Which Antipsychotic Medication Is Right For Me
Your psychiatrist will work with you to find the best medication for you. It may be an FGA or an SGA.
If youâve had thoughts of suicide or you have treatment-resistant schizophrenia, your doctor may try the SGA clozapine . Itâs the only antipsychotic medication thatâs FDA-approved to treat refractory schizophrenia. Itâs also the only antipsychotic medication shown to reduce suicidal thoughts. But there are risks, so your doctor will weigh the risks and benefits.
Your doctor will try to balance effectiveness and risk of serious side effects. For example, they may look at your response to a medication and how much risk you have of developing a movement disorder or metabolic problems. Theyâll also consider your priorities, history, and all of your medical and psychiatric issues.
It may take time to find a medication that you tolerate well. You may start taking one medication, then try another if it doesnât work well for you.
You may also think about cost when choosing a medication. The price of antipsychotics can be as low as $5 per month or as high as $2,000 or more every month. You can choose a generic instead of a name brand to bring costs down.
Antipsychotics In The Treatment Of Schizophrenia: An Overview
Rajiv Tandon, MD
Antipsychotics in the Treatment of Schizophrenia: An Overview
Rajiv Tandon, MD
Corresponding author: Rajiv Tandon, MD, Department of Psychiatry, University of Florida College of Medicine, PO Box 103424, Gainesville, FL 32610-3424 .
doi:10.4088/JCP.10075su1.01
Schizophrenia is a chronic remitting and relapsing psychotic disorder associated with significant impairment in social and vocational functioning1-3 and an average reduction in lifespan of 15 to 25 years.3-5 Treatment includes medication and a range of psychosocial interventions.6 The objectives of treatment are to reduce frequency and severity of psychotic exacerbation, ameliorate a broad range of symptoms, and improve functional capacity and quality of life. Until the introduction of antipsychotic medications a half-century ago, standard treatment for schizophrenia consisted of providing patients with a safe and supportive environment in a long-stay psychiatric hospital. The introduction of chlorpromazine, the first antipsychotic medication, sparked a revolution in the pharmacotherapy of schizophrenia.7 Since that time, antipsychotics have become the cornerstone of pharmacologic treatment for schizophrenia.
PHARMACOLOGY OF ANTIPSYCHOTIC AGENTS
COMPARATIVE EFFECTIVENESS
Efficacy
Depressive symptoms. Similarly, antipsychotics can ameliorate depressive symptoms in conjunction with producing improvement in positive symptoms, but can also cause “neuroleptic dysphoria” associated with EPS.36
Do Antipsychotics Affect Other Medication
Antipsychotics can interact with many different medications. This means if you take an antipsychotic and another medication, they can affect each other.
For example, some antipsychotics can interact with tricyclic antidepressants. In some cases, this means they shouldnt be prescribed together.
Some antipsychotics can cause drowsiness, so doctors should be careful about prescribing benzodiazepines too. It could make you feel drowsier.
Your doctor may prescribe you different medications with antipsychotics, which is common. Your doctor will carefully monitor this to ensure your safety.
You should tell your doctor about all the medicines you are taking. This includes any supplements. This will allow your doctor to prescribe the right antipsychotic. It is important to note that supplements, such as natural health products can interact with antipsychotics.
If youre taking a supplement, which your doctor agrees with, always get the same brand. Switching brands, even if its the same supplement, can have an effect your antipsychotics.
You may benefit from keeping an up-to-date medication list. This should include all the medication youre currently taking so you can give it to healthcare professionals.
Its also very important to not stop or start any medication without checking with a healthcare professional. This could be a doctor or a pharmacist.
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Atypical Antipsychotics To Treat Schizophrenia:
| Lamotrigine | Mood stabilizer | Might be able to prevent some psychotic symptoms induced by NMDA receptor antagonists to treat symptoms of schizophrenia. |
| Lithium | Mood stabilizer | Works to stabilize mood and is often used as an add-on treatment in addition to antipsychotics to treat schizophrenia. Might reduce both depressive and manic symptoms. |
Talk to your psychiatrist or healthcare professional about the possible risks and benefits associated with the above medications before starting treatment.
