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Schizophrenia can make you feel like your mind has turned against you. This condition can cause you to see or hear something that isn’t there, feel confused or scared, and have trouble connecting with other people.
If you’re living with schizophrenia, it’s important to know that these symptoms don’t reflect who you are as a person. They are clinical features of a serious disease, and with the right treatment, these symptoms can be managed.
Although schizophrenia doesn’t yet have a cure, it’s treatable. First-line treatments are the standard therapies that doctors recommend trying first. If first-line treatments don’t help enough, your doctor may suggest other options.
Understanding how schizophrenia is treated is an important first step toward living a healthier, safer, and more independent life. Here, we’ll discuss the latest first-line treatment options for schizophrenia. You can discuss these in more detail with your doctor to find a treatment plan that fits your needs.
Antipsychotic drugs are the first-line treatment for managing symptoms of schizophrenia. These medications are also useful for long-term maintenance treatment.
Antipsychotics fall into two categories: first-generation (older) and second-generation (newer). Second-generation antipsychotics are typically the first treatments doctors recommend for treating schizophrenia.
Second-generation antipsychotics (also called atypical antipsychotics) are the most commonly used medications in schizophrenia treatment. Although they’re generally safer than some first-generation options, they’re commonly associated with weight gain and metabolic syndrome.
Some second-generation antipsychotics may also help with depression symptoms. These medications work by acting on the brain’s dopamine and serotonin receptors. Dopamine and serotonin are brain chemicals that affect pleasure, mood, emotions, and appetite.
These medications may be taken daily as a pill, tablet, or liquid. Some are also available as a regularly scheduled injection. Common second-generation antipsychotics approved by the U.S. Food and Drug Administration (FDA) include:
Healthcare providers describe certain schizophrenia symptoms as either “positive” or “negative.” Positive symptoms don’t mean they’re good — it means they’re added experiences that aren’t usually part of everyday thinking, like hallucinations (seeing or hearing things that aren’t real) and delusions (strong beliefs that don’t match reality).
Negative symptoms refer to aspects of functioning that are missing or reduced, like decreased emotional expression, low motivation, or social withdrawal.
Second-generation antipsychotics help treat both positive and negative symptoms, while first-generation options focus on reducing positive symptoms.
Injectable medications that release the medication slowly over time may be a good choice for people who have a hard time sticking to their prescribed treatment plan.
Second-generation antipsychotic medications are injected into the muscle. Each injectable has its own particular schedule, ranging from every two weeks to every six months, depending on the formulation. These are sometimes called long-acting injectables.
Injectables can cause side effects such as pain, lumps, or bleeding at the injection site.
People who take injectable antipsychotics may have a lower risk of relapse, overdose, and hospitalization. More research is needed to know if injectable antipsychotics are more beneficial than oral antipsychotics.
Getting a scheduled shot can make it easier to stay on track with treatment. Injected medication requires traveling to a clinic, however, which may be difficult for some people.
Not all doctors agree on whether injectable second-generation antipsychotics should be used as a first-line treatment. Some believe that these options should be used only after oral medications are tried without success. Others believe that long-acting injectables can be an effective treatment for people who have trouble remembering or prefer not to take daily medications.
Injectables are not considered first-line treatments for everyone, but they’re increasingly used earlier in the treatment phase when compliance is a concern. Your healthcare team can advise you on the best first-line treatment options for you.
Injectable second-generation antipsychotics include aripiprazole, olanzapine, paliperidone, and risperidone.
First-generation antipsychotics (also called typical antipsychotics) were the first medications developed to treat schizophrenia. They’re less commonly used today because of side effects, such as heart problems and tardive dyskinesia — involuntary, repetitive jerking movements commonly occurring in the face, tongue, and neck. However, these medications may be prescribed in certain cases, and they may cost less than second-generation options.
First-generation antipsychotics work similarly to second-generation antipsychotics by blocking dopamine receptors in the brain but are different in that they have little effect on serotonin. Some common first-generation antipsychotics include chlorpromazine and haloperidol.
“Next-generation antipsychotics” is not an official FDA classification, but it is widely used in clinical and academic literature to distinguish these treatments from traditional dopamine blockers.
