If you’ve been diagnosed with schizophrenia, you will almost certainly be offered antipsychotic medication. But it’s important to understand that medication is just one component of schizophrenia treatment.
Since many people with schizophrenia require medication for extended periods of time—sometimes for life—the goal is to find a medication regimen that keeps the symptoms of the illness under control with the fewest side effects.
As with all medications, the antipsychotics affect people differently. It’s impossible to know ahead of time how helpful a particular antipsychotic will be, what dose will be most effective, and what side effects will occur. Finding the right drug and dosage for schizophrenia treatment is a trial and error process. It also takes time for the antipsychotic medications to take full effect.
Some symptoms of schizophrenia may respond to medication within a few days, but others take weeks or months to improve. In general, most people see a significant improvement in their schizophrenia within six weeks of starting medication. If, after six weeks, an antipsychotic medication doesn’t seem to be working, your doctor may increase the dose or try another medication.
The two main groups of medications used for the treatment of schizophrenia are the older or “typical” antipsychotic medications and the newer “atypical” antipsychotic medications.
The typical antipsychotics are the oldest antipsychotic medications and have a successful track record in the treatment of hallucinations, paranoia, and other psychotic symptoms. However, they are prescribed less frequently today because of the neurological side effects, known as extrapyramidal symptoms, they often cause.
Common extrapyramidal side effects of the typical antipsychotics include:
When the typical antipsychotics are taken long-term for the treatment of schizophrenia, there is a risk that tardive dyskinesia will develop. Tardive dyskinesia involves involuntary muscle movements, usually of the tongue or mouth. In addition to facial tics, tardive dyskinesia may also involve random, uncontrolled movements of the hands, feet, trunk, or other limbs. According to the National Alliance on Mental Illness, the risk of developing tardive dyskinesia is 5 percent per year with the typical antipsychotics.
In recent years, newer drugs for schizophrenia have become available. These drugs are known as atypical antipsychotics because they work differently than the older antipsychotic medications. Since the atypical antipsychotics produce fewer extrapyramidal side effects than the typical antipsychotics, they are recommended as the first-line treatment for schizophrenia.
Unfortunately, these newer atypical antipsychotic medications have side effects that many find even more distressing than extrapyramidal side effects, including:
If you or a loved one is bothered by the side effects of schizophrenia medication, talk to your doctor. Medication should not be used at the expense of your quality of life. Your doctor may be able to minimize side effects by switching you to another medication or reducing your dose. The goal of drug treatment should be to reduce psychotic symptoms using the lowest possible dose.