Which Antipsychotic Medicine Will Be Best For Me
People respond differently to different antipsychotic medicines some work well for one person but not so well for another. Or side effects may be a problem with one medicine but less so with another. So, treatment for schizophrenia is tailored specifically for each individual.
In Australia, antipsychotics are available only on prescription. The medicine that your doctor or psychiatrist prescribes will depend on:
- your symptoms and how long you have had them
- likely side effects of medicines
- your age and sex and
- whether you have any other conditions or take other regular medicines.
Sometimes the first antipsychotic medicine you try wont be effective or will cause troublesome side effects, so you may need to change medicines. Your doctor will work with you to find the best medicine for you and the right dose.
A second-generation antipsychotic is usually the first choice for people who are having a psychotic episode for the first time. If the first medicine tried is not effective in controlling symptoms, a different second-generation or a first-generation antipsychotic may need to be tried.
Its usually recommended that people take antipsychotic medicines for 2 to 5 years after a psychotic episode. After a certain period of time , some people may be able to have a trial of no medicines under their doctors supervision. If they remain symptom free, they may not need to take long-term medicines.
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What Was The First Drug Used To Treat Schizophrenia
Schizophrenia is a complicated, chronic neuropsychiatric disorder that affects how you feel, think, and behave. Less than 1% of people in the United States have schizophrenia, and its exact cause isnt known. While there isnt a cure for schizophrenia, understanding as much as possible about it can help with both treatment and learning to manage the disorder.
Schizophrenia treatment can greatly improve most, if not all, symptoms. Effective treatment also reduces the likelihood of a recurrence of negative symptoms.
Schizophrenia medications like antipsychotics and other meds when combined with psychological treatments like cognitive behavioral therapy and other psychotherapy techniques work together to significantly reduce symptoms.
Keep reading to learn more about meds for schizophrenia. Were discussing everything you need to know, including how they work, what side effects may occur, and how to get medication to treat schizophrenia.
Inclusion And Exclusion Criteria
Inclusion criteria were nonrandomized studies in English about the use of LAIs in patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder.
Studies were excluded if they were randomized or double-blind investigated only pharmacokinetic or pharmacodynamic characteristics of LAIs patients included were not treated by their psychiatrist according to usual clinical practice and/or if patients had other psychiatric pathologies.
A flow chart is presented in Figure B to illustrate the study selection process and results. A detailed list of the studies included is presented in the Additional file . Abstracts and full-text articles were screened according to the inclusion and exclusion criteria and the publication full texts were retrieved for those matching the inclusion criteria. Various settings in different countries and populations were included in the nonrandomized studies, as these were not restricted by the inclusion criteria.
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Nicotinic Receptors In Schizophrenia
Many people suffering from schizophrenia smoke. This can be attributed to the disease itself or its treatment . There are numerous reports about disturbed brain cholinergic transmission in patients with schizophrenia . Patients communicate that smoking helps them to relieve negative symptoms which can be linked to their deficiencies regarding nicotinic receptors.
The high rate of smokers among patients with schizophrenia stimulated the research on the role of nicotinic receptors in this disorder . Studying of 7 receptors with specific venomous toxins showed that 7 receptors are located in brain regions involved in cognition . Deterioration of cognitive abilities such as working memory and cognitive flexibility, as well as attention, anticipate psychotic symptoms and are a prognosticator of functional outcome .
The results of trials with 7 nicotinic receptor agonists or positive allosteric modulators are promising but require further investigation.
Does Smoking Affect Antipsychotics
You should tell your doctor if you smoke. This is because smoking interacts with the way medication is absorbed in your body. If you are thinking of quitting smoking, you should discuss this with your doctor. If you stop smoking suddenly, this can affect the levels of medication in your body. This can cause serious side effects.
