premises for POM medicines to be dispensed, required by law.
    • The medicine has been specifically prescribed for the patient holding the prescription, so it is considered safe for only the recipient to take.
    • Just a small example of these include most antibiotics and all antidepressants or antidiabetic medications.
    • Drugs included as POM are high-strength painkillers such as oxycodone and tramadol, medications such as Zolpidem (Ambien), diazepam (Valium), and certain topical preparations such as corticosteroids.
    • These medicines are often sold by drug dealers, especially those marked as “CD POM,” which are controlled due to abuse risk such as dipipanone, temazepam, and methadone.
  • General Sales List (GSL), available off the shelf with no pharmacy training required to sell (so they can be sold anywhere, such as supermarkets).
    • In general, they are considered safe for most people when taken correctly.
    • Examples of these include 16-packs (or less) of painkillers such as paracetamol and ibuprofen as well as a host of other safe medications such as small pack sizes of antiallergy tablets, laxative medication, and skin creams.
  • Pharmacy Medicines (P) are medicines that are legally neither a POM or GSL medication.
    • These can be sold from a registered pharmacy but should not be available for self-selection (although directions to discuss a ‘P’ product may be allocated shelf space with associated GSL items).
    • ‘P’ medications are reserved from the GSL list as they are either associated with a need for advice on use, or used in conditions which may require referral to a medical prescriber.
    • Suitable trained counter assistants may sell a ‘P’ medication under the supervision of a pharmacist and will ask questions to determine if the customer needs to be referred for a discussion with a pharmacist.
    • Some ‘POM’ medicines are available for use in certain situations and doses as ‘P’ medicines.

If it is not appropriate to sell a ‘P’ medication – i.e. the condition is not suitable for self-management and requires referral to a medical prescriber – then a sale should not occur and the pharmacist has a legal and professional obligation to refer this on to an appropriate service.

Examples of these include some sleep aid tablets such as Nytol, human deworming tablets such as Mebendazole, painkillers with small amounts of codeine (up to 12.8 mg per tablet), and pseudoephedrine. Medication available only with a prescription is marked somewhere on the box/container with [POM]. Pharmacy-only products are marked with [P]. A prescription is not required for [P] medicines, and pharmacy sales assistants are required by Royal Pharmaceutical Society codes to ask certain questions, which varies for what the customer says. If they ask for a specific product, the pharmacy assistant must ask “Who is it for,” “How long have you had the symptoms,” “Are you allergic to any medication,” “Are you taking any medication” (‘WHAM’ questions). If a customer asks for a remedy, e.g. hay fever, then the two WHAM questions must be followed “Who is it for,” “What are the symptoms,” “How long have you had the symptoms,” “Have you taken any action towards your symptoms,” and “Are you taking any other medication.” It is with this information that the pharmacist can halt the sale, if need be. No [POM], [P] or [GSL] products that are stocked in a pharmacy can be sold, dispensed, or pre-made until a responsible pharmacist is signed in and on the premises. Some medication available in supermarkets and petrol stations is sold only in smaller packet sizes. Often, larger packs will be marked as [P] and available only from a pharmacy. Frequently, customers buying larger-than-usual doses of [P] medicines (such as DXM, promethazine, codeine or Gee’s linctus) will be queried, due to the possibility of abuse.

Transitions between Prescription and OTC

As a general rule, over-the-counter drugs have to be used primarily to treat a condition that does not require the direct supervision of a doctor and must be proven to be reasonably safe and well tolerated. OTC drugs are usually also required to have little or no abuse potential, although in some areas drugs such as codeine are available OTC (usually in strictly limited formulations or requiring paperwork or identification to be submitted during purchase).

Over time, often 3-6 years, drugs that prove themselves safe and appropriate as prescription medicines may be switched from prescription to OTC.[citation needed] An example of this is diphenhydramine (Benadryl), an anti-histamine which once required a prescription but now is available OTC nearly everywhere. More recent examples are cimetidine and loratadine in the United States, and ibuprofen in Australia.

It is somewhat unusual for an OTC drug to be withdrawn from the market as a result of safety concerns, rather than market forces, though it does happen occasionally. For example, phenylpropanolamine was removed from sale in the United States over concern regarding strokes in young women. A study has been done examining consumer’s perceptions about the risk of and access to non-prescription medication. The study concluded that a small percentage of consumers prefer having access to medication over potential risks of taking non-prescribed medication. Ranitidine was withdrawn from multiple markets due to concerns over the carcinogen N-nitrosodimethylamine (NDMA).

