Schizophrenia is a serious and life-changing mental health disorder. Its symptoms include hallucinations, delusions, and other cognitive (relating to intellectual activity) changes. Living with schizophrenia can be challenging. It is important to stick to the treatment plan recommended by your doctor.
Although schizophrenia is not yet curable, it is treatable. In particular, first-line, or preferred, treatments are the standard therapies that doctors recommend trying first. If first-line treatments aren’t successful in helping to manage symptoms, doctors may suggest other options.
Some of the treatments recommended for schizophrenia overlap with those prescribed for people with depression or bipolar 1 disorder. Understanding how schizophrenia is treated is an important first step toward living a healthier, safer life.
Antipsychotics are considered first-line treatment for the symptoms of schizophrenia and are useful for long-term maintenance. Antipsychotics fall into two categories: first generation and second generation. Second-generation antipsychotics are typically the first treatments that a person tries after receiving a diagnosis of schizophrenia.
Second-generation antipsychotic drugs (also called atypical antipsychotics) are the most commonly used schizophrenia treatment. Second-generation antipsychotics are considered safer than some traditional schizophrenia medications recommended in the past, but they are not without their side effects. These include sedation, high blood pressure, weight gain, and sexual dysfunction.
Some second-generation antipsychotics also have antidepressant effects. This is due to their mechanism of action (how a drug works). Second-generation antipsychotics act on the brain’s dopamine (a chemical released in the brain that makes you feel good) system by blocking dopamine type 2 receptors. They also act on the serotonin type 2A receptor, which is where their antidepressant actions come from. Serotonin is a chemical produced in the brain that affects mood, emotions, appetite, and digestion. Common second-generation antipsychotic medications include:
The above second-generation antipsychotics are taken as a pill, tablet, or liquid once per day. You can also try medications that are injected into the muscle once or twice per month.
Injectable medications may be easier to manage for people who forget to take or don’t like their daily medication. Injectable antipsychotics can also lead to a lower risk of relapse, overdose, and hospitalization. On the other hand, they require traveling to a clinic, which may be difficult for some people, and can cause side effects such as pain, lumps, or bleeding at the injection site. Injectable second-generation antipsychotics include aripiprazole (Abilify Maintena), risperidone (Risperdal Consta), and paliperidone (Invega Sustenna).
People with schizophrenia need to work with their doctors to find a treatment plan that fits their needs.
First-generation antipsychotics (also known as typical antipsychotics) were the first antipsychotics developed. They are less commonly used today because of their side effects, such as heart problems and tardive dyskinesia (abnormal and repetitive jerking movements of the face, tongue, and neck). However, they are still occasionally prescribed for a few reasons including that they are less expensive than second-generation options. These first-generation antipsychotics work in the same way as second-generation antipsychotics. They block dopamine type 2 receptors. Some common first-generation antipsychotics include chlorpromazine, haloperidol, and thioridazine.
While not considered first-line, some other types of medications may be used by doctors to help lessen certain symptoms of schizophrenia or treat associated mental health conditions.
Mood stabilizers can help even out mood swings. Although these medications are primarily used to treat mood disorders such as bipolar 1, they are also sometimes recommended for people with schizophrenia who experience a depressed mood or aggression. However, research has found that mood stabilizers often aren’t helpful for people with schizophrenia, and many experts don’t recommend using them to treat this health problem.
The mechanism of action of mood stabilizers is fairly complicated and can vary depending on the medication. Essentially, they slow down brain communication. Mood stabilizers can also have side effects, such as weight changes, tremors, hair loss, sexual dysfunction, nausea, and effects on the blood. Examples of mood stabilizers include:
Antidepressants work by acting on serotonin. They can also affect other mood-altering chemicals, such as noradrenaline and dopamine. This is why they are the primary line of defense against major depression or other depressive disorders.
Some research from the European Journal of Clinical Pharmacology has found that antidepressants may also reduce certain signs of schizophrenia, including negative symptoms — experiencing a lack of emotion or displaying a lack of interest in the surrounding environment. However, doctors don’t often recommend antidepressants to treat schizophrenia because other research has found that these medications don’t have much effect.
Antidepressants can cause side effects like weight gain, nausea, dry mouth, and seizures. Antidepressants prescribed today are typically of the selective serotonin reuptake inhibitor (SSRI) class. Common SSRI antidepressants include:
Antidepressants don’t always work for everyone. However, never discontinue medication without first consulting your psychiatrist or another health care provider. There may be another therapeutic combination of medications that might work better for you or your loved one.
There is still a lot to learn about the treatment of schizophrenia. Although some people may go into remission (a decrease or disappearance of symptoms), currently, no treatment is available that will completely cure this medical condition.
Psychotherapy (talk therapy with a psychologist or other mental health professional) is an important component of many treatment plans for schizophrenia. In fact, psychotherapy helps with many mental illnesses, including depression.
Research has shown that a form of psychotherapy called cognitive behavioral therapy (CBT) can help individuals living with schizophrenia improve their quality of life. CBT focuses on being aware (or mindful) of patterns of thought and behavior. It is a skill-based therapy in which techniques such as self-calming or problem-solving can be worked on during a session or out in everyday life.
There are a few forms of CBT therapy, including second-wave techniques such as dialectical behavioral therapy (DBT) and acceptance and commitment therapy (ACT). A study of 80 people with psychosis found that four sessions of ACT reduced the need for hospitalization for at least a year after the sessions. CBT can also help those with medication-resistant psychosis.
While medications and psychotherapy are used for the long-term maintenance of schizophrenia, other treatment options can also be used either for maintenance or acute (severe and sudden) episodes. Electroconvulsive therapy (ECT) is one option.
ECT involves passing an electrical current through a person’s head to induce a seizure. Some studies have shown that this technique, when prescribed periodically for longer than six months, has been successful to prevent relapse in those with schizophrenia. Another study of 27 people with severe, medication-resistant schizophrenia found research to suggest that ECT may make medications for psychosis more effective.
Another treatment method that may be used more in the future is deep brain stimulation (DBS). DBS involves passing an electric current through an individual’s head in a particular location. There is preliminary research in animals to support the use of DBS for psychotic symptoms. One recent pilot study of two men with severe, treatment-resistant schizophrenia supports the need for further research into DBS for schizophrenia that is difficult to treat.
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