Medications for Schizophrenia

Content provided by the Faculty of the Harvard Medical School
Excerpted from a Harvard Special Health Report

Schizophrenia requires a combination of treatments, including medication, psychological counseling and social support.

The major medications used to treat schizophrenia are called antipsychotics. They are quite effective at treating the positive symptoms of schizophrenia, but relatively less successful for negative symptoms, with one notable exception (see clozapine, below). Every person reacts a little differently to antipsychotic drugs, so a patient may need to try several before finding the one that works best. It is also important to continue the treatment even after symptoms get better, because there is a high likelihood that psychosis will return without medication, and each returning episode may be worse.

Newer medications called "atypical" antipsychotics usually are tried first. They are as effective as older medications at treating the psychotic symptoms of schizophrenia, and they also may be a little better at treating cognitive symptoms. These medications include risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon) and aripiprazole (Abilify). The most serious side effect of these newer drugs is weight gain, which increases the risk for developing diabetes or high cholesterol.

Older antipsychotic medications, such as chlorpromazine (Thorazine) and haloperidol (Haldol), are still quite effective and worth trying if atypical antipsychotics do not provide enough relief. However, the older medications can cause sedation, muscle spasms or rigidity, restlessness, dry mouth, constipation, weight gain or changes in blood pressure. With long-term use, there is a risk of developing involuntary muscle movements (called tardive dyskinesia).

Clozapine (Clozaril) is a unique antipsychotic that is effective not just for positive symptoms, but also the negative symptoms of schizophrenia. However, it has a potentially dangerous side effect. About 1 in 100 people who take this drug lose the capacity to produce the white blood cells needed to fight infection. Anyone taking this drug must have regular tests to check blood counts. Other side effects include changes in heart rate and blood pressure, weight gain, sedation, excessive salivation and constipation. On the positive side, people do not develop the muscle rigidity or the involuntary muscle movements seen with older antipsychotics. Because clozapine may be the best overall treatment for schizophrenia symptoms, some people may decide that the potential benefit of taking it is worth the risks.

Because other disorders can either mimic the symptoms of schizophrenia or accompany schizophrenia, other medications may be tried, such as antidepressants and mood stabilizers. Sometimes anti-anxiety medications help to control anxiety or agitation.

Last Annual Review Date: July 28, 2010 Copyright: © Harvard Health Publications

Reference: Mental Health and Behavior section on Better Medicine

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