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Schizophrenia
What About Medication?
National Institute of Mental Health
Since schizophrenia may not be a single condition and its causes are not yet
known, current treatment methods are based on both clinical research and
experience. These approaches are chosen on the basis of their ability to reduce
the symptoms of schizophrenia and to lessen the chances that symptoms will
return.
Antipsychotic medications have been available since the mid-1950s. They have
greatly improved the outlook for individual patients. These medications reduce
the psychotic symptoms of schizophrenia and usually allow the patient to
function more effectively and appropriately. Antipsychotic drugs are the best
treatment now available, but they do not "cure" schizophrenia or
ensure that there will be no further psychotic episodes. The choice and dosage
of medication can be made only by a qualified physician who is well trained in
the medical treatment of mental disorders. The dosage of medication is
individualized for each patient, since people may vary a great deal in the
amount of drug needed to reduce symptoms without producing troublesome side
effects.
The large majority of people with schizophrenia show substantial improvement
when treated with antipsychotic drugs. Some patients, however, are not helped
very much by the medications and a few do not seem to need them. It is difficult
to predict which patients will fall into these two groups and to distinguish
them from the large majority of patients who do benefit from treatment with
antipsychotic drugs.
A number of new antipsychotic drugs (the so-called "atypical
antipsychotics") have been introduced since 1990. The first of these,
clozapine (Clozaril®), has been shown to be more effective than other
antipsychotics, although the possibility of severe side effects-in particular, a
condition called agranulocytosis (loss of the white blood cells that fight
infection)-requires that patients be monitored with blood tests every one or two
weeks. Even newer antipsychotic drugs, such as risperidone (Risperdal®) and
olanzapine (Zyprexa®), are safer than the older drugs or clozapine, and they
also may be better tolerated. They may or may not treat the illness as well as
clozapine, however. Several additional antipsychotics are currently under
development.
Antipsychotic drugs are often very effective in treating certain symptoms of
schizophrenia, particularly hallucinations and delusions; unfortunately, the
drugs may not be as helpful with other symptoms, such as reduced motivation and
emotional expressiveness. Indeed, the older antipsychotics (which also went by
the name of "neuroleptics"), medicines like haloperidol (Haldol®) or
chlorpromazine (Thorazine®), may even produce side effects that resemble the
more difficult to treat symptoms. Often, lowering the dose or switching to a
different medicine may reduce these side effects; the newer medicines, including
olanzapine (Zyprexa®), quetiapine (Seroquel®), and risperidone (Risperdal®),
appear less likely to have this problem. Sometimes when people with
schizophrenia become depressed, other symptoms can appear to worsen. The
symptoms may improve with the addition of an antidepressant medication.
Patients and families sometimes become worried about the antipsychotic
medications used to treat schizophrenia. In addition to concern about side
effects, they may worry that such drugs could lead to addiction. However,
antipsychotic medications do not produce a "high" (euphoria) or
addictive behavior in people who take them.
Another misconception about antipsychotic drugs is that they act as a kind of
mind control, or a "chemical straitjacket." Anti-psychotic drugs used
at the appropriate dosage do not "knock out" people or take away their
free will. While these medications can be sedating, and while this effect can be
useful when treatment is initiated particularly if an individual is quite
agitated, the utility of the drugs is not due to sedation but to their ability
to diminish the hallucinations, agitation, confusion, and delusions of a
psychotic episode. Thus, antipsychotic medications should eventually help an
individual with schizophrenia to deal with the world more rationally.
NIH 1999
Posted 04/09/2004
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If you are in a crisis please call:
1-800-SUICIDE (784-2433) or
1-800-273-TALK (8255) |
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