A pharmacist is someone who is registered with the Royal Pharmaceutical Society of Great Britain.  In order to be registered, they must have spent at least four years studying drugs and medicines and obtained a degree in pharmacy at an approved university.  They will also have spent at least a year working under the supervision of an experienced pharmacist, usually in a hospital or community pharmacy (chemist's shop).

Before anyone can call themselves a pharmacist, pharmaceutical chemist, Member of the Royal Pharmaceutical Society, or Fellow of the Royal Pharmaceutical Society, he or she must be a registered pharmacist.  It is illegal for anyone to call themselves a pharmacist or even suggest by inference that they are a pharmacist if they are not registered with the Royal Pharmaceutical Society.

During their training pharmacists study all aspects of drug treatment, including:

• the effects of drugs on the mind and the body
• the manufacture of drugs and medicines
• the law relating to drugs and medicines.

They are not medical doctors, although, like anyone else, pharmacists may study for a PhD which allows them to use the title Doctor (Dr).

Are there different sorts of pharmacists?

Once someone is registered as a pharmacist, they are legally allowed to deal with drugs and medicines and could potentially work in a number of different areas:

What does a pharmacist do?

This depends on the type of pharmacist.  All pharmacists are trained as experts in drugs and medicines, but pharmacists working in a community pharmacy will develop a different range of skills from those working solely in specialist areas e.g. within a Mental Health Trust. Indeed, many community pharmacists have only a limited understanding of psychiatry and psychotropic medication (drugs which have an influence on the function of the brain). 

The supply of drugs and medicines:

When you take your prescription to a pharmacist they will first check that what the doctor has prescribed is reasonable.  This means checking that the dose and frequency is usual for the drug concerned.  If your doctor has prescribed more than one drug, the pharmacist will also make sure that there should be no problems when the drugs are given together. (see ‘Is it safe…’ page 5)

If there is anything unusual about your prescription, the pharmacist will contact your doctor to discuss and confirm the details. However, given the vast range of doses that can be used for some medicines, the pharmacist may decide to check with you whether you have had the drugs before. This helps him or her to decide if it is appropriate to discuss your prescription with the doctor.  Usually, a pharmacist will not make changes to your prescription without first confirming it with the doctor.

Advice on treatment

Some hospitals and community trusts employ specialist pharmacists to work in mental health.  These pharmacists often work as part of a multi-disciplinary team and have a direct involvement in your drug treatment.  They will make recommendations on the types of drugs and doses which may be most appropriate for you.  They should also be able to discuss any questions or concerns you may have about any aspect of treatment with drugs or medicines.

Why can I buy some drugs from a pharmacy, but not others?

The law covering the supply of medicines (The Medicines Act) specifies those medicines which can be supplied only on prescription from a doctor (or dentist), and those which can be obtained from a pharmacist.  It also states which medicines you can buy from the newsagent or supermarket.  All drugs used in mental health must be prescribed by a doctor before a pharmacist can supply them. Even if you are in hospital or at a day centre, only a doctor can authorise the supply of your medication.

If you are away from home and find you have run out of your medication, you can contact a pharmacist who may be able to give you an emergency supply of your usual medication.

Where do I find a pharmacist?

This depends on why you need a pharmacist.  If you have been given a prescription by your GP, you may take it to any pharmacy in the country. However, it is probably best to get to know your local pharmacist and take your prescription there - particularly if you use medication regularly.  (If you are not sure where to go, look in Yellow Pages or telephone your local Community Health Council. Talking Pages on (0800) 600900 can also give details of local chemists with ‘out-of-hours’ services). Some High Street pharmacies hold computerised records of patients' or customers' long-term prescriptions (some do not).

If you have a prescription from your hospital, outpatient clinic or day centre, you will usually have to take this to the pharmacy at the hospital or NHS Community Trust where it was issued.  In some cases you will find your drugs and medicines are delivered from the pharmacy and handed to you by your nurse or keyworker.

If there are specialist pharmacists working in your mental health team, you may be given a booklet or leaflet describing how they can be contacted; if not, ask your doctor, nurse or keyworker if you can arrange to see a pharmacist.

What can I ask a pharmacist?

Anything you like about your medication.  However, many drugs can be used for more than one condition, so unless your pharmacist has already been involved in your treatment, it will be impossible for them to know why you have been given a particular medication.  For example, a drug like carbamazepine (Tegretol) could have been prescribed to manage epilepsy or fits, but could equally have been given to control mood swings in someone who does not have epilepsy but has bipolar disorder, a totally unrelated condition.  In this instance, it would be impossible for a pharmacist to tell you why you have been given a particular drug just by looking at the prescription. 

