Treating Schizophrenia to Wipe Out Schizophrenia
On treating schizophrenia, the plan is to treat schizophrenia in a way that will wipe it out altogether. Catch it as it starts, treat it with all we’ve got, and never let it return. It’s the goal of all medical doctors and scientists worldwide that treat and study psychosis. And we’re getting close.
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As we said on the Schizophrenia page, there are ways to treat it that might make it possible to prevent it. These methods do require trying to learn who might develop it and then starting good medicines before it gets to be a full-blown bad psychosis. We now know something that we didn’t know a few years ago Psychosis itself is toxic to the brain. The chemistry in the brain that makes a brain “psychotic” damages the brain’s circuits. As a result, after a bad psychotic episode it’s easier for another psychosis to happen. Each time a person is psychotic it’s harder to treat and harder to get them back to normal. The plan and hope of each person who has schizophrenia is to get back to life as it was before the illness hit. But with each psychosis the person moves further and further from “their old self”, never to return. The plan to prevent it might not always work, but even if it just works partly it works better that yesterday’s standard care.
How Hard to Hit Schizophrenia to Prevent It?
Usually people new to the condition might feel 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 drug hammer if all we see is mild early signs. This has been believed for the past 60 years. But, over the past 10 to 15 years, many experts have gradually come to believe the opposite. If we could see it sooner, earlier when it first starts, and then hit it hard with medicine and other help, we could have much less long-lasting schizophrenia. And, with what schizophrenia might still be around, those people would be much less sick. These experts have further come to believe that too often the early signs are seen too late. And when they finally are seen, these early symptoms are treated with such a light touch for such a short time, it helps only for a short time if at all. Doing it this way won’t stop schizophrenia.
Okay, Then, So, How Long Does He Have to Take the Medicine?
This news is both good and bad. The good news is that, after trying several 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 medicine 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 some people might think is bad news is that, once you find this good-fit medicine, it probably should never be stopped. It’s a lifelong help, like insulin for a diabetic or a cholesterol-lowering medication for high cholesterol.
There Are Many Effective Schizophrenia Medicines
Today there are many medicines in many forms to treat schizophrenia with success. This wide variety gives doctors and people with the condition more choices and a better chance for success. Much of the special skill of treating the condition involves finding that best match of a medicine for the person. With so many choices one is more likely to find the right one, and might even find that right one quicker. There are newer medicines, of course, and older medicines. Some of the older drugs are better in some situations than the newer ones. One example is clozapine. (The old, original brand name was Clozaril.) Many doctors think clozapine works the best for “positive” symptoms when nothing else has helped. (“Positive” symptoms means one has lost touch with reality, like hallucinations, delusions, really odd thoughts, or acting poorly organized.)
The Medicine for the Person – A Near Unique Match
Sometimes it’s easy to treat schizophrenia, sometimes not. There is no “one-size-fits-all”, one medicine that works best for everyone. To find the best medicine 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 medicines work better than no medicine, 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 physical illness. It’s mainly a physical brain illness. It physical just like diabetes or high blood pressure. Just as really bad diabetes or way too high blood pressure is harder for a doctor to treat, a really bad psychosis can be hard for the doctor to find the right medicine in the right amount. So, sometimes the first medicine 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 drug with side effects that are actually a 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 be sleepy at bedtime. But, if you’re tired, sleepy, and feel lazy all day, a medicine that gives you energy during the day might be helpful.
There are medicines that are well known to have calming side effects, for example, quetiapine (Seroquel), olanzapine (Zyprexa), or chlorpromazine. Additional medications in the list at the bottom of the page might help.
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
But the trial-and-error is there because any one medicine can feel different to different people. For one person, as an example, aripiprazole might give him a good sense of energy. For another person it might cause upset and nervousness. The person might need to stop the aripiprazole because he can’t stand this side effect.
There is a “go-to” drug for schizophrenia that some special doctors can give you when nothing else puts your mind right. It’s clozapine. Many experts think it works better than any other drug for the “positive” symptoms. 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 the 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 okay. (If you’re one of our paid subscribers, see our specific page on Clozapine.)
But Remember there is No “One-Size-Fits-All”
Life can be hard, schizophrenia is hard, and finding the best medicine for you is not simple. One person might think quetiapine is great and makes him a little mellow. Another person might take one dose and be sound asleep in 30 minutes.