Xanomeline and trospium chloride (Cobenfy) is the first next-generation antipsychotic, approved by the FDA in September 2024 to treat schizophrenia in adults. Rather than blocking dopamine receptors, this treatment targets cholinergic receptors (proteins that affect nerve signal transmission). Because it doesn’t block dopamine receptors, it has shown in clinical trials a lower rate of the motor side effects and sleepiness commonly associated with older antipsychotics.
The most common side effects include nausea, indigestion, constipation, vomiting, increased heart rate, and high blood pressure. The treatment also carries a warning for urinary retention, which requires prompt medical attention if it occurs.
This medication may be recommended as an option for people with schizophrenia who have not responded well to other antipsychotics or who have experienced significant side effects with them. Talk to your doctor about whether it may be right for you.
Psychotherapy — or talk therapy — is an important component of many treatment plans for schizophrenia. In fact, psychotherapy helps with many mental health conditions, including depressive symptoms.
A form of psychotherapy called cognitive behavioral therapy (CBT) can help people living with schizophrenia improve their quality of life. CBT helps people become more aware of negative thinking and learn practical skills such as self-calming or problem-solving.
Multiple studies have shown that combining psychotherapy with medication can significantly improve social functioning in people with schizophrenia.
The many forms of CBT include dialectical behavioral therapy (focuses on emotion regulation and mindfulness) and acceptance and commitment therapy (helps people accept difficult thoughts and commit to meaningful actions). Your doctor can refer you to a psychotherapist or mental health professional trained in psychotherapy. They can help you decide which type of therapy best fits your needs.
Although not considered first-line treatments, some other types of medications may be recommended to help relieve certain symptoms that a person may experience alongside schizophrenia or treat other psychiatric conditions occurring at the same time.
Mood stabilizers can help treat mood swings. Although these medications are primarily used to treat mood disorders, they may also be prescribed for people with schizophrenia who experience depressed mood or aggression. Mood stabilizers can be used along with antipsychotics if needed to better manage the condition.
Side effects of mood stabilizers may include weight changes, tremors, frequent urination, constant thirst, and nausea.
Antidepressants are commonly used to treat major depression and other depressive disorders. Doctors sometimes prescribe antidepressants along with antipsychotics for people with schizophrenia.
There’s limited evidence that antidepressants improve schizophrenia symptoms, but some studies suggest they might help reduce negative symptoms of schizophrenia such as emotional flatness or lack of interest. More research is needed to fully understand these effects.
Possible side effects of antidepressants may include headache, drowsiness, diarrhea, and sexual dysfunction.
While medications and psychotherapy are the main treatments for managing schizophrenia over time, other options may be used during long-term care or during a sudden, severe episode (called an acute psychotic episode). Electroconvulsive therapy (ECT) is one option.
ECT involves passing an electrical current through a person’s head to induce a seizure. This might sound scary, but ECT can help reset abnormal brain activity that occurs in schizophrenia.
Some studies have shown that this technique has been successful in preventing relapse for some people with schizophrenia. A small study of 27 people with severe, medication-resistant schizophrenia found that ECT improved symptoms and led to a renewed medication response in 10 of the participants.
Another treatment being studied is deep brain stimulation (DBS). Like ECT, DBS involves delivering electrical stimulation to parts of the brain, but unlike ECT, DBS targets specific areas with implanted electrodes and does not cause a seizure.
Research in animals suggests that DBS may help reduce some psychotic symptoms. A small pilot study involving two males with severe, treatment-resistant schizophrenia found that DBS might offer benefits, but more research is needed.
There’s still a lot to learn about the treatment of schizophrenia. Although some people may experience remission (a decrease or disappearance of symptoms), there’s currently no cure for this medical condition.
Treatments for schizophrenia can take time to start working. Never stop taking your medication without first talking to your psychiatrist or another healthcare provider. If you’re not happy with your medication because of side effects or you don’t feel it’s helping, check with your doctor. They may be able to adjust your plan or try a different medication.
On MyDepressionTeam, people come together to share their experiences with depression and related conditions, get advice, and find support from others who understand.
Are you or a loved one being treated for schizophrenia? Let others know in the comments below.
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I am serving on the board of directors for this issue where I live. Early diagnosis is important and depression is heavy with it.
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