Apart from this, the pharmacist should be able to answer any other questions you may have about your drug treatment.  Where a specialist pharmacist has been involved in your treatment, naturally you can expect them to explain all about the drug and why you have been given it.

What are the most important questions I should ask?

The pharmacist will be able to tell you which different parts of the body the drug affects, and what this means for you taking the drug.  In the field of mental health in particular, there is still a great deal of uncertainty about exactly how some of the drugs used produce their effects; but this should not stop the pharmacist explaining what the drug does in general terms.  If you already know why you have been given a particular drug, tell the pharmacist; this will make it easier for them to explain the relevant points.

None of the drugs available at the moment actually cures mental health problems; they all aim to reduce, relieve or suppress the symptoms.

All drugs produce side effects.  Once a drug is taken, it does not magically know where in the body (or brain) to act.  The drug passes into the blood stream and is carried throughout the body.  Therefore, there is a likelihood that the drug may affect more than one system in the body.  If it does, and it produces an unwanted effect, this is called a "side effect".  Sometimes people use the term "adverse effect" to describe the negative side effects of a drug.

Given the complexity of drugs as well as of the mind and body, some drugs have the potential to cause many side effects. Some of them may affect the majority of people who take the drug, while others may be very rare - affecting only 1 in 1000 people or fewer. Some may be very minor effects - others so severe that the drug must be stopped immediately.  If you have only a short time to speak to the pharmacist, you might want to ask which side effects are common and if there are any serious side effects.

Even simple questions like this one can sometimes be difficult to answer.  Drowsiness, for example, is a common side effect of many drugs used in mental health, but is it serious?  Clearly that depends on the severity of the drowsiness.  Neuroleptic malignant syndrome, however, is a potentially life-threatening side effect of anti-psychotic drugs (also referred to as neuroleptics and, misleadingly, as major tranquillisers).  Reports vary, but the syndrome may occur in about 1% of people taking anti-psychotics.  Is 1 in 100 common?

This depends on the type of medication you have been given and why it has been prescribed for you.

Again, this depends on the type of medication you are taking and also on how one defines addiction.

This does happen with some drugs, but generally speaking all the drugs commonly used in mental health are unlikely to become less effective as you continue to take them. The exception being benzodiazepines or sleeping tablets.

None of the available drugs cures mental distress.  Unfortunately, for many people the symptoms are only controlled while they continue taking the drug.  If drug treatment is stopped prematurely there may be a risk of symptoms returning.

When two or more drugs are taken together, they can interact in a number of ways. So, if you usually take medication and are prescribed another it would be wise to check that it is safe to take the two together.  Some drugs can interfere with your usual medication by preventing it from working as well as it should.  Other drugs can affect the way the body deals with your usual medication.  For instance, some drugs can speed up the rate at which your medication passes through the body - causing it to work less efficiently.  Others still can slow down the process of removal - making your medication more effective, but perhaps also increasing the side effects experienced.  Some drugs produce the same side effects, which can also cause problems.  For example, if your medication makes you feel sleepy and you take another drug that has the same side effect, you may end up feeling extremely sleepy.

There are hundreds of interactions, with more being discovered all the time.  Most interactions are not dangerous but a very few can be - so it always pays to ask.

Some drugs can interact with oral contraceptives (the pill). So you may need to use a different method of contraception while taking that particular medication.

Drugs taken during pregnancy and when breastfeeding may affect the developing baby or newborn infant. To minimise any risk of harm, it is best to completely avoid taking medication at this time. Medication should only be prescribed if the benefits to you, the mother, outweigh the potential risk of harm to the baby. Your pharmacist should be willing to discuss the pros and cons of drug treatment during pregnancy or breastfeeding with you.

Why do drugs have more than one name?

When a drug is first produced, it is given a chemical name, which is the approved name for that particular drug.  When a drug company manufactures the drug in a form which can be given to a patient, they are allowed to give it any name they like (a brand name). For example, the drug chlorpromazine is given the brand name Largactil when it is manufactured as a tablet by one particular drug company.  In practical terms especially when a drug is used a lot and has been on the market for a long time, the two names are interchangeable.  If more than one drug company make the same drug, it will be given a different brand name by each drug company that supplies it.  If your GP prescribes a particular brand of drug, the pharmacist must supply you with that specific brand.  In hospitals or Community Trusts this is not the case; they may give you a different brand of the same drug.