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What Else Should I Consider Before Taking Antipsychotics
Can antipsychotics cause sexual problems?
Sexual problems have been reported as a side effect of antipsychotics. Evidence shows that many people taking antipsychotics experience sexual problems. But some antipsychotics have less sexual side effects than others.
Some antipsychotics can cause a hormone called prolactin in your body to increase. This seems to be why antipsychotics can cause sexual side effects. The following side effects are common. Higher levels of prolactin can cause:
- periods to stop,
- a lack of sex drive,
- breast enlargement in both men and women,
- problems getting aroused, and
If you are experiencing any of these problems, you should contact your doctor. They may reduce the dose or stop the medication. If you are advised to stay on it, you might be able to take medications to help with these problems.
What if Im pregnant or planning on getting pregnant?
You can speak to your doctor about the risks of medication while pregnant or breastfeeding. You could also discuss this with your midwife or health visitor. Taking antipsychotics during pregnancy may have certain risks. You shouldnt stop taking your antipsychotics without speaking to your doctor first.
It is thought that there may be a small risk of complications if you take antipsychotic drugs during pregnancy. Overall, the research isnt clear whether first generation or second-generation drugs will affect your unborn child.
What Are The Symptoms Of Schizophrenia
This mental illness is one of the most complex and difficult to manage because there are so many symptoms, which can vary in intensity. Individuals can be diagnosed at any age, but the disease usually develops in the teenage years and slowly intensifies over time unless treated properly and managed. The severity of a persons symptoms is heavily affected by high levels of stress, refusal to take prescribed medication, and drugs or alcohol. This disorder changes how an individual thinks and behaves and its also slightly more common in men than women. Here are some common symptoms of schizophrenia:
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What Side Effects Might I Experience From Taking Antipsychotics
Your medication should come with a leaflet called a patient information leaflet. This leaflet will tell you what the side effects are and explain what to do if you are experiencing any side effects.
Side effects of antipsychotics can include the following.
- Uncontrollable movements of the jaw, lips and tongue. This is known as tardive dyskinesia. This includes shakiness. This can often be reduced by lowering the dose. But, if a high dose is necessary, the shakiness can be treated with antimuscarinic medication.
- Uncomfortable restlessness, known as akathisia.
- Sexual problems due to hormonal changes.
- Sedation. Such as sleepiness and slowness.
- Hyperprolactinaemia, such as the production of milk in both men and women from their breasts.
- Blurred vision.
Not all antipsychotics will have these side effects and medication can affect different people in different ways. Second generation or atypical antipsychotics are less likely to cause movement side effects, but you might still experience them. If you do, then your doctor might change your medication. Or they may give you medication to help manage the involuntary movements.
You can find more information about Medication choice and managing problems by clicking here.
You may also find the following websites helpful learn more about antipsychotics:
How might antipsychotics effect my physical health?
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How To Get Schizophrenia Medication
Finding the right medication for schizophrenia is part of managing it. Even if youre already seeking treatment through therapy, it can be a good idea to reach out to your doctor or psychiatrist to discuss your options. In case you cant visit your psychiatrist in person and need a prescription, you can reach out to a licensed online psychiatrist to get you the medication you need.
One of the first things you should consider is how any medication might affect you. Candid conversations with your doctor or psychiatrist can ensure youre learning everything you need to know about potential schizophrenia medications. This way, youll be confident in your decision if you begin taking any specific type of medication. You can also have discussions with your doctor about medication adherence and medication nonadherence in case there are unique situations that prevent you from taking medicine as initially prescribed by your doctor.
To get meds for schizophrenia, complete the following steps:
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How Well Do Antipsychotics Work
It is thought that for every 10 people who take these medicines, 8 will experience an improvement in their symptoms. Unfortunately, antipsychotics do not always make the symptoms go away completely, or for ever. A lot of people need to take them in the long term even if they feel well. This is in order to stop their symptoms from coming back. Even if you take these medicines on a long-term basis and they are helping, sometimes your symptoms can come back.
