4 First-Line Treatments for Schizophrenia: What You Should Know | MyDepressionTeam

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4 First-Line Treatments for Schizophrenia: What You Should Know

Medically reviewed by Paul Ballas, D.O.
Updated on April 10, 2024

Schizophrenia is a serious and life-changing mental health disorder. Symptoms include hallucinations, delusions, and other cognitive changes that can affect thinking and memory. Living with schizophrenia can be challenging. If you’re living with the condition, it’s important to stick to the treatment plan recommended by your doctor.

Although schizophrenia is not yet curable, it is treatable. In particular, first-line treatments are the standard therapies that doctors recommend trying first. If first-line treatments aren’t successful in helping to manage symptoms of schizophrenia, doctors may suggest other options.

Some of the treatments recommended for schizophrenia overlap with those prescribed for people with depression or bipolar type 1 disorder. Understanding how schizophrenia is treated is an important first step toward living a healthier, safer, and more productive life.

Here are 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.

1. Second-Generation Oral Antipsychotics

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, which are newer antipsychotic therapies. Second-generation antipsychotics are typically the first treatments a person tries after receiving a diagnosis of schizophrenia.

Second-generation antipsychotic drugs (also called atypical antipsychotics) are the most commonly used schizophrenia treatment. They’re considered safer than some schizophrenia medications recommended in the past, but they are not without their side effects. Potential adverse effects include sedation, high blood pressure, weight gain, and sexual dysfunction.

Second-generation antipsychotics are typically the first treatments a person tries after receiving a diagnosis of schizophrenia.

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Some second-generation antipsychotics also have antidepressant effects and act on the brain’s dopamine type 2 receptors and serotonin type 2A receptors. Dopamine and serotonin are chemicals in the brain that affect pleasure, mood, emotions, and appetite.

Common second-generation antipsychotic medications might be taken daily by pill, tablet, or liquid. They include:

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Clozapine (Clozaril or Versacloz)
  • Lurasidone (Latuda)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)
  • A combination of olanzapine and samidorphan, sold as Lybalvi

2. Injectable Second-Generation Antipsychotics

Injectable medications may be easier to manage for people who forget to take medication or don’t like to take daily medication. Some second-generation antipsychotic medications are injected into the muscle once or twice per month. These are sometimes called long-acting injectables.

People who take injectable antipsychotics have been found to have a lower risk of relapse, overdose, and hospitalization than those who take oral medications. However, injected medication requires traveling to a clinic, which may be difficult for some people. Injectables can also cause side effects such as pain, lumps, or bleeding at the injection site.

Injectable second-generation antipsychotics include aripiprazole, risperidone, and paliperidone.

3. First-Generation Antipsychotics

First-generation antipsychotics (also known as typical antipsychotics) were the first antipsychotics developed. They are less commonly used today because of 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 and are less expensive than second-generation options.

First-generation antipsychotics work similarly to second-generation antipsychotics. They block dopamine type 2 receptors. Some common first-generation antipsychotics include chlorpromazine, haloperidol, and thioridazine.

4. Psychotherapy

Psychotherapy — or talk therapy — is an important component of many treatment plans for schizophrenia. In fact, psychotherapy helps with many mental illnesses, including depressive symptoms.

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 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.

Psychotherapy — or talk therapy — is an important component of many treatment plans for schizophrenia.

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There are a few forms of CBT therapy, including dialectical behavioral therapy 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.

Your doctor can provide a referral for a psychotherapist or mental health professional.

Other Medication

While not considered first-line treatments, some other types of medications may be recommended to help relieve some symptoms of schizophrenia or treat associated mental health conditions.

Mood Stabilizers

Mood stabilizers can help even out mood swings. Although these medications are primarily used to treat mood disorders such as bipolar disorder 1, they may be recommended for people with schizophrenia who experience a depressed mood or aggression. However, psychiatry 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.

