Therapy and Medications for Schizophrenia

Medically Reviewed by Jabeen Begum, MD on April 23, 2024
Written by Deanna Altomara
14 min read

Schizophrenia is a serious mental illness that affects your thinking, emotions, relationships, and decision-making. And because there’s no cure, getting the proper treatment early is the best way to improve your chances of managing the illness.

Schizophrenia treatment will center on managing your symptoms. You may need to stay on medication for a long time, possibly even for life. Psychotherapy, a kind of talk therapy, will likely also be a big part of the plan to help you understand and manage your symptoms. 

Don’t wait to get help. The sooner you start treatment, the better it usually works. It can help you find well-being, have a better quality of life, build healthy relationships with others, and live and work in your community. The right treatments, along with practical and emotional support from your loved ones, can go a long way. 

Schizophrenia treatment care team

Many types of professionals can help you manage schizophrenia. Each is an expert in something different and is able to support you in different ways. When everyone works together, you can get well-rounded care.

Your care team might include:

  • Social workers
  • Community mental health nurses
  • Occupational therapists
  • Counselors, psychotherapists, or therapists
  • Psychiatrists or psychologists
  • Pharmacists

Schizophrenia treatment costs

One study found that people with schizophrenia have more than $1,800 in medical bills each month (paid by the insurance company and the patient). This is over four times higher than for people without schizophrenia. On average, prescription drugs (including antipsychotics and antidepressants) cost patients about $450 per month, and outpatient care cost nearly $600 per month.

The study also found that costs are usually highest ($6,600) in the month of diagnosis. This is largely due to hospitalizations and emergency department visits.

Therapy can help you manage your symptoms. Types of therapy include:

Individual psychotherapy

During sessions, a therapist or psychiatrist can teach you how to deal with your thoughts and behaviors. You’ll learn more about their illness and its effects, as well as how to tell the difference between what’s real and what’s not. It can also help you manage everyday life. 

Cognitive behavior therapy (CBT)

Cognitive behavioral therapy (CBT) can help you change your thinking and behavior. You learn to recognize what thinking patterns are causing your negative emotions or behaviors and how to replace them with positive thoughts. For example, you might learn to identify voices and hallucinations and how to deal with them.CBT sessions usually last an hour. Most people get CBT for several months.

Cognitive enhancement therapy (CET)

This type of therapy is also called cognitive remediation. It teaches you how to better recognize social cues, or triggers. It also helps you improve your attention, memory, and ability to organize your thoughts. It combines computer-based brain training and group sessions.

Art therapy

Art therapy can help you express your feelings in new and creative ways. It can help you process your experiences, relate to others, and even reduce your schizophrenia symptoms. You can meet with an art therapist one-on-one or in a small group. 

In addition to therapy, your care team will likely prescribe certain medications to help you manage your symptoms, which may include:

First-generation antipsychotic drugs

You might hear these drugs called typical or conventional. These medications block a brain chemical called dopamine and are more likely than second-generation antipsychotics to cause significant movement disorders like intense muscle stiffness (called dystonia) or a condition that may develop over long-term exposure called tardive dyskinesia. Drugs in this group include:

Ways to take the medication. Most antipsychotics are pills you take by mouth. Several drugs come in tablets that dissolve easily in your mouth. 

Newer antipsychotic drugs

These are also called second-generation or atypical antipsychotics. They’re newer than the first-generation drugs. They generally cause fewer side effects, such as repetitive or involuntary movements like eye blinking, than older antipsychotics. Medications include:

Second-generation antipsychotics work about equally as well as older drugs. The one exception is clozapine, which is effective against schizophrenia that doesn’t respond to other treatments.

If you have trouble taking pills every day, you can get shots for several second-generation antipsychotics. These long-acting drugs require injections every couple of weeks to every 3 months. They include aripiprazole, haloperidol, olanzapine, paliperidone, and risperidone.

Side effects. Different atypical antipsychotics cause different side effects. Your doctor will help you pick a drug that works best for you with the minimum amount of adverse effects. Some common issues may include:

  • Weight gain
  • Higher blood sugar and cholesterol levels
  • Low blood pressure
  • Drowsiness
  • Type 2 diabetes
  • Constipation
  • Blurry vision
  • Dry mouth

In this procedure, electrodes are attached to the person's scalp. While they’re under general anesthesia, doctors send a small electric shock to the brain. A course of ECT therapy usually involves two or three treatments per week for several weeks. Each shock treatment causes a controlled seizure. A series of treatments over time leads to improvement in mood and thinking. 

Scientists don’t fully understand exactly how ECT and the controlled seizures it causes help, although some researchers think that ECT-induced seizures may affect the release of neurotransmitters in the brain. It can help when medications no longer work or if severe depression or catatonia makes treating the illness difficult. Find out more on how electroconvulsive therapy works.

Although the main treatments for schizophrenia are medication and therapy, other options also exist. Using more than one treatment approach can help you manage the illness from multiple angles. This way, you have a well-rounded support system that can help you find well-being in all parts of your life. 