In the United Kingdom, it was announced in February 2007 that Boots the Chemist would try OTC sales of Viagra in stores in Manchester, England (previous available as prescription only). Men aged between 30 and 65 could buy four tablets after a consultation with a pharmacist.

Can Lorazepam be Considered to be a Clinically Effective Means of Treating the Acutely Agitated Patient?

Research Paper Title

Treatment of Agitation With Lorazepam in Clinical Practice: A Systematic Review.

Background

Acute agitation is a frequent occurrence in both inpatient and outpatient psychiatric settings, and the use of medication to calm a patient may be warranted to mitigate the situation. Lorazepam is a benzodiazepine that is widely used for management of acute agitation. Despite its widespread use, there is remarkably little clinical evidence for the benefits of lorazepam in acute agitation.

Methods

The researchers performed a systematic review with focus on lorazepam, including all randomised clinical trials on lorazepam in mental and behavioural disorders, excluding studies on dementia and paediatric patients and in mixed conditions.

Results

A total of 11 studies met inclusion criteria, and all were in patients with mental and behavioural disorders. Most trials generally found improvements across a variety of outcomes related to agitation, although there was some disparity if specific outcomes were considered.

In the five studies with haloperidol, the combination of lorazepam and haloperidol was superior to either agent alone, but with no differences between monotherapy with the individual agents.

Conclusions

In the study comparing lorazepam to olanzapine, olanzapine was superior to lorazepam, and both were superior to placebo.

As expected, the safety of lorazepam among the different studies was consistent with its well-characterised profile with dizziness, sedation, and somnolence being the most common adverse events.

Based on this structured review, lorazepam can be considered to be a clinically effective means of treating the acutely agitated patient.

Reference

Amore, M., D’Andrea, M. & Fagiolini, F. (2021) Treatment of Agitation With Lorazepam in Clinical Practice: A Systematic Review.

Book: A Straight-talking Introduction to Children’s Mental Health Problems

Book Title:

A Straight-talking Introduction to Children’s Mental Health Problems (Straight Talking Introductions).

Author(s): Sami Timimi (Author), Richard Bentall (Editor), and Pete Sanders (Editor).

Year: 2009.

Edition: First (1st).

Publisher: PCCS Books.

Type(s): Paperback and Kindle.

Synopsis:

Rates of diagnosis of psychiatric disorders such as ADHD, and the subsequent prescription of psychiatric drugs in children, have increased alarmingly over recent years. Yet diagnoses are supported by very little scientific evidence and the effectiveness and safety of drugs for children is highly questionable. Unlike medications, psychotherapeutic or ‘talking therapies’ with children, adolescents and their families have established themselves as both safe and effective. Here, Sami Timimi arms you with some of the information you’ll need to make informed choices about a child’s diagnosis and treatment. He provides an honest account of the dangers of medicating children or adolescents and discusses alternative therapies. He also describes practical advice on things parents can try themselves, common pitfalls to avoid, and how to find the professionals you need.

Book: A Straight Talking Introduction to Psychiatric Drugs: The Truth About How They Work and How to Come Off Them

Book Title:

A Straight Talking Introduction to Psychiatric Drugs: The Truth About How They Work and How to Come Off Them (The Straight Talking Introduction Series).

Author(s): Joanna Moncrieff.

Year: 2020.

Edition: Second (2nd), Revised Edition.

Publisher: PCCS Books.

Type(s): Paperback and Kindle.

Synopsis:

In an era when more people are taking psychiatric drugs than ever before, Joanna Moncrieff’s explosive book challenges the claims for their mythical powers. Drawing on extensive research, she demonstrates that psychiatric drugs do not ‘treat’ or ‘cure’ mental illness by acting on hypothesised chemical imbalances or other abnormalities in the brain. There is no evidence for any of these ideas. Moreover, any relief the drugs may offer from the distress and disturbance of a mental disorder can come at great cost to people’s physical health and their ability to function in day-to-day life. And, once on these drugs, coming off them can be very difficult indeed. This book is a wake-up call to the potential damage we are doing to ourselves by relying on chemical cures for human distress. Its clear, concise explanations will enable people to make a fully informed decision about the benefits and harms of these drugs and whether and how to come off them if they so choose.

What is the Role of the Microbiota-Gut-Brain Axis in Mental Health & Medication Response?

Research Paper Title

The Microbiota-Gut-Brain Axis in Mental Health and Medication Response: Parsing Directionality and Causality.

