Twelve questions worth asking before you start a psychiatric medication

Most people leave the appointment with the prescription and none of the answers, because the questions only occur to them in the car park. The fix is embarrassingly simple: write the list down beforehand and put your phone face-up on the desk with it open.

Nobody minds. A prescriber would far rather spend three extra minutes now than deal with someone who stopped everything in week two without saying why.

1. What is it called, and what class is it?

Get the generic name, not just the brand — the same drug appears under several brand names and your tablets may change colour and packaging between pharmacies. Knowing the class ("it's an SSRI", "it's a second-generation antipsychotic") lets you read anything sensible about it later without falling into a forum.

2. What is it meant to change, for me specifically?

Not "it's for depression". What is it supposed to do to your sleep, your appetite, your concentration, the voices, the panic, the mornings? If you don't know the target, you can't tell whether you've hit it.

3. How will we know it's working, and by when?

Ask for a rough timescale. For antidepressants the NHS puts it at one to two weeks before any effect and up to eight weeks for the full effect. Knowing that in advance is what stops you abandoning it at day ten.

4. What are the two or three most likely side effects for me?

The leaflet lists everything anyone ever reported. Your prescriber can tell you which ones actually turn up, and roughly how long they last. That converts a terrifying list into two things to expect.

5. Which side effects mean I ring you, and which mean 999?

The most important question on the list, and almost nobody asks it. You want a specific, memorable answer — not "let me know if you have any problems". Day 4 covers the general warning signs, but yours will depend on what you're taking.

6. Does this need blood tests, an ECG or other monitoring?

Some medications come with monitoring that isn't optional — lithium levels, kidney and thyroid checks, mandatory blood counts with clozapine, weight and blood sugar with several antipsychotics, blood pressure and pulse with ADHD medication. Ask what yours needs, who arranges it, how often, and what happens if you miss one.

Monitoring is not a sign the drug is dangerous. It's a sign somebody is watching.

7. What does it interact with?

Ask specifically about: everything else you take including over-the-counter painkillers and cold remedies, herbal remedies (St John's wort is a serious offender and is sold freely in supermarkets), supplements, contraception, alcohol, and recreational drugs if that's relevant to you — and it is worth being honest about that, because the risk is real and the reaction won't be what you fear.

Any list you get, including this one, is illustrative rather than complete. Your pharmacist can check the full picture against everything you actually take, free, the same day.

8. What if I want children — now or in the future?

This is a question for men as well as women, and it should be asked before starting, not when a pregnancy test is positive.

Valproate is the clearest example of why. Under MHRA rules, valproate must not be started in any new patient, male or female, younger than 55 unless two specialists independently consider and document that there is no other effective or tolerated treatment. In pregnancy it carries a risk of physical birth defects in around 1 in 9 babies exposed and neurodevelopmental disorders in around 3 to 4 in 10. Women taking it are managed under a Pregnancy Prevention Programme. In February 2025 the MHRA confirmed that the two-specialist review is required when starting valproate under 55, but not for men already established on it.

Other medications carry their own considerations in pregnancy and breastfeeding, in both directions — untreated illness carries risk too. That is a planned conversation, ideally months ahead.

9. Can I drive?

Some psychiatric medications cause drowsiness or slowed reactions, particularly at the start and after a dose change. Separately, there are legal limits for certain prescribed drugs while driving, with a defence if you are taking them as prescribed — which is a reason to carry evidence of your prescription. There are also circumstances in which the DVLA must be told about a mental health condition itself. Ask directly, and check the current rules on GOV.UK.

10. How long am I likely to be taking it?

"Until we review it" isn't an answer. Ask for the expected shape: months, a year, indefinitely with reviews. The Royal College of Psychiatrists notes antidepressants are usually taken for at least six months after symptoms have gone. Knowing the plan makes it a treatment rather than a life sentence.

11. What's the plan for stopping?

Ask this at the start. It changes the answer you get, and it flags that you expect a taper rather than a stop. Day 3 covers why that matters.

12. What happens if it doesn't work?

Because there's a decent chance the first one won't, and knowing there's a plan B before you start removes most of the despair from week eight. Switching or adding is routine, not a failure.

Getting real answers in ten minutes

• Bring the list on paper or on your phone. Say at the start: "I've got four questions, can we do those before I go?" That reframes the appointment in one sentence.
• Bring someone if you can. Two people remember roughly twice as much, and it is much harder to be brushed off in front of a witness.
• Ask for the important bits in writing. Even a note on the prescription. Nobody retains verbal instructions while anxious.
• Ask for the patient information leaflet and, if you want it, a printed decision aid. They exist.
• Take the leftovers to the pharmacist. Interactions, timing, what to do about a missed dose, whether it can be taken with food — a pharmacist will answer all of that without an appointment, and they are the most under-used clinicians in the country.
• If you disagree, say so in the room. "I'm not comfortable with that — what else is there?" is a legitimate sentence. Nodding and then not collecting the prescription helps nobody, and it's the version that ends up on your record as non-compliance.