The best treatment for psychotic illness usually includes a combination of antipsychotic medication, psychological therapy and community support. This pamphlet answers commonly-asked questions about antipsychotic medication (antipsychotics).
How do antipsychotic medications help?
Antipsychotic medications are helpful to people with schizophrenia, schizoaffective disorder and some forms of bipolar disorder. They are able to reduce, or sometimes eliminate, the distressing and disabling symptoms of psychosis, such as paranoia, confused thinking, delusions and hallucinations, so that the person taking them feels better.
How do antipsychotic medications work?
People with schizophrenia and other psychotic illnesses often have an imbalance in certain natural chemicals in the brain, especially dopamine. Antipsychotic medications help the brain to restore its usual chemical balance and so reduce symptoms.
How long do they take to work?
People should begin to feel better within 6 weeks of starting to take antipsychotic medication. However, it can take several months before the full benefits are felt.
What else do we know about antipsychotics?
They don’t change your personality. While you might notice changes in your mood and the way you cope with stress, antipsychotics will not change your personality.
They don’t make you feel good all the time
While antipsychotics can relieve the symptoms of psychosis-related disorders, they do not stop you from feeling the normal ups and downs of life. You may notice, though, that you find it easier to think more clearly.
They are not the only treatment that helps you get better
Taking antipsychotic medication is one important step in getting better but is rarely enough on its own. As well as medication, effective treatment for schizophrenia and related disorders usually includes ongoing clinical support in the community, psychological therapies, education about the illness and how to deal with it, psychosocial rehabilitation, and accommodation and employment support.
They are not addictive
Antipsychotics, like many medications, change the way you feel. This means that if you stop taking the medication you may start to feel the way you did before the treatment. However, antipsychotic medications are not addictive, and you will not become dependant on them (you do not need to take higher and higher doses to get the same benefits).
What types of antipsychotic medications are there?
There are 2 types of antipsychotic medications: atypical (newer) and typical (older). While both are effective, the atypical medications have advantages over the typical ones. These advantages include:
- Fewer side effects such as trembling or stiffening of muscles.
- Less risk of developing ‘tardive dyskinesia’ — movement of the mouth, tongue and sometimes other parts of the body over which the person has no control.
- Some evidence suggests that the newer medications may be effective in improving overall mood, thinking and motivation.
While the atypical antipsychotic medications are used more than the typicals, some people find that the typical medications suit them better.
What about injections — depot medication?
Depot medication is given by injection, which releases the drug slowly over some weeks. Some people prefer injections as they find remembering to take tablets difficult. Some people are required to take depot medication as a condition of a community treatment order.
Are there any side effects?
Like any type of medication, antipsychotics can cause some unwanted effects. Your doctor should talk about this with you and encourage you to report back any problems you experience, as there is much that can be done to minimise these effects. Often these are temporary and wear off with time as your body adjusts to them. As a general rule they are less of a problem with lower doses of medication. Remember that not everyone will experience the same unwanted effects with the same medication — and some people have none. Possible unwanted effects with some medications include:
- dry mouth;
- lower sexual responsiveness;
- loss of periods in women;
- stiffness or trembling in muscles;
- mild involuntary movements;
- low blood pressure;
- nausea; constipation; and
- weight gain.
Changing the dose of medication can ease side effects, as can changing the time of day you take it. That is why it is important to let your doctor know as soon as possible if you are concerned about any of these side effects. Your doctor should also monitor any weight gain closely to minimise the potential risk of developing diabetes. There are things you can do too, for example, sucking sugar-free lollies can help a dry mouth, and diet changes and an exercise programme may help with weight gain, as well as improving your overall fitness.
How do I know which one is right for me?
Choosing the best medication to prescribe is not always straightforward because people may respond to medications differently. This means that finding the right one for you may involve trying one or more. However, there are some things you and your doctor can consider to work out what type of antipsychotic medication is likely to be most helpful, including whether you have had any physical health problems and what symptoms you experience.
Will I need to take other medications?
Certain types of medication can be prescribed in addition to, or instead of, antipsychotics. These include:
- Mood stabilisers to help with rapidly changing moods. This type of medication aims to prevent episodes of mania and depression and is typically used in people with bipolar disorder.
- Anti-anxiety medication to treat agitation.
- Antidepressant medication to treat depression.
- Sleeping tablets to help insomnia.
- Side effect medication to treat movement disorder — rare if using newer atypical medication.
How can I make sure I am taking the medication safely?
To get the most out of your medication:
Give your doctor as much information as possible
Remember to tell the doctor if you are taking any other medication, if you have any allergies, and when you usually wake up and go to bed. This can help them to work with you to develop a medication plan that best suits you.
Store your medication in an appropriate place
Heat and damp can affect most medications, so don’t store them in the bathroom, near a sink, or in your car. Instead, keep them in a box (safely out of reach of children) in your bedroom or kitchen cupboard.
Don’t share medication with other people
You should not take medication prescribed for other people, even if their symptoms seem similar. The medication prescribed to you by your doctor is individually tailored to you; other medications may not be suitable and can have adverse effects.
Take the prescribed dose
Studies show that people who take the prescribed dose at the times recommended by their doctor are more likely to feel better than those who take too little or too much. So make sure that you follow the directions on the pack to get the best benefit from your medication.
Will I ever stop taking medication?
When medication starts working and you fell better it can be tempting to stop taking it. Like people with diabetes, high blood pressure and asthma, many people with mental illness will need to take medication as prescribed on an ongoing basis to prevent symptoms coming back. Usually medication is taken for at least a year or 2 after recovering well from a first episode. If there is a second episode, medication will probably need to be taken for up to 5 years before your doctor reviews the treatment. It is very important to talk with your doctor before reducing or stopping any medication.
Are antipsychotics safe in pregnancy?
It is important to let you doctor know if you think you may be pregnant or if you are breast feeding. Babies are sensitive to medication and your doctor can advise you about the safest ones to use.
What about my physical health?
Some antipsychotics lead to putting on a lot of weight. Because of the effects on your physical health, it is important to look at ways of countering this, by being physically active and eating healthily, for example. Smoking cigarettes also affects how well medications work, in addition to causing serious illnesses.
Talk to your doctor about monitoring your physical health (through waist measurements and simple blood tests, for example), and practical ways to improve it, through being more physically active, eating better, and quitting smoking.
How do I find out more?
It is important to ask your doctor about any concerns you have.
SANE Australia also produces a range of easy-to-read publications and multimedia resources on mental illness. For more information about this topic see:
- SANE Guide to Medication and other Treatments. Explains how all the different aspects of treatment work, by looking at clinical care, medication, support in the community and helping yourself.
- SANE Guide to Schizophrenia and other Psychotic Illness. Helps people diagnosed with a psychotic illness such as schizophrenia, their family and friends by explaining what it means to have this diagnosis, examining effective treatments and what family and friends can do to help.
- Voices: The Auditory Hallucinations Project. An Audio CD that explains how it feels to hear voices and what can be done to help.
To order visit the SANE Bookshop at www.sane.org or call 1800 18 SANE (7263).