Struggling in the heat: what I need to know about my medicationBMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p2199 (Published 29 September 2023) Cite this as: BMJ 2023;382:p2199
- Stephanie Allan
I’m in my mid 30s and have been taking antipsychotic medication for schizophrenia for more than 10 years. When someone is first prescribed an antipsychotic, they are likely to be having a tricky time and potentially in the strange new environment of a hospital ward, which means they may not always remember initial conversations clinicians had with them about side effects. Or at least, this was the case for me. In a similar way, medications acquired from a pharmacy will readily provide lists of side effects, but these are often long and generic.
For me, side effects are not fixed. They change over time and can be impacted by alterations in antipsychotic type, circumstances, or behaviours. They can also be influenced by factors that affect everyone, such as the climate crisis.
I knew my medication made me drowsy and prone to weight gain. But for many summers I had also noticed that I struggled to tolerate the heat as the UK weather grew more extreme. I would sweat profusely, my skin would feel clammy, and I would feel very tired, irritable, and would struggle to think. I began to assume that I was being lazy. I had no idea this was related to my medication. I am well supported by my mental health team, but if they ever mentioned this side effect to me, I do not remember it.
I am very lucky to work in mental health research. I will never forget visiting a mental health team in a historically warm country and seeing how their waiting room was covered with information about coping with heat when you are taking antipsychotics. There it was—I was not their patient, but reading their thoughtfully prepared material changed my life and helped me recognise that I was experiencing a side effect.
When I returned to Scotland after that work trip, I looked up lots of health communication from warm countries and learned about things I could do to help myself. These include finding a cooler place to sit, drinking plenty of fluids, and avoiding overexertion. Just knowing that I had to be more aware of the heat and ensure I was taking extra care was helpful.
The importance of information
Not everyone gets access to important health information in a way that is accessible to them. Not everyone prescribed antipsychotics is able to implement strategies to reduce the impact of the heat and may need support to do so. Having access to this information has been beneficial for my health. I hope that more health professionals will consider the potential impact of the changing climate on patients, especially those who may be more affected by the rising temperatures.
What you need to know
Heat intolerance induced by antipsychotic medications can be unpleasant or even dangerous
Some people prescribed antipsychotics may live in situations where the health risks of intense heat are hard to avoid
Conversations about antipsychotic side effects should seek to make patients aware of these risks and challenges
Education into practice
How do you consider the impact of climate change on patients when prescribing?
What information could you share with patients who are facing increased health concerns related to climate change?
How do you communicate medication side effects and their potential management?
State of New Jersey Division of Mental Health and Addiction Services. Heat and sun risks for users of antipsychotic medications. https://www.nj.gov/humanservices/dmhas/publications/miscl/Summer_Heat_Risks_ENG.pdf
Competing interests: xxx
Provenance and peer review: commissioned; not externally peer reviewed.