Schizophrenia: The Challenges of Taking Medication

For people with schizophrenia, a common question is, “How long is medication needed to treat schizophrenia?” The answer is usually: people most benefit from taking medication for schizophrenia most of their lives. But there are a few challenges with taking any medication for such a long period of time, including reduced effectiveness and unwanted long-term side effects.

Antipsychotic medications — including newer atypical antipsychotics — reduce the risk of future psychotic episodes in patients who have schizophrenia. Even with continued drug treatment, some people will typically suffer relapses — but far higher relapse rates are seen when medication is discontinued. In most cases, it would not be accurate to say that continued drug treatment prevents relapses; rather, it reduces their intensity and frequency. The treatment of severe psychotic symptoms generally requires higher dosages than those used for maintenance treatment. If symptoms reappear on a lower dosage, a temporary increase in dosage may prevent a full-blown relapse.

Sticking to the Treatment Plan

Because relapse is more likely when antipsychotic medications are discontinued or taken irregularly, it’s beneficial when people with schizophrenia stick to their treatment. Sticking to treatment is also called “adherence to treatment,” which simply means keeping to the treatment plan arrived at between the patient and their psychiatrist or therapist.

Good adherence involves taking prescribed medication at the correct dose and proper times each day, attending doctor’s appointments, and following other treatment efforts. Treatment adherence is often difficult for people with schizophrenia, but it can be made easier with the help of several strategies and can lead to improved quality of life.

There are a variety of reasons why people with schizophrenia may not adhere to treatment. Patients may not believe they are ill and may deny the need for medication, or they may have such disorganized thinking that they cannot remember to take their daily doses. Family members or friends may not understand schizophrenia and may inappropriately advise the person with schizophrenia to stop treatment when he or she is feeling better.

Psychiatrists and doctors, who play an important role in helping their patients with their treatment, may neglect to ask patients how often they are taking their medications. Or such professionals may be unwilling to accommodate a patient’s request to change dosages or try a new treatment.

Some patients report that side effects of the medications seem worse than the illness itself — and that’s the reason they stop taking their medication. Further, substance abuse can interfere with the effectiveness of treatment, leading patients to discontinue medications. When a complicated treatment plan is added to any of these factors, good adherence may become even more challenging.

Fortunately, there are many strategies that patients, doctors, and families can use to improve adherence and prevent worsening of the illness. Some antipsychotic medications, including ones like haloperidol (Haldol), fluphenazine (Prolixin), perphenazine (Trilafon), are available in long-acting injectable forms that eliminate the need to take pills every day.

A major goal of current research on treatments for schizophrenia is to develop a wider variety of long-acting antipsychotics, especially the newer agents with milder side effects, which can be delivered through injection. Medication calendars or pill boxes labeled with the days of the week can help patients and caregivers know when medications have or have not been taken. Using electronic timers that beep when medications should be taken, or pairing medication taking with routine daily events like meals, can help patients remember and adhere to their dosing schedule. Engaging family members in observing oral medication taking by patients can help ensure adherence. In addition, through a variety of other methods of adherence monitoring, doctors can identify when pill taking is a problem for their patients and can work with them to make adherence easier. It is important to help motivate patients to continue taking their medications properly.

In addition to any of these adherence strategies, patient and family education about schizophrenia, its symptoms, and the medications being prescribed to treat the disease is an important part of the treatment process and helps support the rationale for good adherence.

Schizophrenia Medication Side Effects

Antipsychotic drugs, like virtually all medications, have unwanted side effects along with their beneficial, therapeutic effects. During the early phases of drug treatment, patients may be troubled by side effects such as drowsiness, restlessness, muscle spasms, tremor, dry mouth, or blurring of vision. Most of these can be corrected by lowering the dosage or can be controlled by other medications. Different patients have different treatment responses and side effects to various antipsychotic drugs. A patient may do better with one drug than another.

The long-term side effects of antipsychotic drugs may pose a considerably more serious problem. Tardive dyskinesia (TD) is a disorder characterized by involuntary movements most often affecting the mouth, lips, and tongue, and sometimes the trunk or other parts of the body such as arms and legs. It occurs in about 15 to 20 percent of patients who have been receiving the older, “typical” antipsychotic drugs for many years, but TD can also develop in patients who have been treated with these drugs for shorter periods of time. In most cases, the symptoms of TD are mild, and the patient may be unaware of the movements.

Antipsychotic medications developed in recent years all appear to have a much lower risk of producing TD than the older, traditional antipsychotics. The risk is not zero, however, and they can produce side effects of their own such as weight gain. In addition, if given at too high of a dose, the newer medications may lead to problems such as social withdrawal and symptoms resembling Parkinson’s disease, a disorder that affects movement. Nevertheless, the newer antipsychotics are a significant advance in treatment, and their optimal use in people with schizophrenia is a subject of much current research.