Schizophrenia Meds: what to Expect

Antipsychotic drugs can be a big help in managing your schizophrenia symptoms. But they can have side effects. Your doctor should talk with you about their benefits and risks.

Antipsychotic medications change the way some of your brain chemicals act.

These drugs can help with symptoms such as hearing voices or seeing things that aren't real. Each person responds to antipsychotic medications differently.

These drugs also take time to control different symptoms:

• Within a few days, you may feel less agitated and your hallucinations may fade.
• Within a few weeks, delusions often ease. A delusion is a false belief that you can’t let go of. An example of a delusion is believing that others are always trying to hurt you.
• Within about 6 weeks, many people feel much better.

How well your medications work can depend on your age when the illness began, how bad your symptoms are, and lifestyle habits.

How Long You’ll Take Them

Each person with schizophrenia is different. Most people need to take some form of medication their whole lives.

Sometimes, people need to try a different dose or medication. But you should never stop suddenly. If the doctor says you can stop a medication, you will taper off it, a little at a time.

Your doctor may suggest other ways to address so-called negative symptoms, which include social withdrawal, lack of motivation, or lack of emotional expression. Antipsychotics don't work as well for these kinds of symptoms.

Also, your doctor may prescribe antidepressants if you get depressed.

Older and Newer Antipsychotics

Older antipsychotic drugs, known as typical or first-generation ones, have been around for decades. Newer, or atypical antipsychotics, may work better to improve:

• Problems showing emotion
• Trouble interacting with others
• General symptoms of anxiety, guilt, tension, and poor attention or judgment

The older and newer antipsychotics share some side effects. For example, atypical antipsychotics generally seem less likely than typical ones to cause involuntary movements as a side effect.

You often take antipsychotics by pill. People who have trouble doing this may get a long-acting antipsychotic shot in the shoulder muscle or buttocks, sometimes once a month or once every 3 months, at a doctor's office or hospital. It may help prevent relapses.

Possible Side Effects

When you start to take an antipsychotic, take some time to adjust. Don't drive until you know how the medicine affects your alertness and reaction time.

In most cases, early side effects, such as drowsiness or dizziness, go away within days. If not, you can work with your doctor to manage this. A different dose or medication may help.

These are some of the more common side effects of antipsychotic medications:

• Drowsiness
• Dizziness when you change positions
• Blurry vision
• Dry mouth
• Rapid heartbeat
• Sensitivity to the sun
• Skin rash
• Menstrual problems
• Problems with sex
• Enlarged breasts (even in males)

Both older and newer antipsychotics may cause a rare condition called neuroleptic malignant syndrome. Symptoms include:

• High fever
• Sweating
• Big swings in blood pressure
• Muscle stiffness

With long-term use, older and newer drugs may also cause a serious condition called tardive dyskinesia (TD). This is more likely with older antipsychotics, though.

TD causes random muscle movements such as facial grimacing, lip smacking, and eye blinking. It can:

• Be mild or more severe
• Develop slowly over months, years, or decades
• Sometimes go away after stopping the medicine, but also may be permanent

The medications deutetrabenazine (Austedo) and valbenazine (Ingrezza) have proven effective in treating adults with TD.

Older antipsychotics are more likely to cause side effects such as:

• Stiffness in arms and legs
• Muscle spasms
• Trouble swallowing
• Tremors
• Restlessness or pacing
• Very slow movements
• Changes in breathing and heart rate

Newer antipsychotic drugs are more likely to lead to weight gain. This can make you more likely to get diabetes and high cholesterol. For this reason, your doctor should regularly check your weight, blood sugar levels, and cholesterol levels.

Managing Side Effects of Antipsychotics

Stay in close contact with your doctor about how you feel, and let them know about any side effects from your schizophrenia medications. There are a few basic principles that doctors use to try and keep side effects to a minimum:

• Use antipsychotic meds only where there is a clear need.
• Continue antipsychotics only where the benefit is clear.
• If benefit is clear and side effects aren’t life threatening, a lower dose or different dosing schedule is the first choice for adjustment.
• The next option is to change the type antipsychotic, though this should be weighed against the risk of another psychotic episode or relapse.
• In some cases, in consultation with your doctor, you may be able to try a behavioral intervention or therapy in place of medication.

Additional meds, called concomitant medications, can help lessen the side effects of antipsychotic medications. Though less desirable than other strategies, there are a number of medications that could help including:

• For muscle spasms and tremors: Anticholinergic medications
• For restlessness (akathisia): Beta-blockers and anticholinergic medications
• For weight gain: Metformin
• For excess salivation (drooling): Anticholinergic drops under the tongue
• For tardive dyskinesia: Valbenazine and deutetrabenazine are approved, though it’s not yet clear how well they work

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