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:

  • Carbamazepine (Tegretol)
  • Lamotrigine (Lamictal)
  • Lithium
  • Sodium valproate (Depakote)

Antidepressants

Antidepressants 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:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)

Other Treatment Options

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) psychotic 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 has been successful in preventing relapse for some people with schizophrenia. Another study of 27 people with severe, medication-resistant schizophrenia found ECT may make medications for psychotic disorders more effective.

Another treatment method that may be used more in the future is deep brain stimulation (DBS) which involves passing another type of electric current through the brain. There is preliminary research in animals that suggests DBS may relieve some psychotic symptoms. One pilot study of two men with severe, treatment-resistant schizophrenia found some potential benefits from DBS for people with schizophrenia, but determined a need for further research.

Always Get Medical Advice Before Changing Your Treatment Plan

Treatment options for schizophrenia may take time to start working. Never stop taking your medication without first consulting your psychiatrist or another health care provider. If you are not happy with your medication, talk to your doctor. There may be other 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.

Talk With Others Who Understand

MyDepressionTeam is the social network for people with depression and their loved ones. On MyDepressionTeam, more than 146,000 members come together to ask questions, give advice, and share their stories with others who understand life with mental health conditions like depression and schizophrenia.

Are you or a loved one being treated for schizophrenia? Share your experience in the comments below, or start a conversation by posting on your Activities page.

References
  1. Schizophrenia — American Family Physician
  2. Schizophrenia — National Institute of Mental Health
  3. Schizophrenia — Mayo Clinic
  4. Schizoaffective Disorder — Mayo Clinic
  5. Serotonin — Cleveland Clinic
  6. First-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness — Comparative Effectiveness Reviews
  7. Head-to-Head Comparisons of Metabolic Side Effects of Second Generation Antipsychotics in the Treatment of Schizophrenia: A Systematic Review and Meta-Analysis — Schizophrenia Research
  8. Comparison of the Anti-Dopamine D2 and Anti-Serotonin 5-HT2A Activities of Chlorpromazine, Bromperidol, Haloperidol and Second-Generation Antipsychotics Parent Compounds and Metabolites Thereof — Journal of Psychopharmacology
  9. Long-Acting Injectable Antipsychotics: A Systematic Review of Their Non-Systemic Adverse Effect Profile — Neuropsychiatric Disease and Treatment
  10. Antipsychotic Medications — StatPearls
  11. Use of Antidepressants and Mood Stabilizers in Persons With First-Episode Schizophrenia — European Journal of Clinical Pharmacology
  12. Mood Stabilizer Psychopharmacology — Clinical Neuroscience Research
  13. Mental Health Medications — National Institute of Mental Health
  14. Mechanism of Action of Antidepressants and Therapeutic Perspectives — Therapie
  15. Addressing the Side Effects of Contemporary Antidepressant Drugs: A Comprehensive Review — Chonnam Medical Journal
  16. Cognitive-Behavioral Therapy for Schizophrenia: A Review — Focus
  17. What Is Cognitive Behavioral Therapy? — American Psychological Association
  18. Long-Term Effects of Brief Acceptance and Commitment Therapy for Psychosis — Behavior Modification
  19. Cognitive-Behavioral Therapy for Medication-Resistant Psychosis: A Meta-Analytic Review — Psychiatric Services
  20. Maintenance ECT in Schizophrenia: A Systematic Review — Psychiatry Research
  21. ECT Rekindles Pharmacological Response in Schizophrenia — European Psychiatry
  22. Mapping Brain Regions in Which Deep Brain Stimulation Affects Schizophrenia-Like Behavior in Two Rat Models of Schizophrenia — Brain Stimulation
  23. Habenula Deep Brain Stimulation for Intractable Schizophrenia: A Pilot Study — Journal of Neurosurgery

Updated on April 10, 2024
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Paul Ballas, D.O. is an attending psychiatrist at Friends Hospital in Philadelphia, Pennsylvania. Review provided by VeriMed Healthcare Network. Learn more about him here.
Brooke Dulka, Ph.D. is a freelance science writer and editor. She received her doctoral training in biological psychology at the University of Tennessee. Learn more about her here.
Maureen McNulty studied molecular genetics and English at Ohio State University. Learn more about her here.

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