Do I need to be taking medication before I can discuss it with a pharmacist?

No.  The pharmacist will be able to explain and discuss drug treatment with you, even if you are not taking it.  Prior to starting long-term treatment, with a drug such as lithium for example, it may be helpful to arrange to see a pharmacist to discuss it.  Some people may be worried about the effects taking (or not taking) medication might have on a relative or friend. Again, it is fine to discuss this with a pharmacist. In both cases speaking to a pharmacist who specialises in mental health would be particularly helpful.

Do I need an appointment to see the pharmacist?

This depends on how long you need to spend with the pharmacist.  You can walk into any community pharmacy and ask to speak to the pharmacist.  If they are not already dealing with someone else, they might be able to spend some time answering your questions. However, if the pharmacist is busy they may suggest that you call back at a quieter time in order to spend longer with you. Some pharmacists have a quiet area set aside where you can talk in some privacy.

Specialist pharmacists in hospitals or community trusts may have specific times when they are available to discuss medication; others are available throughout normal working hours.  There are no fixed rules and the availability of pharmacists depends on local arrangements.  You should always be able to call in to a pharmacy or telephone a pharmacist for advice or information about your medication.  If you are not sure where to contact a pharmacist, telephone the Hospital or Community Trust.

Can I ask the pharmacist to speak to local user groups or self-help groups?

Yes.  Most pharmacists, particularly those employed as specialists, will be quite happy to arrange to speak about drugs or to come along and answer any questions group members may have about medication.

Do pharmacists have a Code of Ethics?

Yes.  It is published by the Royal Pharmaceutical Society. 

The code of ethics lays down the fundamental duties of all pharmacists.  There are nine principles in all, which form the basis of the code.  It reminds pharmacists that their prime concern must be the welfare of the patient, as well as ensuring that all pharmacists act in an appropriate and professional manner.  Other parts of the code include ensuring that the pharmacist's knowledge remains up-to-date, and that they are always in a position to maintain their independent professional judgement.  Finally, as with other health professionals, a pharmacist must respect the confidentiality of any information acquired in the course of professional practice, and never disclose this information to others without the patient's consent. 

Every registered pharmacy is visited regularly by an Inspectorate from the Royal Pharmaceutical Society. Any pharmacist who is found to have breached the code of ethics could have their name removed from the register and would therefore be unable to practise.

What if I want to make a complaint?

Any complaint about a pharmacist?s work or professional conduct can be made in writing or by telephone to the Professional Standards Directorate at the Royal Pharmaceutical Society (see Helpful Organisations page 8), who will carry out an investigation or refer complainant to other official bodies as appropriate.

Where else can I find out about my drugs and medicines?

Some people have very limited access to pharmacies and pharmacists. For example, only 21% of rural parishes have a pharmacy (be that independent or part of the GP’s surgery)¹ - so there is a great need for other sources of information. Obviously, doctors, nurses and keyworkers should be able to answer queries about drug treatment. Here are some other alternatives:

Note: You should always check the publication dates of this type of information and make sure you are looking at the most up-to-date information available. 

Note: If you do spend time looking up information about your medication in books and leaflets, it is probably still sensible to discuss this with a pharmacist, who will be able to help you to put the information into context.

Helpful Organisations

Details of specialist pharmacists or community mental health trusts can be found in the local telephone directory.

Royal Pharmaceutical Society of Great Britain
1 Lambeth High Street
London
SE1 7JN

Further reading

Available from Mind Publications on (020) 8221 9666:

Making Sense of Treatments and Drugs:           

• Anti-depressants
• Major Tranquillisers
• Minor Tranquillisers
• Lithium

Mind Publications also stocks a range of books on drugs and treatments, including The Complete Guide to Psychiatric Drugs – A Layman’s Guide by Ron Lacey, which explains the benefits, adverse effects and hazards of the complete range of psychiatric drugs.

Further information on several types of anti-depressant and major tranquilliser, tardive dyskinesia and taking lithium during pregnancy is also available from Mind’s Information Unit.

Contact Mind at: 15-19 Broadway, London E15 4BQ 
website www.mind.org.uk

Based on original work by Peter Pratt, Chief Pharmacist at Community Health Sheffield.

Mind Information Unit

Updated August 1999.

[1] 1997 survey of rural services, Rural Development Commission

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