Those Who Work the Hardest Win the Biggest
Anyone deserves a lot of praise who can tough it out, take the time, work with their doctor, and try drug after drug until the right one is found. It ain’t easy.
List of Medicines
At the bottom of this page is a long list of medicines for schizophrenia that are available in the U.S.
Treating the Negative Symptoms of Schizophrenia
We briefly defined “positive” symptoms above. The past 70 years have been spent looking for better drugs for these “positive” symptoms. Now people are looking for better medicines to help with “negative” symptoms. Negative symptoms are things 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, 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
Medicines for Negative Symptoms
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 drug like methylphenidate or amphetamine could help. But they don’t, not with psychosis. These drugs work in the brain in a way opposite the medicines that treat psychosis. So taking a stimulant would push the wrong direction, push against the useful medicine and make the psychosis worse.
You Probably Need More Than Medications
Medicines almost never do it all. While a 2nd or 3rd medicine might be needed to get everything under control and keep it so, at some point adding one more medicine might not help. There are other treatments that are valuable. Supportive therapy focused on social skills training will help. It can be useful, in a safe therapy setting, to have the opportunity to practice talking to people, to learn and practice “small-talk”, 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
There are positive symptoms, and negative symptoms, and then one more type of symptom of schizophrenia: “cognitive” symptoms, being poorly able to think clearly and focus on something. How well can one function in life if you can’t think well, clearly, and quickly? With psychosis, one is less able to plan, less able to focus mentally and concentrate, just plain less able to think. It also makes memory worse. If memory is bad and you forget to take you 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 medicine to another, it’s important to notice how clearly you’re thinking on each drug. It might be best to keep a record of how well you (and you relatives and friends) think you’re doing on each medicine. In some people some medicines might help with thinking and some might make cognition worse.
Again, One Probably Needs More than Medication
As with negative symptoms, there are therapies to help lessen the poor thinking of psychosis. These “cognition” therapies are helpful approaches like occupational therapies, that help one to practice paying attention, improving memory, setting priorities, solving hard questions, and getting the tasks of everyday life done each day. Also, physical exercise can help with clearer thinking. A good exercise program can help. It doesn’t have to be intense. Walking twenty minutes a day on 5 days a week is enough to make a difference.
Did You Know That… Veronica Lake had schizophrenia?
Veronica Lake was an actress in the 1940’s. She is famous mostly for starring in stylish Hollywood crime dramas filled with cynical viewpoints and sexual motivations. She was diagnosed as having schizophrenia as early as her childhood years. While it’s hard to know what this diagnosis really meant in a child in the 1920’s and 30’s beyond a general label as a troubled child, as an adult she was indeed known for her over-the-top, at times even violent, outbursts. One might note, given her later diagnoses, she started college as a pre-med major with a plan for medical school and a career as a surgeon. Veronica became a big Hollywood star based on movies like Sullivan’s Travels and her four movies with Alan Ladd. Her femme fatale characters along with her trademark “peek-a-boo” hairstyle made her a memorable actress. Sadly, eventually her schizophrenia derailed her career, as is true for many people with schizophrenia. By the late 1940’s she was headed downhill, with alcoholism added to her troubles. She was only 50 years old when she died in 1973 from liver and kidney failure.
Here is a (near complete) list of the schizophrenia medicines available in the U.S.
- quetiapine (Seroquel)
- aripiprazole (Abilify)
- risperidone (Risperdal)
- ziprasidone (Geodon)
- lurasidone (Latuda)
- clozapine (Clozaril, FazaClo, Versacloz)
- olanzapine (Zyprexa)
- chlorpromazine (Thorazine)
- paliperidone (Invega)
- asenapine (Saphris)
- trifluoperazine (Stelazine)
- iloperidone (Fanapt) –
- loxapine (Loxitane, Adasuve)
- thioridazine (Mellaril)
- brexpiprazole (Rexulti)
- aripiprazole lauroxil extended-release Injection (Aristida)
- cariprazine (Vraylar)
- haloperidol (Haldol)
- thiothixene (Navane)
- reserpine (Raudixin, Serpalan, Serpasil) – But reserpine is such a problematic medicine 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.