Treating Schizophrenia’s Goal to Eliminate Schizophrenia
When launching into the topic of treating schizophrenia, we have to say that the best plan would be to treat schizophrenia in a way that will just plain stop it in its tracks, before it blossoms into real trouble. To do so, we need to catch schizophrenia immediately as it starts, at that first sign of psychosis. Or even, at the first signal of an approaching psychosis. Start the right medications and therapies immediately. Then, continue to treat it with every tool we have, and never let the psychotic mental state return. It’s the goal of all medical doctors, scientists, and governments worldwide to conquer schizophrenia. And they’re getting close.
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To Be Honest, Treating Schizophrenia Can Be a Difficult Conversation
Why is treating schizophrenia a difficult discussion? Well, because, most everyone who asks questions about how to treat schizophrenia comes with a preconceived idea in mind of what answers they want to hear. And, understandably, everyone wants to hear clear, concise, easy to follow answers. So, the good news is that there can be good outcomes for someone with schizophrenia. The dilemma is that getting a good outcome is not always easy. The path forward is not a straight, clear road. It’s a winding maze to be learned and successfully navigated. Take heart, all of you who can accept a challenge. And, read on to understand.
Preventing Schizophrenia by Aggressively Treating Schizophrenia
As we said on our Schizophrenia page, there are ways to treat it that might make it possible to prevent it. But it’s a challenge. These methods require trying to learn who might develop schizophrenia. Once these at-risk people are identified, start good medications and therapies before it gets to be a full-blown bad psychosis. We now know something that we didn’t know years ago. Psychosis, the brain state in which the brain is psychotic, is itself toxic to the brain. The chemistry changes in the brain that makes a brain “psychotic” damage the brain. As a result, after a bad psychotic episode it’s easier for another psychosis to happen. And that next psychosis will be harder to treat. So over time it gets harder and harder to get the person back to normal.
Getting Back to Normal After a Psychosis – Treating Schizophrenia
Getting back to normal. That’s the plan and hope of every person who comes down with this medical condition, and the hope of everyone who loves them. To get back to life as it was before the illness hit. That’s why it’s so important to understand that the brain state of psychosis damages the brain. Because it’s true that with each episode of psychosis the person moves further and further from “their old self”. And if they get too far from their old self they can never return. The plan to prevent schizophrenia might not always work, but even if it just works partly, it works better that yesterday’s standard care.
Doing It Right – Doing It Wrong – How Hard to Hit Schizophrenia to Prevent It?
Usually people who don’t know about schizophrenia and don’t understand it believe that it should be treated gently at first, with a light touch. They might believe that it’s wrong to wallop the person with a medication hammer and a lot of therapy if all we can see is mild early signs of psychosis. This start low, go slow path has been a standard method for the past 60 years. But over the past 15 years many experts have gradually learned that exactly the opposite is true. If we could see schizophrenia sooner, earlier, when it first starts, and then hit it hard with just the right medication and therapies, we could have much less long-lasting schizophrenia.
Will Aggressive Initial Treatment Really End Schizophrenia?
Realistically, no. While it can and does work, with the best methods we have now not everyone can do it. Having said that, however, if we could actively treat as much as possible, individuals with schizophrenia would probably be much less sick. Another wrinkle in this grand plan is that too often those earliest signs are seen too late. Then, when they finally are seen, these early symptoms are too often treated briefly with a light touch. The benefit then fades pretty quickly. Another dilemma is just people. As the COVID-19 pandemic illustrated, if a person does not want to be treated, they’ll avoid it. Good advice doesn’t help, especially if someone is already suffering with psychosis.
A Reader Asks: Okay, Then, So, How Long Do I Have to Take This Medication?
This news is both good and bad. The good news is that, after trying several medications and going through all the usual fits and starts to find just the right one, you likely will find a one that works well for you. This would be a medication that you can take, it works, and you have only a few side effects. The further good news is that, once you have done this hard work and found the just-right-for-you medication, it will likely remain effective for you for a long time. The part that some people might think is bad news is that, once you find this good-fit medication, it probably should never be stopped. It’s a lifelong help, like insulin for a diabetic. Or blood pressure medicine for a person with high blood pressure. Or a cholesterol-lowering medication for someone with high cholesterol.
