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.