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Schizophrenia Medication Treatment Options

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Medication

Although there is no cure for schizophrenia, it is successfully treatable with a combination of antipsychotic medications and supportive counseling. Though both therapy modalities are important, medication is the more important means of therapy; the only therapy that can effectively reduce acute symptoms. Psychosocial therapies delivered in isolation from antipsychotic medication will not help schizophrenic patients all that much.

The efficacy of antipsychotic drugs is well-established. These medications can make symptoms milder, shorten the course of an episode, and increase the time between psychotic episodes. These drugs are not perfect tools, however. Studies show that while approximately 70% of patients improve while on these drugs, about 25% show only minimal improvement and about 5% actually deteriorate.

Antipsychotic or neuroleptic medications affect brain chemicals called neurotransmitters that enable communication between the nerve cells making up the brain. Schizophrenia symptoms (at least positive ones) appear to result from problems with multiple neurotransmitter systems, including dopamine, serotonin and glutamate, and the antipsychotic medicines appear to correct or minimize these problems (see "Evidence That Schizophrenia is a Brain Disease" above).

Although antipsychotic medications are effective in treating schizophrenia, not all medications are equal, and there is no single best treatment protocol. Different patients respond best to different types and dosages of medicine. The potential for side effects must be factored in too, as antipsychotic medicines have numerous side effects (some quite serious in nature - see discussion below). Medicine and dosage must be individually determined and balanced for each patient being treated. These kinds of medication determinations take time to get right and can only be made by a psychiatrist or allied medical professional working under the supervision of a psychiatrist. An antipsychotic medication can take weeks or even months to start working at full strength, so patience on the part of the clinician and patient is required.

Typical and Atypical Medicine Generations

Antipsychotics are divided into two categories: first-generation, also known as "typical" drugs, and second-generation, also known as "atypical" drugs and dopamine partial agonists. Typical antipsychotics are so-called because they were the first family of drugs discovered to have antipsychotic properties. Some examples of "typical" antipsychotic medications are: chlorpromazine, fluphenazine, haloperidol, molindone, thiothixene, thoridazine, trifluoperazine, and loxapine. Atypical antipsychotic drugs were developed later on and named to distinguish them from the earlier drugs. Some examples of "atypical" antipsychotic medications include: clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole. The distinction in these drug category names also reflects differences in how they were thought to work. Typical medications were originally thought to work primarily by affecting dopamine, while atypical drugs were thought to work through other neurotransmitter systems. Recent research suggests that all of these drugs mainly affect dopamine systems, however.

Even though all antipsychotic medicines work through dopamine, atypical medications can offer some advantages over typical medications. Atypical medications seem to produce greater negative symptom relief, less cognitive impairment, better relapse prevention and functional capacity, fewer extrapyramidal symptoms (EPS; see discussion below), and less tardive dyskinesia (TD). These are significant advantages and suggest that where tolerated and appropriate, atypical medication therapy may result in a better quality of life for those living with schizophrenia.