A Reader Asked: This article is responding to a reader’s question, asking:
When Can I Get Off Treatment for Schizophrenia?
One of our Canadian readers sent in the question: “When Can I Get Off Treatment for Schizophrenia?” A great question. This question is like a gold mine with many nuggets of information waiting to be uncovered. It’s an opportunity to look at schizophrenia treatment and medication safety. Let’s explore at least a few of the possible answers.
Get Off Your Treatment for Schizophrenia Immediately?
Given that schizophrenia is a lifelong medical condition requiring medication for a lifetime, the idea of stopping one’s medication immediately might seem radical. But there are times when you need to stop it immediately (and call your doctor and/or head for the nearest hospital emergency department). There are uncommon side effects of the medicines commonly used to treat schizophrenia that are dangerous, cannot be reversed, and could be life threatening. For example, allergic reactions, heart rhythm problems (QT interval prolongation, torsades de pointes), thromboembolism, seizures, stroke, and pancreatitis. These are important and we cover them in more detail below. But if one of these side effects occurs, call your doctor immediately for advice.
Another “Get Off Your Treatment for Schizophrenia Immediately” Answer
This answer is not about medication. As with any disorder affecting the brain, it’s helpful to work with a “guide” since at times your brain is not at it’s best. This helper person might be viewed as a guide, or an educator, or a therapist or psychotherapist. Whatever you call this person, he/she is a “support person” to help you through the rough spots of life. Also, when things are good, to work with you to prepare for the next rough spot. Because that’s how we all experience life, a series of rough patches with smoother sailing in between. If this person is no help at all, or even worse, just another problem person in your life, just stop. Find a new therapist. There are many good therapists, even some great ones. Respect yourself enough to not stay with a lemon therapist thinking you can make lemonade.
When Can I Get Off Treatment for Schizophrenia? Soon!
Soon, but not today. There are medical conditions for which the person needs to take a medication for the rest of his/her life. Type 1 diabetes, for example. The patient needs insulin. Without insulin for a while, they die, as did all type 1 diabetics before 1922. Or high blood pressure. Without treatment, it might take a decade or two, but high blood pressure will kill you with a stroke or heart attack. Medication for high blood pressure is usually needed for the rest of your life. Schizophrenia is another one. You need to take the right medication forever. So you need a medication that you can take, that doesn’t make you sick, that you can tolerate. So if you’re taking a medication that you can’t tolerate or that you don’t like, that’s not going to work. Talk to your doctor.
Finding the Right Medication for the Rest of Your Life
People argue about the best exercise program to stay healthy. Some say aerobic exercise like jogging, running, or dancing. Others swear by weightlifting, like chest presses and biceps curls. Others like flexibility and balance, like yoga and tai chi. But wisdom says the best exercise is the one you will do and keep doing. The same is true of your medication for schizophrenia. The best medication, the absolutely best medication, is the one that you will take regularly and keep taking forever. To find that right medication might become hard work. It can be a challenge, it might take time and trial and error. So if you don’t like your medication, talk to your doctor about changing it. Work with her to find the best one. And, if you feel your doctor can’t work with you to do this, find a new doctor.
When Can I Get Off Treatment for Schizophrenia? Back To Stopping Your Medication Immediately
Above, when we listed the medical emergencies for which you should stop your medications immediately, we said we would cover these reasons in more detail. Below is that detail.
We mention below calling “the emergency number“. For the U.S. and Canada this is 911, for the UK it’s 999. Ireland is 112 or 999. In New Zealand it’s 111 and In Europe and India it’s 112. In Australia it’s 000.
Back To Stopping Your Medication Immediately – Allergic Reaction
Any food, any medication, any substance, can cause an allergic reaction. This is not just a feeling that you don’t like the medication or that it gives you a headache. We mean a specific IgE-mediated allergic reaction. (IgE is immunoglobulin E.) A real allergic reaction to your medication for schizophrenia, a severe hypersensitivity reaction, can progress to “anaphylaxis”. The symptoms can come within minutes. Symptoms like hives and itching and flushed skin, wheezing and difficulty breathing, a weak, rapid pulse, nausea, dizziness, and fainting. This is life-threatening; it can kill you. You need to go to a hospital emergency department. And don’t take another dose of your medication until your doctor reviews your medical situation.
Back To Stopping Your Medication Immediately – Heart Rhythm Problems
There are a couple of heart rhythm problems of grave concern. One is called “QT interval prolongation.” The other is called “torsades de pointes.” Neither one, as you can see, is everyday conversation. But here’s the deal. You know that old expression, “What you don’t know won’t hurt you.” Well, it’s not true in these situations. Either of these heart rhythm problems can kill you whether you know about them or not.
What the heck is QT Interval Prolongation?
