Medication

Why take medication?

The aim is to reduce the effects of the symptoms on your life. Medication should:
 
  • weaken delusions and hallucinations gradually, over a period of a few weeks
  • help you to think more clearly
  • increase your motivation and ability to look after yourself.

How is it taken?

  • Medication for schizophrenia comes as tablets, capsules, or syrup. It's hard for anybody to remember to take tablets several times a day, so there are now some that you only need to take once a day.
  • If you find it hard to take tablets every day, you may find it easier to take antipsychotic medication as an injection. This is called a 'depot injection' and is given at weekly or every 2,3 or 4 weeks. Most of the depot injections are older, "typical" antipsychotics, but one of the atypicals, Risperidone, is now available in this form.

"Typical" antipsychotics

In the mid-1950s, several medications appeared that could reduce the symptoms of schizophrenia. They became known as "antipsychotic" medications. These older drugs are called "typical"or "first-generation" antipsychotics. They work by reducing the action of a particular chemical messenger in the brain called dopamine.
 
Side-effects
 
  • Stiffness and shakiness, like Parkinson's disease, along with feeling sluggish and slow in your thinking. In most cases, this will mean that you are taking too much of the medication. It should be reduced to a level at which these symptoms disappear. If you need higher doses, these side-effects can be controlled with anti-Parkinsonian medication.
  • Uncomfortable restlessness (akathisia).
  • Problems with your sex life.
  • A long-term side-effect is tardive dyskinesia (TD for short) - persistent movements, usually of the mouth and tongue. This affects about 1 in 20 people every year who are taking these medications.

Some Typical antipsychotics:

Tablets Trade Name Normal Daily Dose (mg) Max. Daily Dose (mg)
Chlorpromazine Largactil 75-300 1000
Haloperidol Haldol 3-15 30
Pimozide Orap 4-20 20
Trifluoperazine Stelazine 5-20  
Sulpiride Dolmatil 200-800 2400
Depot Injections (may be given 2-4 weekly) Trade Name Normal 2 weekly dose Max. 2 weekly dose
Haloperidol Haldol 50  
Flupenthixol decanoate Depixol 40  
Fluphenazine decanoate Modecate 12.5-100  
Pipothiazine palmitate Piportil 50  
Zuclopenthixol decanoate Clopixol 200  

"Atypical" antipsychotics

Over the last 10 years, several newer medications have appeared. They work on a different range of chemical messengers in the brain (such as serotonin) and are called "atypical" or "second-generation" antipsychotics. They are less likely to cause Parkinsonian side-effects, although they may cause weight gain and problems with sexual function. They may also help the negative symptoms, on which the older drugs have very little effect. They also seem much less likely to produce tardive dyskinesia. Many people who use these newer medications have found the side-effects less troublesome than those of the older medications.
 
Side Effects
 
  • Sleepiness and slowness
  • Weight increase
  • Interference with your sex life
  • Increased chance of developing diabetes.
  • In high doses, some may produce the same Parkinsonian side-effects as the typicals.

Some Atypical antipsychotics:

Tablets Trade Name Normal daily dose (mg) Max. daily dose (mg)
Amisulpiride Solian 50 - 800 1200
Aripiprazole Abilify 10-30  
Clozapine Clozaril 200-450 900
Olanzapine Zyprexa 10-20 20
Quetiapine Seroquel 300-450 750
Risperidone Risperdal 4-6 16
Sertindole Serdolect 12-20 24
Zotepine Zoleptil 75-200 300
Depot Injections Trade Name Normal 2 weekly dose Max. 2 weekly dose
Risperidone Risperdal Consta 25 50
Clozapine
  • This is an atypical antipsychotic medication and the only one that has been shown to be more effective for people who do not respond to other sorts of antipsychotic. It also seems to reduce suicide in people with schizophrenia.
  • It has many of the same side-effects as other atypical antipsychotics, but may also make you produce more saliva.
  • The main drawback is that it can affect your bone marrow. This leads to a shortage of white cells which makes you vulnerable to infection. If this happen, the medication needs to be stopped as quickly as possible to allow the bone marrow to recover. Weekly blood tests need to be done for the first 6 months of taking Clozapine, then 2 weekly and eventually 4 weekly.

How well does medication work?

  • These medications work well for many people - about 4 in 5 people get help from them. They control the disorder, but do not cure it. You have to go on taking the medication to prevent the symptoms returning.
  • Even if the medication helps, the symptoms may come back. This is much less likely to happen if you carry on taking medication, even when you feel well.

How long will I have to take medication for?

  • Most psychiatrists will suggest that you take medication for a long time.
  • If you want to reduce or stop your medication, discuss this with your doctor.
  • You should usually reduce your medication gradually so you can notice any symptoms returning, before you become unwell again.

What happens if you stop your medication?

If you stop taking the tablets, the symptoms of schizophrenia will usually come back - not immediately, but often within 6 months.

Getting back to normal

What happens after your positive symptoms have been controlled? Schizophrenia can make it difficult to deal with the demands of everyday life. Sometimes, this is because of the symptoms. Sometimes, the illness may have gone on for so long that you may just have got out of the habit of doing things for yourself. It can be difficult to get back to doing ordinary things, like washing, answering the door, shopping, making a phone call or chatting with a friend.

Is medication enough?

Medication is very useful. However, even if you are taking medication, you will usually need to use other types of help to give yourself the best chance of a good recovery.
© 2007 Royal College of Psychiatrists