Schizophrenia medicines
A person experiencing a schizophrenic or psychotic ‘episode’ may lose contact with reality and experience delusions, hallucinations and disturbances of thought. During such episodes, antipsychotic medications, as their name suggests, help to minimise or take away these symptoms, and are also used to try to prevent them occurring. Some people will have to take the medicines long term to prevent relapses and to control symptoms.
Medicines used to treat schizophrenia are often known as antipsychotics. They work by helping to restore the brain’s natural chemical balance, reducing the symptoms associated with psychotic episodes. Although these medicines cannot cure the condition, they help many people with schizophrenia to lead relatively normal, productive lives by taking away the distressing, painful symptoms, such as delusions, hallucinations and thought disorders.
Medicines for schizophrenia can be broadly classified into ‘older’ and ‘newer’ antipsychotics.
Older medicines
These were first developed in the 1950s and revolutionised the treatment of schizophrenia, because for the first time, many people affected by it became able to live in the community rather than spending their lives in a psychiatric hospital. Most of these early medicines, or derivatives of them, are still used by doctors today. They include chlorpromazine (Largactil), haloperidol (Serenace), fluphenazine (Modecate), trifluoperazine (Stelazine) and pericyazine (Neulactil).
All the older antipsychotic medicines work, but they have some important differences — the main one being in the potency, that is, the dose of the medicine needed to have an effect. The doctor’s choice will depend on a person’s symptoms and the known side effects of the medicines available, some of which may be desirable. For example, if a person is having trouble sleeping or has symptoms of agitation, the doctor may prescribe a medicine with a marked sedative effect.
Some older medicines, such as Modecate, can be given as ‘depot injections’ to prevent relapse of symptoms. Here, doctors give an injection deep into a person’s buttock, allowing the medicine to be slowly released into the body. The injection may be effective at controlling symptoms for between 2 and 4 weeks once the person is stabilised on the medicine.
Newer medicines
Newer antipsychotics, known as ‘atypical’ antipsychotics, have been developed in recent years as alternatives to the older medicines. These medicines, which many doctors now prefer to try before the older ones, include olanzapine (Zyprexa), quetiapine (Seroquel), aripiprazole (Abilify), amisulpride (Solian), risperidone (Risperdal) and clozapine (Clozaril).
Doctors believe that these newer medicines are more effective than the older ones against what are known as the ‘negative’ symptoms of schizophrenia, such as social withdrawal, loss of motivation and lack of emotional expression. Doctors believe they also have fewer side effects, especially trembling and stiffening of muscles, and are better tolerated than the older traditional medicines.
Clozapine, although it is very effective, is usually reserved for people who have not been helped by other antipsychotic medicines, and is available in Australia only through designated hospital outpatients’ departments. This is because it has been known to cause agranulocytosis, a serious blood disorder that causes the number of white blood cells in a person’s body to decrease. As white blood cells are used to fight infection, any drop in their numbers may cause a person to be susceptible to contracting serious infections they would normally be able to resist. To minimise the possibility of this happening, people taking clozapine need to have regular blood tests.
Side effects of antipsychotics
Most antipsychotic medicines have side effects. These can include:
- drowsiness;
- weight gain;
- loss of menstrual periods;
- dizziness when standing up;
- stiffness or trembling in muscles;
- dry mouth; and
- impotence.
However, not everyone who takes a particular medicine will get the same side effects. Talk to your doctor if you get side effects and they worry you. If weight gain is a problem, your doctor will be able to advise you on diet and exercise which may help.
Long-term maintenance treatment
Some people may need to take antipsychotic medication for an extended period, and these are usually people who have a history of repeated episodes of schizophrenia, or ongoing schizophrenia. So-called maintenance treatment can be very helpful in preventing symptoms from returning in these situations.
Tardive dyskinesia
When assessing whether a person would benefit from long-term use of antipsychotic medicines, doctors consider very seriously the risks of that person developing a distressing condition called tardive dyskinesia. Tardive dyskinesia is a disorder of movement characterised by abnormal, uncontrollable movements of the mouth, lips, tongue and jaws. The arms, legs and trunk are also often affected.
This may occur in up to one-third of people who take the older medicines for a long period, and although it is less likely to occur with the newer medicines it may still do so. Unfortunately, there is no known treatment for it at present, and it may range from mild to severe. If a person does need antipsychotic medicine for a long period, doctors will try to prevent tardive dyskinesia occurring by using the lowest dose of medicine possible.
Last Reviewed: 16 May 2005
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