More Good News: There Are Many Effective Schizophrenia Medications
Today there are many medications in many forms and formulations to treat schizophrenia successfully. This wide variety gives doctors and people with the condition more choices and a better chance to find that good-fit medication. Much of the special medical skill of treating the schizophrenia involves finding that best match medication. With so many choices, one is more likely to find the right one, and might even find that right one quicker. There are newer medications, of course, and older medications. Some of the older drugs are better in some situations than the newer ones. One example is clozapine (Clozaril®). Many doctors think clozapine works the best for “positive” symptoms when nothing else has helped. (“Positive” symptoms are things like losing touch with reality, hallucinations, delusions, really odd thoughts, or acting poorly organized.)
The Medication for the Person – A Near Unique Match
Sometimes it’s easy to treat schizophrenia, sometimes not. There’s no “one-size-fits-all”, one medication that works best for everyone. To find the best medication for a person takes time and work, trial-and-error. At times it can be hard, for both the individual and for his/her doctor. While it’s true that any of the medications work better than no medication, some work better than others for a specific person. And beyond working well, considering the side effects are important to find the best fit. For a specific person likely one or only a few of the many good drugs will work well and the rest will not be good, either because they don’t work or because they have bad side effects.
At Times a Person’s Schizophrenia is Not Easy to Treat
Schizophrenia is a medical condition, a physical illness. It’s mainly a physical brain disorder though it does affect other body systems. It’s physical just as diabetes and high blood pressure are physical. Just as really bad diabetes or way too high blood pressure is harder for a doctor to treat, a really bad psychosis can make it hard for the doctor to find the right medication in the right amount. So sometimes the first medication tried works for right now but is not the best one to take for a long time.
One Person’s Side Effect can be Another Person’s Help
A good doctor can find a medicine with side effects that might actually help. For example, if you feel upset and anxious all day and can’t sleep at night, a drug with side effects of calming and sleepiness might help you feel calmer during the day and then become sleepy at bedtime. On the other hand, if you’re tired, sleepy, and feel lazy all day, a medication that gives you energy during the day might be helpful.
Calming Medications
There are medications that are well known to have calming side effects, for example, quetiapine (Seroquel®), olanzapine (Zyprexa®), or chlorpromazine. There are more medications in the list at the bottom of the page.
Energizing Medications
Other drugs give a person energy, like a cup of coffee or tea. Examples are lurasidone (Latuda®) and cariprazine (Vraylar®). Again, there are others in the list at the bottom of the page that can have this same effect.
What Works for Her Might Not Work for You
The trial-and-error testing phase is always needed because any one medication can feel remarkably different to different people. For one person, as an example, aripiprazole might give him a good sense of vigor and energy. For another person it might cause upset, anxiety, and nervousness, and he might need to stop the aripiprazole because he can’t stand this side effects.
Clozapine (Clozaril®)
There’s an almost unique “go-to” drug for schizophrenia. Only a few special doctors are permitted to prescribe it. It might set your mind right when nothing else works. It’s clozapine. The old trade name was Clozaril®. Many experts think it works better than any other drug for the “positive” symptoms of schizophrenia. Sadly, nothing is perfect. Clozapine has one rare but really bad side effect that needs to be caught early or it could kill you. So, before a doctor will give it to you he/she needs to do blood tests to look at your white blood cell count. Then, as you’re taking it, you’ll need to have more blood tests now and then to make sure you’re still okay. (If you’re one of our paid subscribers, see our specific page on Clozapine.)
But Remember there is No “One-Size-Fits-All”
For some of us, life can be hard. For most people schizophrenia is hard. And one of the hard parts is finding that best medication for you. But some people do “get lucky” and find the right medicine on the first or second try.
Those Who Work the Hardest Win the Biggest
Anyone deserves a lot of praise who can take on the challenge, spend the time, work with their doctor, and try drug after drug until the right one is found. Sometimes it’s easy, sometimes it ain’t.
List of Medications
At the bottom of this page is a long list of medications for schizophrenia that are available in the U.S.
Treating the Negative Symptoms of Schizophrenia
We briefly mentioned the “positive” symptoms of schizophrenia above. The past 70 years have been spent looking for better drugs for these “positive” symptoms, and as we’ve said above, we have many good ones. Now people are looking for better medications to help with “negative” symptoms. Negative symptoms are things aren’t there, like feeling too little emotion about life, having a poor ability to plan and follow through, poor personal hygiene, not liking social settings, always staying too quiet, or not wanting to do anything. One of the links below has a research paper on treating the negative symptoms. Here it is if you want to click it now: Treating Negative Symptoms
Medications for the Negative Symptoms of Schizophrenia
Sometimes a drug that is usually for depression helps with these negative symptoms, but not always. One that might work is reboxetine, another is mirtazapine. At first, without knowing the history, you might think that to boost social energy and mental focus a stimulant like methylphenidate or amphetamine could help. But they don’t work because they make the psychosis worse. These stimulant drugs work in the brain in a way exactly the opposite of the way the medications work that treat psychosis. So taking a stimulant would push the brain chemistry the wrong direction, push against the useful medication, and make the psychosis worse.
