In 1989, a new generation of antipsychotics -- called atypical antipsychotics -- was introduced. At the correct doses, fewer of the neurological side effects -- which often include such symptoms as muscular rigidity, painful spasms, restlessness, or tremors -- are seen.
The first of the new generation, Clozaril is the only drug that has been shown to be effective where other antipsychotics have failed. It is not linked with the side effects mentioned above, but it does produce other side effects, including weight gain, changes in blood sugar and cholesterol, and possible decrease in the number of infection-fighting white blood cells. Blood counts need to be monitored every week during the first six months of treatment and then every two weeks and eventually once a month indefinitely in order to catch this side effect early if it occurs.
Other atypical antipsychotics include Abilify, Geodon, Invega, Latuda, Risperdal, Saphris, Seroquel, and Zyprexa. Another atypical antipsychotic, Fanapt, has been FDA-approved for acute (but not long-term) treatment of schizophrenia. The use of all of these medications has allowed successful treatment and release back to their homes and the community for many people suffering from schizophrenia.
Although sometimes more effective and better tolerated than older conventional neuroleptics, atypical antipsychotics also have side effects, and current medical practice is developing better ways of understanding these effects, identifying people at risk, and managing complications. Importantly, all atypical antipsychotics carry the possible risk for causing weight gain and raising blood sugar, cholesterol, and triglyceride levels, which must be periodically monitored during treatment. Some antipsychotics -- typical and atypical -- can cause heart rhythm problems that may require monitoring by a doctor.
Most of these medications take two to four weeks to take effect. Patience is required if the dose needs to be adjusted, the specific medication changed, and another medication added. In order to be able to determine whether an antipsychotic is effective or not, it should be tried for at least four weeks (or even as long as several months in the case of Clozaril).
Because the risk of relapse of illness is higher when antipsychotic drugs are taken irregularly or discontinued, it is important that people with schizophrenia follow a treatment plan developed in collaboration with their doctors and with their families. The treatment plan will involve taking the prescribed medication in the correct amount and at the times recommended, attending follow-up appointments, and following other treatment recommendations.
People with schizophrenia often do not believe that they are ill or that they need treatment. Other possible things that may interfere with the treatment plan include side effects from medications, substance abuse, negative attitudes towards treatment from families and friends, or even unrealistic expectations. When present, these issues need to be acknowledged and addressed for the treatment to be successful.