Social skills training

These are classes that teach social skills like eye contact, volume control, and body language. This can improve your ability to communicate clearly with others, resulting in better social interactions and stronger relationships. 

Rehabilitation

Schizophrenia usually develops during your teens and 20s, when many people are building careers. Once you have your schizophrenia under control, you might need help starting your career. So rehabilitation may include job counseling, problem-solving support, and education in money management. This can help you get ready for work, find a job, and keep it.

Support groups

This is when multiple people gather to talk about life with mental illness. The meeting can be online or in-person. They might focus on schizophrenia or general mental health. Some are just for people with mental health issues, but others welcome family and friends, too. Support groups can help you practice social skills, build relationships, and cope with schizophrenia. 

One popular option is the National Alliance on Mental Illness (NAMI)’s free peer-to-peer program. It connects you with someone else who has schizophrenia or their loved one. The program lasts 10 sessions.

Coordinated specialty care (CSC)

This treatment is for people having psychosis for the first time. It’s a team approach that combines medication, psychological therapies, and support with school or work. CSC tries to include the family whenever possible. 

People with schizophrenia who get early and intensive treatment have the best long-term results. By treating the disease early with strong, well-rounded supports, CSC tries to set you up for lifelong recovery. In fact, CSC is better than other treatments at reducing symptoms, getting you back to school or work, and helping you find well-being.

Assertive community treatment (ACT)

This offers highly personalized services to people who are regularly hospitalized or unhoused. A team of professionals help you meet life’s daily challenges, like taking medications. They also help you prevent and solve problems.

Social recovery therapy

This treatment is a type of CBT. It helps you set and achieve goals. The therapist works with you to solve problems that get in the way of those goals. This helps you make positive change in your life and feel optimistic about the future.

People with schizophrenia sometimes have psychotic episodes. These might include delusions, hallucinations, or suicidal behavior.

If you are having a mental health crisis:

  • Call 911 or go to the nearest emergency room. You also can dial a crisis hotline like the 988 Lifeline. It’s free and open all day, every day. You also can text or chat online. 

Making a crisis plan

When you have a serious mental illness, it’s important to make a plan for emergencies. This way, you will have a say in how you want a crisis to be handled.

Your doctor can help you make this plan. Family and friends also can help. Even if they’re not directly involved, you can share the plan with them so they know how to help you in an emergency.

The plan should include things like:

  • Contact information for your doctor and other mental health providers
  • Contact information for trusted friends and family
  • Phone numbers for crisis hotlines
  • The names and addresses of local treatment centers
  • A description of your medical and psychiatric history
  • Things that upset or trigger you
  • Things that help you

You, your loved ones, or medical professionals can look at this plan for important information during an emergency. Keep copies with loved ones and in your home, car, or wallet.

You also might want to consider a psychiatric advance directive. This is a legal document that gives someone else the right to make treatment decisions if you are unable to do so. You sign it when you are mentally stable. It only applies during a mental health emergency.

A more extreme option is a conservatorship. This is when the court decides to let someone else make important decisions for you. It gives them the same decision-making power that a parent has over a child. It is only used in situations where you refuse treatment despite being a great danger to yourself. 

Hospitalization

During an emergency, you might go to a hospital or other psychiatric facility. You can choose to go by yourself. But if you’re a danger to yourself or others, someone else can force you.

You can go to:

  • A psychiatric hospital. These hospitals specialize in helping people with severe mental illness. Many general hospitals have a psychiatric ward or wing.
  • A crisis stabilization unit. These are small, inpatient centers designed to help people with mental health emergencies.
  • An extended observation unit. These centers can exist on their own or as part of a crisis stabilization unit. They’re for people who have emergencies that can be solved in less than 24 hours. They’re generally less restrictive than hospitals.
  • An emergency room. If you don’t have other options, you can go to the emergency room. Tell them that you’re having a mental health emergency. Many hospitals have a crisis intervention team that is trained to help in these situations.

When you get to the hospital, you’ll probably have to fill out some paperwork, show them your insurance card (if you have one), and answer some questions. 

Then, medical staff will talk to you about your situation. This will help them decide how they can best help you.

They’ll probably start by giving you medicine to calm down. The medicine also will help you feel like yourself again and start eating and sleeping as usual. When you’re feeling better, they can explain the situation to you and give you crisis counseling.

Before you leave the hospital, you should meet with a social worker or case manager. Loved ones should also join the meeting. Together, you can make a plan for how to manage your symptoms and get back to your normal routine.

After you leave the hospital, it’s important to continue your medications for at least 12 months. This will help keep your mood stable so you can take care of yourself. It will also help prevent your symptoms from getting worse. People who stop taking their medications are more than twice as likely to relapse compared with people who continue them.  

Involuntary vs. voluntary hospitalization

An involuntary hospitalization happens when you are a danger to yourself or others but refuse to go to the hospital voluntarily. It usually lasts less than 3 days.

If the treatment center thinks your involuntary hospitalization should last longer, they must organize a court hearing. In order for the stay to be extended, a judge and at least two doctors must agree that you are still a danger to yourself or others. But every state has different rules.

