Schizophrenia Treatment

How is Schizophrenia Treated?

Because the causes of schizophrenia are still unknown, current treatments focus on eliminating the symptoms of the disease.

Antipsychotic medications

Antipsychotic medications have been available since the mid-1950s. They effectively alleviate the positive symptoms of schizophrenia. While these drugs have greatly improved the lives of many patients, they do not cure schizophrenia.

Everyone responds differently to antipsychotic medication. Sometimes several different drugs must be tried before the right one is found. People with schizophrenia should work in partnership with their doctors to find the medications that control their symptoms best with the fewest side effects.

The older antipsychotic medications include chlorpromazine (Thorazine®), haloperidol (Haldol®), perphenazine (Etrafon®, Trilafon®), and fluphenzine (Prolixin®). The older medications can cause extrapyramidal side effects, such as rigidity, persistent muscle spasms, tremors, and restlessness.

In the 1990s, new drugs, called atypical antipsychotics, were developed that rarely produced these side effects. The first of these new drugs was clozapine (Clozaril®). It treats psychotic symptoms effectively even in people who do not respond to other medications, but it can produce a serious problem called agranulocytosis, a loss of the white blood cells that fight infection. Therefore, patients who take clozapine must have their white blood cell counts monitored every week or two. The inconvenience and cost of both the blood tests and the medication itself has made treatment with clozapine difficult for many people, but it is the drug of choice for those whose symptoms do not respond to the other antipsychotic medications, old or new.

Some of the drugs that were developed after clozapine was introduced—such as risperidone (Risperdal®), olanzapine (Zyprexa®), quietiapine (Seroquel®), sertindole (Serdolect®), and ziprasidone (Geodon®)—are effective and rarely produce extrapyramidal symptoms and do not cause agranulocytosis; but they can cause weight gain and metabolic changes associated with an increased risk of diabetes and high cholesterol.

People respond individually to antipsychotic medications, although agitation and hallucinations usually improve within days and delusions usually improve within a few weeks. Many people see substantial improvement in both types of symptoms by the sixth week of treatment. No one can tell beforehand exactly how a medication will affect a particular individual, and sometimes several medications must be tried before the right one is found.

When people first start to take atypical antipsychotics, they may become drowsy; experience dizziness when they change positions; have blurred vision; or develop a rapid heartbeat, menstrual problems, a sensitivity to the sun, or skin rashes. Many of these symptoms will go away after the first days of treatment, but people who are taking atypical antipsychotics should not drive until they adjust to their new medication.

If people with schizophrenia become depressed, it may be necessary to add an antidepressant to their drug regimen.