Abstract

There is increasing evidence for the role of the microbiome in various mental health disorders. Moreover, there has been a growing understanding of the importance of the microbiome in mediating both the efficacy and side effects of various medications, including psychotropics.

In this issue, Tomizawa and colleagues report on the effect of psychotropic drugs on the gut microbiome of 40 patients with depression and/or anxiety disorders.

In their longitudinal cohort, the authors find that antipsychotics, but not anxiolytics, decrease microbiome alpha diversity. They further find that antipsychotics dosage was negatively correlated with alpha diversity in these patients.

The health consequences of these microbiome alterations remain to be fully understood. In this commentary, the authors will discuss such findings through the lens of several recent studies on the microbiota-gut-brain axis. They also use the paper as a backdrop to discuss directionality and, by extension, causality in relation to microbiota-gut-brain-brain signalling.

Reference

Bastiaanssen, T.F.S. & Cryan, J.F. (2021) The Microbiota-Gut-Brain Axis in Mental Health and Medication Response: Parsing Directionality and Causality. The International Journal of Neuropsychopharmacology. 24(3), pp.216-220. doi: 10.1093/ijnp/pyaa088.

Principles for Improving Investment in Translational Neuroscience Aimed at Psychiatric Drug Discovery

Research Paper Title

Time to re-engage psychiatric drug discovery by strengthening confidence in preclinical psychopharmacology.

Background

There is urgent need for new medications for psychiatric disorders. Mental illness is expected to become the leading cause of disability worldwide by 2030. Yet, the last two decades have seen the pharmaceutical industry withdraw from psychiatric drug discovery after costly late-stage trial failures in which clinical efficacy predicted pre-clinically has not materialised, leading to a crisis in confidence in preclinical psychopharmacology.

Methods

Based on a review of the relevant literature, the researchers formulated some principles for improving investment in translational neuroscience aimed at psychiatric drug discovery.

Results

The researchers propose the following 8 principles that could be used, in various combinations, to enhance CNS drug discovery:

  1. Consider incorporating the NIMH Research Domain Criteria (RDoC) approach;
  2. Engage the power of translational and systems neuroscience approaches;
  3. Use disease-relevant experimental perturbations;
  4. Identify molecular targets via genomic analysis and patient-derived pluripotent stem cells;
  5. Embrace holistic neuroscience: a partnership with psychoneuroimmunology;
  6. Use translational measures of neuronal activation;
  7. Validate the reproducibility of findings by independent collaboration; and
  8. Learn and reflect.

They provide recent examples of promising animal-to-human translation of drug discovery projects and highlight some that present re-purposing opportunities.

Conclusions: We hope that this review will re-awaken the pharma industry and mental health advocates to the opportunities for improving psychiatric pharmacotherapy and so restore confidence and justify re-investment in the field.

Reference

Tricklebank, M.D., Robbins, T.W., Simmons, C. & Wong, E.H.F. (2021) Time to re-engage psychiatric drug discovery by strengthening confidence in preclinical psychopharmacology. Psychopharmacology (Berl). doi: 10.1007/s00213-021-05787-x. Online ahead of print.

Book: Anatomy of an Epidemic

Book Title:

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America.

Author(s): Robert Whitaker.

Year: 2010.

Edition: First (1ed).

Publisher: Crown Publishing Group.

Type(s): Hardcover and Kindle.

Synopsis:

The award-winning author of Mad in America presents a controversial assessment of the rise in mental illness-related disabilities that considers if drug-based care may be fuelling illness rates throughout the past half century.

The Substance: Albert Hoffman’s LSD (2011)

Introduction

The Substance: Albert Hofmann’s LSD is a 2011 documentary film directed by Martin Witz.

The film documents the coincidental discovery of the drug LSD by the Swiss chemist Albert Hofmann in 1943.

Outline

In 1943, the year in which the first A-bomb was built, Albert Hofmann discovered LSD, a substance that was to become an A-bomb of the mind. Fractions of a milligram are enough to turn our framework of time and space upside down. The story of a drug – its discovery in the Basel chemistry lab, the first experiments by Albert Hofmann on himself, the 1950s experiments of the psychiatrists, the consciousness researchers, the artists. Could it actually be possible to find a path to the core of our human existence by means of a chemical? Spirituality at the flick of a switch? Do the enigmatic effects of this drug really help us to better understand the human soul? Could LSD be an instrument of contemporary psychiatry? Of modern brain research?

