Medication for Schizophrenia

“One of the most important advances in the treatment of schizophrenia over the last half century has been the discovery of antipsychotic medications that reduce the troubling symptoms of the disorder and give people the chance to live normal lives,” Irene Levine, also a psychologist, said.

Unfortunately, there are many misconceptions about medication and “stigma attached to taking medications for a mental disorder as compared to taking them for physical problems,” she added. However, medications form the “foundation on which the recovery process is built,” Velligan said. “With good medication on board, individuals can turn their attention to improving their quality of life and attaining their recovery goals.”

Are some medications better than others? According to Levine, the second generation antipsychotics are “no better or worse” than the first generation. Almost all antipsychotics have similar efficacy. The main difference is in the side effects: “The older drugs give rise to movement disorders, while the newer ones set the stage for weight gain and metabolic side effects.” (For more on antipsychotic medications, see here and here.)

Finding the right medication or combination of medications is a complex and highly individual process. It’s often a balancing act between making sure the patient experiences benefits and doesn’t experience intolerable side effects. “Just like blood pressure or cholesterol-lowering drugs, medications for schizophrenia may have to be changed, increased, decreased and tinkered with for optimal results,” Irene Levine said.

Still, patients may get frustrated and want to stop taking their medication. “Many clinicians use too low or too high a dose, or combine many medications at once in the absence of any evidence for a clear benefit,” which can worsen schizophrenia and side effects, Dr. Rose said.

Tips for Taking Medication

When taking medication, keep the following in mind:

  • Become an active participant. Watching your treatment — or the treatment of a loved one — on the sidelines doesn’t help anyone. Taking an active role leads to more successful treatment.
  • Educate yourself. Whether you or your loved one has schizophrenia, educate yourself “about the various drugs and potential side effects,” Irene Levine said. Invest the time in learning everything you can about these medications. But, if you come across personal experiences (whether the accounts concern pharmacological or psychosocial treatments), keep in mind that this is an idiosyncratic experience, Dr. Drake said. So don’t rule out a certain medication or treatment because of negative information but do raise the concerns to your provider and do more research.
  • Be sure it’s a partnership. Because finding the best balance is already a hard process, not having a provider you trust can make it even harder, Dr. Drake said. Make sure that your provider welcomes a collaborative relationship with patients.
  • Create a medication list. Keep an updated list of your medications handy. Your list should include “all medications taken, the length of time they were taken, the dose and the adverse effects,” Dr. Torrey writes in Surviving Schizophrenia.
  • Create a wish list. Another excellent tip from Dr. Torrey: Write out a list of things you wish you could do but that schizophrenia prevents you from doing. What did you do prior to your illness that you wish you could do again? On your list, you might write “read a book, go into a crowded room without panicking, hold a job at least half-time, have a boyfriend,” Dr. Torrey writes. Essentially, this list includes goals you’d like to attain with the help of medication and other treatments. The list serves as a reminder of why you’re taking medication and why you’re open to trying new medications to improve symptoms, he writes.
  • Take medication as prescribed. Do you forget to take your medication? “You don’t want (the prescribing physician) to raise the dose because you forgot to take the pills half the time,” Velligan said. Have you decided to stop taking them altogether?
  • Speak up. Maybe you’ve stopped taking your medication because it just doesn’t feel right. Maybe you’re experiencing bothersome side effects. “Communicate with doctors on an ongoing basis to make sure that the medications are safe and effective,” Levine said. “Consumers and doctors constantly need to evaluate medication regimens and weigh the pros and cons of any treatment.”
  • Create reminders. “No one is very good at remembering to take every dose of medication,” Velligan said. To stay on track, find reminders that work for you. Velligan suggests pill containers, voice alarms, signs and checklists.

Schizophrenia and Substance Abuse

Almost 50 percent of individuals with schizophrenia suffer from substance abuse, such as alcohol and nicotine. Research has shown that patients with dual diagnoses are more susceptible to severe symptoms, higher rates of hospitalization, illness, violence, victimization, homelessness, medication noncompliance and poor response to medication. Conventional antipsychotics don’t seem to help; research shows that individuals with dual diagnoses seem to have a tougher course than those without substance abuse (see Green, Drake, Brunette & Noordsy, 2007).

Integrated Dual Disorder Treatment (IDDT) is one option. It treats both disorders simultaneously and has been shown to be highly effective. Unfortunately it isn’t readily available. If you’re having issues with substance use or suspect your loved one is, talk to your primary provider about getting a proper evaluation and treatment services.