You Will Definitely Need More Than Just Medications
Medications don’t do it all. While a 2nd or 3rd medication might be needed to get everything in a nice place and keep it so, at some point adding one more medication is not going to be the answer. There are other valuable and necessary treatments. A big one is supportive therapy focused on social skills training. It’s really useful, in a safe therapy setting, to have the opportunity to practice talking to people, to learn and practice “small-talk”, to learn how to go about dating, and learn and try better ways of making friends. A full team of clinical helpers might be the best, coming with many abilities to help.
Cognitive (Thinking) Symptoms
Okay, so above we talked about positive symptoms and negative symptoms. We’re not done. There’s one more big category of schizophrenia symptoms: “cognitive” symptoms. Cognitive symptoms mean being poorly able to think clearly and focus your attention on something. It’s really hard to succeed in life if you can’t think clearly and quickly. With psychosis, one is less able to plan, less able to focus mentally and to concentrate, and just plain less able to think. Psychosis also makes memory worse. If your memory is poor and you forget to take your medication, it all falls apart, and the positive and negative symptoms come flooding back.
Treating the Cognitive Symptoms
When you and your doctor change you from one medication to another, it’s important to notice how clearly you’re thinking on each one. It might be best to keep a record, like a diary, of how well you (and you relatives and friends) think you’re doing on each medication, including how well you’re thinking. In some people some medications might help with thinking and some might make cognition worse. And as we mentioned above, one can’t clear thinking and mental focus with a stimulant like methylphenidate or amphetamine. They don’t work because they make the psychosis worse. In the brain the medications for psychosis push the chemistry one way and these stimulants push the chemistry in exactly the opposite way, and make the psychosis worse.
Again We Emphasize, Medication Alone Is Not Enough
As with negative symptoms, there are therapies to help push against the poor thinking of psychosis. These “cognition” therapies are really useful approaches. For example, occupational therapy helps one to practice paying attention, improving memory, setting priorities, solving hard questions, and getting the tasks of everyday life done each day. In addition, physical exercise is a great approach, so don’t overlook it. Physical exercise can help with clearer thinking. The exercise program doesn’t have to be intense physical exercise. Walking twenty minutes a day on 5 days a week is enough to make a difference in clearer thinking.
Helpful links
The National Institutes of Health on Schizophrenia
A Current Treatment Options paper on Treating Negative Symptoms
The Mayo Clinic on Schizophrenia
Schizophrenia Information from the American Psychiatric Association
The National Alliance on Mental Illness on Schizophrenia
Medication List
Here is a (near complete) list of the schizophrenia medications available in the U.S.
- quetiapine (Seroquel) – calming, sedating
- aripiprazole (Abilify) – balanced between activating and calming
- risperidone (Risperdal) – balanced between activating and calming
- ziprasidone (Geodon) – calming, sedating
- lurasidone (Latuda) – activating, energizing
- clozapine (Clozaril, FazaClo, Versacloz)
- olanzapine (Zyprexa) – calming, sedating
- clozapine Clozaril) – calming, sedating
- chlorpromazine (Thorazine) – calming, sedating
- paliperidone (Invega) – not activating or sedating
- asenapine (Saphris) – calming, sedating
- trifluoperazine (Stelazine) – activating, energizing
- pimozide (Orap) – activating, energizing
- molindone (Moban) – calming, sedating
- fluphenazine (Prolixin) – calming, sedating
- iloperidone (Fanapt) – calming, sedating
- loxapine (Loxitane, Adasuve) – calming, sedating
- thioridazine (Mellaril) – calming, sedating
- brexpiprazole (Rexulti) – not activating or sedating
- aripiprazole lauroxil extended-release Injection (Aristida) – activating, energizing
- cariprazine (Vraylar) – activating, energizing
- haloperidol (Haldol) – activating, energizing
- thiothixene (Navane) – calming, sedating
- reserpine (Raudixin, Serpalan, Serpasil) – But reserpine is such a problematic medication that it probably should not be used. It has adverse effects such as severe depression, significant hypotension, exacerbation of asthma, peptic ulceration and hemorrhage, and extrapyramidal (muscle tremor and spasm) side effects.
If you think we’ve missed a good one, let us know.