Production & Filming Details

  • Narrator(s): Trevor J. Roling (English), Hanspeter Muller (German), and Mario Scarabelli (Italian).
  • Director(s): Martin Witz.
  • Producer(s):
    • Elda Guidinetti … producer.
    • Peter Luisi … co-producer.
    • Andres Pfäffli … producer.
    • Carl-Ludwig Rettinger … co-producer.
  • Writer(s): Martin Witz.
  • Music: Marcel Vaid.
  • Cinematography: Pio Corradi and Patrick Lindenmaier.
  • Editor(s): Stefan Kalin.
  • Production:
    • Ventura Film (presents).
    • RSI-Radiotelevisione Svizzera (in co-production with).
    • Teleclub AG (in co-production with) (as Teleclub).
    • Lichtblick Film- und Fernsehproduktion (I) (in co-production with) (as Lichtblick Filmproduktion).
    • Spotlight Media Production AG (in co-production with) (as Spotlight Media Productions).
  • Distributor(s):
    • Officine UBU (2012) (Italy) (all media).
    • Cinema Delicatessen (2012) (Netherlands) (theatrical).
    • I Wonder Pictures (2013) (Italy) (theatrical).
    • Mindjazz Pictures (2012) (Germany) (theatrical).
    • Film1 Sundance Channel (2015) (Netherlands) (TV) (limited).
    • Frenetic Films (2011) (Switzerland) (all media).
    • Icarus Films (2012) (USA) (all media).
    • Soda Pictures (2011) (UK) (DVD).
    • Yleisradio (YLE) (2012) (Finland) (TV).
  • Release Date: 07 August 2011 (Locarno Film Festival, Switzerland).
  • Running Time: 90 minutes.
  • Rating: 15.
  • Country: US.
  • Language: English.

Video Link

Book: Psychiatric and Mental Health Nursing: The craft of caring

Book Title:

Psychiatric and Mental Health Nursing: The Craft of Caring.

Author(s): Mary Chambers.

Year: 2017.

Edition: Third (3rd).

Publisher: Routledge.

Type(s): Hardcover, Paperback and Kindle.

Synopsis:

This new edition of a bestselling, evidence-based textbook provides a comprehensive overview of psychiatric and mental health nursing. Keeping service users and their recovery at the centre of care, the holistic approach will help nurses to gain the tools and understanding required to work in this complex area.

Extensively updated for this new edition, the text looks at:

  • Aspects of mental health nursing: covering topics such as ethics, developing therapeutic relationships and supervision.
  • The foundations of mental health nursing: discussing diagnosis, assessment and risk.
  • Caring for those experiencing mental health distress: looking at wide range of troubles including anxiety, bipolar disorder, eating disorders and issues around sexuality and gender.
  • Care planning and approaches to therapeutic practice: exploring ideas, pathways and treatments such as recovery, CBT, psychodynamic therapies and psychopharmacology.
  • Services and support for those with mental health distress: covering topics such as collaborative work, involvement of service users and their families and carers, and a range of different mental healthcare settings.
  • Mental health nursing in the twenty-first century: highlighting emerging and future trends including the political landscape, physical health and health promotion, and technological advances.

This accessible and comprehensive textbook integrates service user perspectives throughout and includes student-friendly features such as learning outcomes, key points summaries, reflection points and further reading sections. It is an essential resource for all mental health nursing students, as well as an invaluable reference for practising nurses.

Book: Psychopharmacology: A mental health professional’s guide to commonly used medications (Nursing)

Book Title:

Psychopharmacology: A mental health professional’s guide to commonly used medications (Nursing).

Author(s): Herbert Mwebe.

Year: 2018.

Edition: First (1st).

Publisher: Critical Publishing Ltd.

Type(s): Paperback and Kindle.

Synopsis:

This jargon-free guide is suitable for all trainee and registered health professionals who require knowledge and understanding of drugs used in the treatment of mental health conditions for prescribing or administering purposes. A life-saving pocketbook that you can easily carry anywhere you go!

Introductory material provides a background on psychotropic drugs, the aetiology of mental illness, some of the commonly used drugs in practice and brief notes on common non-pharmacological interventional options. It also examines biochemical and neurodevelopmental theories and the link to the pathophysiology of mental illness as well as clinical decision making.

The central chapters of the book provide comprehensive coverage of all the major medications used in mental health. Each focuses on a specific class of drug, detailing the most commonly used medicines, including side effects, average doses, contra-indications and clinical management interventions that may be required. At the end of each chapter a series of review questions enable readers to review their learning, and theory is clearly related to practice throughout.