Symptoms may take 2-4 weeks to ease after starting medication and it can take several weeks for full improvement. The dose of the medicine is usually built up gradually to help to prevent side-effects .
Antipsychotic Agents And Their Use In Schizophrenia
Clozapine
Three Types of Symptoms
Symptoms of schizophrenia can be divided into three groups: positive symptoms, negative symptoms, and cognitive symptoms. Positive and negative symptoms are shown in Table 24.1.
TABLE 24.1
Positive and Negative Symptoms of Schizophrenia
| Positive Symptoms |
|
Poor self-care |
Positive Symptoms and Negative Symptoms
Positive symptoms can be viewed as an exaggeration or distortion of normal function, whereas negative symptoms can be viewed as a loss or diminution of normal function. Positive symptoms include hallucinations, delusions, agitation, tension, and paranoia. Negative symptoms include lack of motivation, poverty of speech, blunted affect, poor self-care, and social withdrawal. Positive and negative symptoms respond equally to FGAs and SGAs.
Cognitive Symptoms
Cognitive symptoms include disordered thinking, reduced ability to focus attention, and prominent learning and memory difficulties. Subtle changes may appear years before symptoms become florid, when thinking and speech may be completely incomprehensible to others. Cognitive symptoms may respond equally to FGAs and SGAs.
Acute Episodes
Residual Symptoms
Long-Term Course
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What Is Coordinated Specialty Care For Schizophrenia
A 2016 study found that early intervention after the onset of a first episode of psychosis with a coordinated, team-based approach and low doses of antipsychotic medication resulted in more effective treatment for people with schizophrenia.
This team approach is known as coordinated specialty care.
A coordinated specialty care team may include clinicians, therapists, and case workers with experience in the following areas:
- Work or education support
Other therapies for schizophrenia may include these options:
Cognitive behavioral therapy Youll meet with a therapist to work on your thinking and behavior.
The therapist may teach you how to test the reality of your thoughts or perceptions, and help you develop ways to ignore the voices in your head.
Peer support groups These are safe places where you can meet people who are going through the same things as you. Professional therapists are usually not involved.
Family therapy This involves seeing a therapist along with members of your family.
Its important that your family knows as much about your schizophrenia as possible. Therapists can help your family develop coping strategies and problem-solving skills.
Rehabilitation These programs can include job counseling, money management, and communications training.
Rehabilitation emphasizes skills that can help people with schizophrenia function better in their communities.
Does Alcohol Affect Antipsychotics
You should tell your doctor if you drink alcohol. Drinking alcohol can make it harder for your body to absorb medication. This could increase the effects alcohol has on you. For example, drinking alcohol with antipsychotics might increase the sedative effects.
This means you might feel very tired. You may find more information about alcohol and your medication in the patient information leaflet.
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Mechanism Of Antipsychotic Action
D2 receptor antagonism in the brain is a general pharmacodynamic property of all antipsychotics this has given rise to the hypothesis that schizophrenia involves a dysregulation of dopaminergic circuits with excess dopaminergic activity in the mesolimbic pathway and reduced dopaminergic signalling in the mesocortical pathway . Evidence for the dopamine hypothesis comes from not only the efficacy of D2 receptor antagonists, but also through the effects of D2 agonists such as amphetamine in precipitating psychosis and the effects of dopamine-depleting drugs such as reserpine in reducing psychotic symptoms.
Antipsychotic action has consistently been shown to occur when the occupation of striatal D2 receptors is more than 65%, but further increases in the level of D2 blockade are not associated with improved antipsychotic efficacy rather, it leads to the onset of side effects such as EPSEs and hyperprolactinaemia. A threshold dose for EPSEs occurs when 80% of the D2 receptors are occupied and for hyperprolactinaemia when D2 blockade exceeds 72%. Despite the association of striatal dopamine blockade with the risk of EPSEs, it is important to note that this is not the critical site of action for therapeutic effect, which occurs most prominently in the mesolimbic brain system.