Antipsychotic Medications
A person who is psychotic is out of touch with reality. People with psychosis
may hear "voices" or have strange and illogical ideas (for example,
thinking that others can hear their thoughts, or are trying to harm them, or
that they are the President of the United States or some other famous person).
They may get excited or angry for no apparent reason, or spend a lot of time by
themselves, or in bed, sleeping during the day and staying awake at night. The
person may neglect appearance, not bathing or changing clothes, and may be hard
to talk to--barely talking or saying things that make no sense. They often are
initially unaware that their condition is an illness.
These kinds of behaviors are symptoms of a psychotic illness such as
schizophrenia. Antipsychotic medications act against these symptoms. These
medications cannot "cure" the illness, but they can take away many of
the symptoms or make them milder. In some cases, they can shorten the course of
an episode of the illness as well.
There are a number of antipsychotic (neuroleptic) medications available.
These medications affect neurotransmitters that allow communication between
nerve cells. One such neurotransmitter, dopamine, is thought to be relevant to
schizophrenia symptoms. All these medications have been shown to be effective
for schizophrenia. The main differences are in the potency--that is, the dosage
(amount) prescribed to produce therapeutic effects-and the side effects. Some
people might think that the higher the dose of medication prescribed, the more
serious the illness; but this is not always true.
The first antipsychotic medications were introduced in the 1950s.
Antipsychotic medications have helped many patients with psychosis lead a more
normal and fulfilling life by alleviating such symptoms as hallucinations, both
visual and auditory, and paranoid thoughts. However, the early antipsychotic
medications often have unpleasant side effects, such as muscle stiffness,
tremor, and abnormal movements, leading researchers to continue their search for
better drugs.
The 1990s saw the development of several new drugs for schizophrenia, called "atypical
antipsychotics." Because they have fewer side effects than the older
drugs, today they are often used as a first-line treatment. The first atypical
antipsychotic, clozapine (Clozaril), was introduced in the United States
in 1990. In clinical trials, this medication was found to be more effective than
conventional or "typical" antipsychotic medications in individuals
with treatment-resistant schizophrenia (schizophrenia that has not responded to
other drugs), and the risk of tardive dyskinesia (a movement disorder) was
lower. However, because of the potential side effect of a serious blood
disorder--agranulocytosis (loss of the white blood cells that fight
infection)-patients who are on clozapine must have a blood test every 1 or 2
weeks. The inconvenience and cost of blood tests and the medication itself have
made maintenance on clozapine difficult for many people. Clozapine, however,
continues to be the drug of choice for treatment-resistant schizophrenia
patients.
Several other atypical antipsychotics have been developed since clozapine was
introduced, they are risperidone (Risperdal),
aripiprazole (Abilify),
olanzapine
(Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon).
Each has a unique side effect profile, but in general, these medications are
better tolerated than the earlier drugs. Click on the links above to each drug
for more information about side effects.
All these medications have their place in the treatment of schizophrenia, and
doctors will choose among them. They will consider the person's symptoms, age,
weight, and personal and family medication history.
Dosages and side effects. Some drugs are very potent and the
doctor may prescribe a low dose. Other drugs are not as potent and a higher dose
may be prescribed.
Unlike some prescription drugs, which must be taken several times during the
day, some antipsychotic medications can be taken just once a day. In order to
reduce daytime side effects such as sleepiness, some medications can be taken at
bedtime. Some antipsychotic medications are available in "depot" forms
that can be injected once or twice a month.
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