Behind the Counter: Medications to treat schizophrenia

Doctors use antipsychotic drugs to treat symptoms of psychosis. These symptoms may include:

• hallucinations: hearing voices, seeing things that others cannot see, or feeling things on the skin that are not there
• delusional thoughts: paranoia or other beliefs that are not based in reality
• disorganized thoughts: difficulty forming logical, coherent, and connected thoughts

These drugs also treat disorders other than schizophrenia, including bipolar disorder and depression. They act on specific messenger chemicals of the brain known as neurotransmitters.

Antipsychotics work primarily on dopamine, serotonin, norepinephrine, and acetylcholine.

Scientists developed first-generation antipsychotics in the 1950s. People take them to treat the so-called positive symptoms of schizophrenia, which include hallucinations, delusions, and disorganized thoughts.

Second-generation antipsychotics are newer and have been around since the 1980s. They also treat the positive symptoms of schizophrenia, but experts consider them to be better than the first-generation drugs in treating the negative symptoms, such as:

• lack of speech
• social withdrawal or isolation
• decreased ability to show emotions

Long-acting injections can be first- or second-generation drugs. They allow a person to receive a slow release of medication over a period of weeks to months to eliminate the need for taking a daily pill.

The treatment of schizophrenia typically begins with second-generation antipsychotics. If it proves difficult to achieve significant control of symptoms, doctors may recommend first-generation drugs to provide more relief.

First-generation antipsychotics may also be the treatment of choice when a person has a personal history of doing well with a drug in this category or is unable to tolerate the side effects associated with second-generation antipsychotics.

Doctors may recommend long-acting injections for people who find it challenging to adhere to an oral medication regimen, such as those who have difficulty remembering to take medication daily.

The symptoms of schizophrenia mean that it can negatively affect a person’s ability to:

• maintain housing
• maintain relationships with loved ones
• make safe decisions

The goal of treatment is to improve functioning.

Medication should help eliminate hallucinations or decrease them to a more quiet, tolerable level.

There should be a decrease in the intensity of response to any delusional thoughts, even if there is not complete understanding that the thoughts are not reality-based.

Thoughts and behaviors may also become more organized, improving communication.

Experts consider first-generation antipsychotics to have a higher risk of what are known as extrapyramidal symptoms, or the movement symptoms. These include:

• muscle spasms
• muscle contractions
• restlessness
• tremor
• slow movements
• muscle jerks

These drugs have an association with sexual dysfunction, as well.

Second-generation drugs are less likely to cause these types of symptoms but may lead to metabolic symptoms, such as:

• weight gain
• elevated blood sugar levels
• increased blood lipids

If left uncontrolled, these symptoms can lead to physical health issues, such as diabetes and heart disease.

When starting medication, an individual should expect to see their physician on a regular basis for monitoring. Physicians monitor for symptom control and the presence of any side effects to the medication.

The physician may do a test every few months to monitor for any movements associated with the medication. They may also order blood tests to monitor levels of blood sugar along with cholesterol and other lipids so that they can address any issues as necessary.

For some people, it will.

For others, the symptoms may not go away. However, having them decrease to a tolerable, more functional level is a huge win.

There are also people who deny any of the positive symptoms of schizophrenia. Their negative symptoms remain, and those can be difficult to control.

It is possible for a person to achieve a level of stability that allows them to live independently, gain employment, and have meaningful platonic and intimate relationships.

People who engage in treatment early and remain in treatment without many episodes of stopping their medication abruptly or not following up with their treatment team are more likely to achieve this level of stability.

When a person stops their medication, the symptoms that were present before treatment usually return. That can mean a decline in functioning and the potential for a setback in any gains that the individual achieved, such as those relating to housing or employment.

When this happens often enough, it can become more difficult for a person to get adequate control of their symptoms, even with the same medication regimen that may have previously been effective.

Most individuals with schizophrenia will require lifelong treatment with medication to assure continued success and stability.

Dr. Nicole Washington is a board certified psychiatrist and Chief Medical Officer of Elocin Psychiatric Services, a primarily virtual practice where she focuses on the mental health needs of the busy professional. Dr. Washington has spent most of her career caring and being an advocate for those who are not typically consumers of mental health services — namely underserved communities and high performing professionals.

Through her practice, the Amazon best-selling book, From Introspection to Action: The High-Level Professional’s 28 Day Journey to Improving Mental Health, and her podcast, The C-Suite Confidant, she hopes to break down barriers to receiving treatment that these populations face, as well as engage listeners in topics relevant to the busy professional. She is a sought-after speaker on a variety of mental health topics and enjoys working with organizations on initiatives that create environments that are supportive of the mental well-being of their employees.