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Medications for Schizophrenia

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

Medications remain an essential part of the treatment of Schizophrenia.  There are now decades of experience and scores of studies confirming that antipsychotic medications help to reduce psychotic symptoms and ease the burden of the illness of Schizophrenia

However, none of these medications offer a complete cure from Schizophrenia.  They are effective in reducing positive symptoms, but far less effective when it comes to negative symptoms [ref] or cognitive deficits [ref], which cause a significant amount of disability.  They also have a wide range of side-effects.  It has been found that as many as three-quarters of patients will discontinue their medications because of side-effects, inefficacy, or other reasons [ref].  This is why it remains important that individuals with Schizophrenia receive additional psychosocial treatments.

The original class of antipsychotic medications that were developed are now called the Typical Antipsychotics.  Because they tend to cause extrapyramidal side-effects, their use has diminished considerably during the last couple of decades with the advent of the Atypical Antipsychotics, a newer generation of medications that cause less extrapyramidal side-effects and, at least initially, were thought to be more effective than the Typical Antipsychotics in treating both positive and negative symptoms.

However, more recent evidence suggests that there is not a very significant difference in the performance of the Typical versus the Atypical Antipsychotics [ref, ref]. Extrapyramidal side-effects can be moderated in the Typical Antipsychotics by using lower doses and choosing lower-potency ones [ref]. Also, the Atypical Antipsychotics have their own problematic side-effects, especially weight gain and elevated blood sugar and cholesterol. That being said, there is now evidence showing that these metabolic side-effects of the Atypical Antipsychotics can be prevented or reversed by using Metformin [ref, ref].

According to current treatment guidelines [ref], it is still recommended to try the Atypical Antipsychotics before moving onto the Typical Antipsychotics. Given the evidence that Metformin can prevent and treat the metabolic side-effects caused by the Atypicals, this is the position taken by the treatment guidelines on this site.

Clozapine remains the most effective medication available for Schizophrenia, with considerable evidence that it is superior to most other available antipsychotics [ref, ref].  The problem, however, is that it also can cause serious side-effects, and people who take Clozapine must go for weekly blood tests to prevent this.  For this reason, Clozapine is usually reserved for cases of Schizophrenia that do not respond to trials of at least two other antipsychotics [ref]. 

Several Typical Antipsychotics, and also Risperidone, are available in long-acting injectable forms, which can be given once every few weeks.  This may be necessary in situations where a person is unable or unwilling to take their medications in a regular and consistent fashion. 

ECT, though not a medication, is a treatment that has a long history of being used in psychiatry to treat Schizophrenia, and there is evidence that it is effective [ref]. It is a safe treatment with arguably fewer side-effects than most of the antipsychotic medications

 

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Psychotherapy

Treatment Guidelines for Schizophrenia