The most important treatment modality when attempting to gain a recovery from schizophrenia is medication. Although medication plays a large role in treatment, it obtains its effectiveness through it’s partnership with psychotherapy. However, the differing schizophrenia medication options are oftentimes very confusing for the newly diagnosed and provide a large stumbling block on the path to recovery. The intention of this article, then, is to provide as much insight into the various medications available at this current time, including their individual purposes, side effects, and attributes.
The Types of Medications for Schizophrenia
When we discuss these medications, it’s easiest to categorize the differing types into subtypes. This helps us keep the information straight in our head, because there is quite a lot to remember. There are atypical antipsychotics, typical antipsychotics, antidepressants, anti-anxiety medications, and a few other supportive medications we will mention at the end.
Don’t let the labels of typical and atypical fool you. Typical simply refers to the conventional, or older, antipsychotics, while atypical refers to the newer “2nd-generation” antipsychotics. Of course there are other reasons for categorizing them separately, as you will see below.
Atypical antispsychotics, while still posing the risk of side effects, generally have what are accepted as less-severe side effects. These are newer medicines that have been approved since 1989, and most recently in 2007. They can be taken as a pill, a liquid, or as an injection. Atypical medications are the type that require patience, because you may need to take them for up to as long as six months before you begin noticing a positive effect from them. This is common with many psychiatric medicines though, and it’s just the way it is right now.
As far as the United States is concerned, there are seven atypical antipsychotic medications that are approved for prescriptions currently. Those are the following, with their medical and brand names, respectively:
- Clozapine / Clozaril
- Aripiprazole / Abilify
- Paliperidone / Invega
- Risperidone / Risperdal
- Quetiapine / Seroquel
- Olanzapine / Zyprexa
- Ziprasidone / Geodon
Clozapine was the first to be approved and appears to the be the one with the most side effects still. There are a couple more that haven’t been approved in the U.S. that go by the names of Zoleptil and Solian, if you’d like to ask your doctor about them. Since these are all relatively newer medicines, there have not been significant longitudinal studies doing comparisons of each other concerning benefits and negatives.
In general, the lesser side effects of atypical antipsychotics are the same as you find on many medications for all kinds of ailments. These include runny or stuffy nose, dizziness, drowsiness, constipation, extra-salivation, increased heart rate, or imparied attention. There are more severe problems that can be associated with these, which include weight gain, hyperglycemia, cholesterol issues, seizures, body temperature fluctuations, cataracts and glaucoma, heart problems, and more. These are to be taken very seriously, even if they are occur to a small percentage of people. Always be prepared and knowledgable of these symptoms so that you might recognize them immediately and seek help sooner rather than later.
A Warning for Diabetics
A very serious warning is on every label concerning patients with diabetes. The U.S. Food and Drug Administration suggests these individuals remain under constant watch with frequent monitoring and blood sugar testing to ensure no further complications arise, and if they do they can be treated immediately.
As mentioned before, typical antipsychotics are the older and more conventional medicines used in the treatment of schizophrenia, but often feature more severe side effects than the atypical variety. There have been plenty of studies that have failed to find any significant variations in the levels of benefits from one typical antipsychotic over another. The reason these are so commonly prescribed is their large impact on symptoms resembling psychosis. These are the delusionary beliefs and sensory hallucinations that are common early in the development of schizophrenia, especially in those experiencing the paranoid subtype.
Among these that are available for use in the United States are the following, again with the medical name and brand names listed, respectively:
- Haloperidol / Haldol
- Chlorpromazine / Thorazine
- Fluphenazine / Prolixin
- Mesoridazine / Serentil
- Perphenazine / Trilafon
- Trifluoperazine / Stelazine
- Thioridazine / Mellaril
The most commonly prescribed of the above list would be Haldol and Thorazine. Many people know of Thorazine as it has made it’s way into the popular culture through films. These are often delivered to patients experiencing a high intensity of positive symptoms to help reduce the severity, but they don’t have much affect on the negative symptoms that may arise.
In previous articles we have discussed how many people dealing with schizophrenia find it very stressful to add difficult side effects on top of the problems they are already experiencing, and will cease taking their medications. This is common with typical antipsychotics, unfortunately.
Some of these side effects of typical antipsychotics include, but are not limited to, Extrapyramidal symptoms (which will be discussed further down), lethargy and drowsiness or sleeplessness, stomach upsets such as nausea, consipation, diarrhea, and heartbearn, dry mouth, hypotension, increased possibility for cardiac arrest, and a dulling of focus and thinking. As you can see from this list, these can all be very disturbing in combination with other symptoms related to schizophrenia, which is why many people have opted for the atypical medications instead.
Extrapyramidal Side Effects
All schizophrenia medications, but the typical antipsychotics especially, can cause what are known as extrapyramidal side effects. The symptoms affect the nervous and muscular systems of the body, which can in turn create difficulties in coordination and general movement. If any of you are familiar with Parkinson’s disease, then you will recognize some of these symptoms.
The symptom that can cause the most intereference in life is tardive dyskinesia which causes the individual to display tics, which are involuntary movements similar to those of Tourette’s syndrome. These can occur in the face or any extremety of the body, or even in the chest or stomach areas. The problem with tardive dyskinesia and these medications is it is hard to determine whether or not it will arise. It may not manifest itself into visible symptoms for up to years after beginning to take the medication. If the medicine is ceased, it can remain for months or possibly be permanent, sadly. There are other similar symptoms that may appear immediately upon taking the medicine, called acute dystonia, which involves strong contractions of the muscles, especially of the face and neck.
To treat these symptoms, first there is an attempt to tweak the dosage to a more suitable amount for the individual, whether that is more or less must be tested. They may also be switched to an atypical antipsychotic as well. They may also be administered an anti-parksonism medicine such as an anticholinergic. Benzodiazepines can also serve to reduce extrapyramidal side effects.
Other Schizophrenia Medications
There are other medicines that will be prescribed to help curb the severity of symptoms associated with schizophrenia, such as antidepressents and anti-anxiety medications. Antidepressents can help reduce the depression symptoms, and anxiolytics can help with the panic and anxiety feelings that can arise. Depression and anxiety both can affect the manifestation of schizophrenic symptoms, and their management can effectively help reduce the risk of relapse. Relapse prevention and symptom reduction are huge benefits, yet a minority of people are using these medications.
Some benzodiazepines such as lithium are helpful in reducing some manic, anxiety related, and depression related symptoms as well. Anti-epileptic medicines can help those who haven’t responded well to the usual medicines. There are some cases where females will be given estrogen replacement medicine, which possibly helps protect the patient from the nervous and muscular system problems discussed above.
These are the main types of medicines that will be prescribed to the newly diagnosed schizophrenic. There is a lot to understand and usually hearing about it for the first time only serves to create more confusion. If you or a friend or loved one has recently been diagnosed with schizophrenia, refer them or take a few reads over this article. It may help you categorize these medicines in your mind to help you think about and understand them more quickly.