Schizophrenia Medication (A complete guide)

In this guide, we will discuss schizophrenia medication, most commonly prescribed medications, what happens when there is no response to treatment and some considerations.

Schizophrenia medication: How many are there?

Schizophrenia medication include second-generation antipsychotics such as:

• Aripiprazole (Abilify)
• Aripiprazole lauroxil (Aristada)
• Asenapine (Saphris)
• Clozapine (Clozaril)
• Iloperidone (Fanapt)
• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Paliperidone (Invega Sustenna)

These are known as antipsychotics and are the most commonly prescribed drugs for the treatment of the symptoms of schizophrenia which tend to alter the effect of neurotransmitters such as dopamine, serotonin, noradrenaline, and acetylcholine.

Perhaps you or a loved one has been diagnosed with schizophrenia and would like to explore the options for treatment through schizophrenia medication. It is important to always discuss this with the doctor treating you or your loved one for a full explanation of the possible treatment options depending on your symptoms, medical history and other important aspects that need to be taken into consideration. 

The use of antipsychotic medications is to manage the symptoms implementing the lowest possible dose, however, doctors may need to try different drugs, doses, and combinations in the search for the one with the best results, since not everyone reacts the same way to all medications and not all of them have the desired effect or result in every case. 

Besides, doctors should also warn patients and their relatives about the possible side effects and it can take a few weeks before they can start seeing results. In addition, other medications may be prescribed, such as the case of antidepressants or anti-anxiety medication. 

There are two types of antipsychotics: first-generation antipsychotics and second-generation antipsychotics. The first type has shown to have frequent neurological side effects such as the risk of developing tardive dyskinesia which can potentially be reversible or permanent. Some of the antipsychotics from this category include:

• Chlorpromazine
• Fluphenazine
• Haloperidol
• Perphenazine

In contrast, second-generation antipsychotics are preferred by physicians since they report the risk of developing side effects is lower than the first-generation antipsychotics. We have already mentioned a few at the beginning but we could also include Quetiapine (Seroquel), Risperidone (Risperdal) and Ziprasidone (Geodon).  You can see the list of medications for schizophrenia and their specifications here.

A brief history of schizophrenia medication

The first drug identified for the treatment of schizophrenia was discovered in 1952 by Henri Laborit, who was a French surgeon looking for a way to reduce surgical shock from the anesthesia administered to his patients, eventually, if he could find a way to use less of the anesthesia then his patients will have a quicker recovery. 

Then, he started to administer higher doses of antihistamines to his patients, which is commonly used to treat allergies. He thought that the effect of the drug was positive since they didn’t seem anxious anymore about having the medical procedure, resulting in less anesthesia used for the procedure. 

How does medication work for schizophrenia?

Medication is said to work by altering the neurochemistry of the brain, especially neurotransmitters dopamine and serotonin.

Studies have shown the effectiveness of antipsychotic medication in reducing the positive symptoms of schizophrenia, such as hallucinations, delusions, and suspiciousness. 

“With the exception of clozapine, careful systematic reviews and meta-analyses have not found convincing evidence that any of antipsychotics are more effective than others for positive symptoms in acute schizophrenia. Clozapine is more effective for patients who do not respond fully to other antipsychotics, but due to increased risk of agranulocytosis is reserved for those who do not respond well to or cannot tolerate other antipsychotics (Uptodate.com).” 

The negative symptoms of schizophrenia such as diminished  emotional expression and lack of motivation, have proven to be difficult symptoms to treat and studies have shown no significant effects of medication, however, cariprazine has shown positive effects in a randomized trial. 

What happens if there is no response to initial treatment?

It is suggested that patients should be observed on a specific dose of antipsychotic medication for 2 to 6 weeks before considering the drug to be ineffective. However, the duration of the observation and trial can vary depending on:

• Most patients improve during the first 2 weeks of starting the treatment, but they can keep improving in the following weeks and even months on the same dose.
• Recent evidence suggests that if the patient is unresponsive or show minimal effects  during the first two weeks then it is highly likely that there won’t be any robust response. However, other studies suggest a 2 to 6 week trial for antipsychotics such as iloperidone and quetiapine. 

Dose adjustments 

Additionally, if there is no response or a partial response, then your doctor will gradually try to increase the dose until the recommended range. Dose reductions are recommended if the patient is showing symptoms such as “akathisia, parkinsonism, sedation, or insomnia have obscured the benefit of a higher antipsychotic dose, or have been mistaken for signs of ineffective treatment, such as agitation or negative symptoms (uptodate.com)”

Switching to another antipsychotic

Subsequently, changing to another antipsychotic can be considered by the doctor. It is considered that switching antipsychotics is less clearly beneficial when the initial medication lacked effectiveness. Most of the studies conducted have shown that poor respond to the first medication increased the chance to have a poor response against a second medication, except if the second drug is clozapine.

Adding a second antipsychotic

If there is little or no response to the initial treatment, then doctors may consider adding another antipsychotic to the treatment. However, research don’t actually back up this practice. 