QT interval prolongation can make heart beats chaotic and can cause sudden heart death. So, if you’re still alive to notice the symptoms, call your doctor, stop your medication, and get help; you are better off than some people. The symptoms of possible QT interval prolongation are lightheadedness, weakness, passing out or fainting, and palpitations (palpitations means being aware of your own heartbeat), chest pain, or too fast a heartbeat. The QT interval is the time between electrical heart beats. Too long is not good. While older people and women are at a higher risk, having your QT interval change to too long can happen to anyone.
Okay, So, What the heck is torsades de pointes?
Torsades de pointes is a heart rhythm problem that is related to the prolonged QT interval problem described above. The symptoms of torsades de pointes are a fast heartbeat, lightheadedness, and feeling faint. If not treated as a medical emergency torsades de pointes can result in a sudden heart attack and death. There are mentions in the medical journals that thioridazine (Mellaril®), ziprasidone (Geodon®), and intravenous haloperidol (Haldol®) were most often associated with torsades de pointes. (“Torsades de pointes” is a French phrase for “twisting of the points”, referring to the heart beat points on an ECT [electrocardiogram, heart rhythm tracing]).
Once More on Stopping Your Medication Immediately – Thromboembolism
When a blood clot (thrombus) forms in your leg, the symptoms will be pain in your calf or thigh, leg swelling, your skin will feel warm, and on your leg you’ll see light red or purple streaks. If a piece of the clot breaks off (embolism) and gets to your lungs (this is the part that could be fatal), you’ll have shortness of breath and rapid breathing, rapid heart rate and chest pain, and might get lightheaded or faint. There’s a lot information in medical journals to say that the medications used for schizophrenia can, at times, cause leg blood clots. And, a piece of clot can break off and go to your lungs. Again, if you think you might have a thromboembolism, call your doctor. He’ll probably have you stop your medication and go right to a hospital emergency department.
Yet Again on Stopping Your Medication Immediately – Seizures
Like the adverse reactions above, it’s rare. But it can happen. You could have a seizure, also called convulsions. Almost all of the medications that are helpful for schizophrenia can increase the risk of someone having a seizure. Some of these medications increase the risk more than others. Risperidone (Risperdal®), haloperidol (Haldol®), molindone (Moban®), fluphenazine (Prolixin®), pimozide (Orap®), and trifluoperazine (Stelazine®) are less likely to cause seizures while chlorpromazine (Thorazine®) and clozapine (Clozaril®) are more likely to cause seizures. But any can cause a medically dangerous seizure, and once you have one you don’t want to have another. As before, if you have had something strange happen and you or someone else thinks it might have been a seizure, call your doctor. She’ll probably want to see you and do an EEG test (brain wave test).
More on Stopping Your Medication Immediately – Stroke
It’s also very rare, but it seems that the medications for schizophrenia can cause a stroke. The symptoms of a stroke vary. For example, a stroke might cause a sudden weakness of an arm and leg on one side of the body, or just an arm or just a leg, or part of the face. Speaking might become difficult with words hard to say or talking that make no sense. Or, the people around the person having a stroke might see that the person looks confused. Or, that they cannot understand the conversation. Vision might go bad or even sudden blindness in one eye, or both eyes. It you are the person who has had the stroke it’s unlikely that you will be the one to call the emergency medical number, but someone needs to call it. And to call the doctor for the person having the stroke.
One Last Thing on Stopping Your Medication Immediately – Pancreatitis
Once again, this is very rare, but the use of the medicines for schizophrenia can cause pancreatitis. The symptoms of pancreatitis are pain in the upper stomach area, maybe that is felt all the way through to the back, and maybe worse after eating. Symptoms might include a fever, a rapid heart rate, nausea and vomiting, and it might hurt if someone touches the stomach area. This side effect might be more likely with olanzapine (Zyprexa®), quetiapine (Seroquel®), risperidone (Risperdal®), and ziprasidone (Geodon®) than with other medications. It’s important to call your doctor but this might not be the same kind of urgent medical emergency like the conditions above. Whether or not it’s an emergency depends on how much you hurt. If the pain is really bad get to a hospital emergency department.
When Can I Get Off Treatment for Schizophrenia?
So, returning to the question, when can I get off my medication (or therapy) for schizophrenia? If you’re on a good medication that works well and that you can tolerate long term, and if you’re seeing a good therapist, don’t ever plan to stop either. Like Type 1 diabetes, schizophrenia is a lifelong condition. If you can get everything set in place for yourself, your life can be better. Stopping good medications that work well will let the next psychosis happen. And, psychosis is toxic to the brain. With each episode of psychosis your are less likely to get well when you restart a medication. And just the right therapist can be hard to find. If you’ve found her or him, stay in therapy. That’s your guide for life’s journey.
The Mayo Clinic on Schizophrenia Diagnosis and Treatment
The Mayo Clinic on Medicine Allergic Reactions
National Institutes of Health on Heart Reactions to Psychotropic Drugs
British Journal of Psychiatry on Medication and Venous Thrombosis
National Center for Biotechnology Information on Antipsychotic Medication and Seizures
National Library of Medicine on Acute Pancreatitis and Antipsychotic Use