If other treatments don’t help, your doctor might recommend clozapine. This is the most effective antipsychotic drug. It helps 30% of patients who have treatment-resistant schizophrenia. In comparison, a combination of chlorpromazine and benztropine helps only 4%. 

Clozapine has some rare but dangerous side effects, like seizures and a dangerously low level of white blood cells. It also can cause you to get dizzy when you stand, have trouble holding in your pee, and drool.

Because of these risks, you’ll need to have regular blood tests. These can help your doctor keep an eye on your white blood cells.

If clozapine doesn’t work, you have other options. Your doctor might suggest combining two or more antipsychotic drugs. They also could add a drug to keep your mood stable. Using multiple drugs can raise your risk for side effects, so only try this with your doctor’s guidance.

Most people with schizophrenia need medication. Finding the right medicine (or combination of medicines) isn’t easy, but it’s worth it. You might need to try several different kinds before you find the one that’s right for you. The right medication will calm your symptoms, making them less disturbing and more manageable. Starting medicine early can even help prevent the disease from causing long-term changes in the brain. 

If you have a hard time remembering when to take pills, there’s another option. Some doctors can give you medicine as a shot instead of a pill. You get the shots once or twice a month. One study found that people who got the shot were less likely to be hospitalized than people who took pills. 

Alternative therapies

Medication is the main treatment for schizophrenia, but it is not the only one. Some people don’t want to take medication. Maybe they’ve had bad experiences with medication in the past. Or maybe they're worried about side effects. These people might benefit from other forms of treatment, like therapy, rehabilitation programs, and support groups.

Even if you take medication, you may still need other forms of therapy to help you learn to cope with your illness. And outside of therapy, you’ll still need to take care of your mental and physical health in other ways. 

Here are other ways you can take care of yourself:

  • Learn about the illness. This can help you understand and be more compassionate with yourself. Plus, the more you know, the more you can advocate for yourself.  You can also teach others, helping to break the stigma around mental health. 
  • Make a treatment goal. Focus on something that’s important to you, like getting a job or your own house. This can motivate you to stay positive and stick to your treatment plan.
  • Follow your treatment plan. Work together with a doctor to make a treatment plan that works for you. This might include therapy, medications, or other supports. Don’t skip therapy visits or doses of medication. If you have a hard time remembering them, a calendar or pillbox can help. You might start to feel better—that’s a sign that the plan is working! Keep up the good work.
  • Join a support group. You can share your feelings with and get advice from people who understand what you’re going through.
  • Avoid alcohol and drugs. These can make it harder to manage schizophrenia symptoms. They also can interfere with some schizophrenia medications.
  • Ask for help. There are many resources that can support people with schizophrenia and other disabilities. Depending on your situation, you might be able to get help with housing, transportation, and other daily needs.
  • Practice coping skills. Activities like yoga and meditation can help you calm down when you’re angry or upset. You can also try journaling, art or creative writing, sports, and other hobbies that distract or uplift you. Coping with stress can help you avoid a psychotic episode.
  • Don’t forget your physical health. A healthy diet, exercise, and plenty of sleep will help you feel your best.

You should also learn the warning signs of a psychotic episode. Think about what triggers you, whether that’s certain places, people, or emotions. You might also have physical symptoms, like trouble sleeping.

Everyone has different warning signs, but some common ones are:

  • Not feeling hungry
  • Anxiety or stress
  • Trouble sleeping
  • Paranoia or fearfulness
  • Hearing voices
  • Difficulty focusing

Pay attention to how you’re feeling, both physically and mentally. You also can ask a loved one to point out these signs. This way, you can surround yourself with extra support when you need it most.

If you're worried a loved one has symptoms of schizophrenia, talk with them about your concerns and ask them how you can help. Encourage them to find a mental health professional and be prepared to get help in case of a medical emergency.

Caring for someone with schizophrenia can be challenging. If you need support, consider the following resources for caretakers:

Family therapy

This form of talk therapy can provide caretakers with education and support on how to best care for someone with schizophrenia. A mental health professional will facilitate these sessions with the entire family, though you may meet with the therapist individually at times.

Family education

Your knowledge of psychosis and schizophrenia can help a friend or family member who has it. Research shows that people with schizophrenia who have a strong support system do better than those without the encouragement of friends and family.

Schizophrenia treatment mainly relies on medication and therapy. A psychiatrist can help you try different treatments and doses until you find one that works for you. With the right treatment, you can live a happy and fulfilling life.

What happens if schizophrenia is left untreated?

When left untreated, schizophrenia can cause depression, drug and alcohol misuse, dangerous behaviors, homelessness, and suicidality.

Why is schizophrenia so difficult to treat?

You may need to try many different types and doses of medication before you find a treatment that works for you. 

Do people with schizophrenia remember episodes?

It depends. Some people remember previous psychotic episodes, especially when they’re triggered.

Is it possible to fully recover from schizophrenia?

There is no cure for schizophrenia, but treatment can help people manage their symptoms and find well-being. With treatment, many people with schizophrenia can build healthy relationships, enjoy a good quality of life, and live and work in the community.