Side effects of schizophrenia medication

It has been known that first-generation antipsychotics are less expensive than second-generation antipsychotics but are said to have more side effects. They can cause higher levels of the hormone prolactin which can affect sex drive, mood, menstrual cycles, and growth of breast tissue in men and women alike (WebMD).

In contrast, second-generation antipsychotics have been associated with weight gain, changes in sugar and cholesterol levels. However, there is a side effect associated with both old and newer medication and that is a movement disorder called tardive dyskinesia. This disorder causes stiff, jerky movements of the face and body without having the ability to control them. 

Additionally, some other side effects may manifest such as:

• Reduced libido
• Drowsiness
• Restlessness
• Dry mouth
• Constipation
• Low white blood cell count
• Seizures
• Nausea
• Blurred vision
• Low blood pressure

When a schizophrenia sufferer starts taking antipsychotic medication they may feel better quickly but it may take a few weeks (4-6 weeks) before seeing improvements in the relief of certain symptoms such as hallucinations and delusions.

Pathophysiology of schizophrenia

Research on schizophrenia has led to suggest that abnormalities in neurotransmitters either excess or deficit are to be blamed for developing this disorder.

Some theories implicate dopamine, serotonin, and glutamate, and others think aspartate, glycine and gamma-aminobutyric acid (GABA) are also responsible for schizophrenia. There are four pathways that seem to be implicated, the nigrostriatal pathway that originates in the substantia nigra and ends in the caudate nucleus where low dopamine levels within this pathway are thought to affect other systems.

The second identified pathway is the mesolimbic pathway that extends from the ventral tegmental area (VTA) to limbic areas and it may play a role in the positive symptoms of schizophrenia when there is excess dopamine. 

The mesocortical pathway will be the third pathway that extends from the VTA to the cortex, thought to have a role in the manifestation of negative symptoms and cognitive deficits in schizophrenia due to low mesocortical dopamine levels.

The fourth implied pathway is considered the tuberoinfundibular pathway which projects from the hypothalamus to the pituitary gland. The decrease/blockade of dopamine results in an elevated prolactin levels, which results in galactorrhea, amenorrhea and reduced libido.

Environment vs Genetic in Schizophrenia

Different theories have emerged to understand how do people develop this disorder, however, the precise cause is still unknown.

It is widely accepted that there are genetic factors and also recognize the influence of the environment into the mix. Researchers suggest that if the mother had obstetric complications such as bleeding during pregnancy, gestational diabetes, emergency cesarean section, asphyxia, and low birth weight have been associated with schizophrenia later in life (Patel, Cherian, Gohil and Atkinson, 2014). 

Moreover, scientific evidence shows that there is a correlation between having relatives with schizophrenia increases the chances of developing the condition as well. They have established the following percentages:

• Having a first-degree relative: 10%
• Having a second-degree relative: 3%
• Monozygotic twins: the risk of one of the twins developing the condition is said to be 48% if the other twin already developed the condition. 
• Dizygotic twins: 12% to 14% to develop the condition if the other twin already has it.
• Parents: if both parents have schizophrenia the risk of having a child with the disorder is 40%.

Patel et al. (2014) suggest that environmental and social factors are also important contributors to developing the disease, especially when the individual is vulnerable to the disorder. Environmental stressors such as trauma during childhood, minority ethnicity, residing in an urban area or social isolation, and social stressors such as discrimination or financial difficulties are also recognized factors that increases the risk of schizophrenia.

Why is this blog about schizophrenia medication important?

If you or someone you love are going through the medication treatment for schizophrenia it is important to understand the different drug options and side effects. Additionally, it is important to be conscious about how people can have different results when using antipsychotics and even can respond inadequately or resist the effect of the medication. 

Always consult with the medical health practitioner the available options, any side effects and also if you notice symptoms get worse or there is no benefit evidenced from the treatment within a couple of weeks after starting it.

Please feel free to comment in the comments section below!

Frequently Asked Questions (FAQs) about schizophrenia medication

Recommended reading

• Schizophrenia: Understanding Symptoms Diagnosis & Treatment [mental illness, schizophrenic, schizophrenia disorder] (schizoid, schizoaffective, schizophrenia paranoia)
• The Heartland: finding and losing schizophrenia 
• The Complete Family Guide to Schizophrenia: Helping Your Loved One Get the Most Out of Life
• Clinical Handbook of Schizophrenia
• Schizophrenia: Understanding Schizophrenia, and how it can be managed, treated, and improved  

References 

Mayo Clinic: Schizophrenia

Drug for treating schizophrenia identified 1952

WebMD: Medicines to treat schizophrenia

Medscape.org

Livingwithschizophreniauk.org

Patel, K. R., Cherian, J., Gohil, K., & Atkinson, D. (2014). Schizophrenia: overview and treatment options. P & T : a peer-reviewed journal for formulary management, 39(9), 638–645.

Uptodate.com