Antipsychotic medications are used to treat schizophrenia and
schizophrenia-related disorders. Some of these medications have been
available since the mid-1950's. They are also called conventional
"typical" antipsychotics. Some of the more commonly used medications
include:
- Chlorpromazine (Thorazine)
- Haloperidol
(Haldol)
- Perphenazine (generic only)
- Fluphenazine
(generic only).
In the 1990's, new antipsychotic medications
were developed. These new medications are called second generation, or
"atypical" antipsychotics.
One of these medications was clozapine
(Clozaril). It is a very effective medication that treats psychotic
symptoms, hallucinations, and breaks with reality, such as when a person
believes he or she is the president. But clozapine can sometimes cause a
serious problem called agranulocytosis, which is a loss of the white
blood cells that help a person fight infection. Therefore, people who
take clozapine must get their white blood cell counts checked every week
or two. This problem and the cost of blood tests make treatment with
clozapine difficult for many people. Still, clozapine is potentially
helpful for people who do not respond to other antipsychotic
medications.
Other atypical antipsychotics were developed. All of
them are effective, and none cause agranulocytosis. These include:
- Risperidone
(Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone
(Geodon)
- Aripiprazole (Abilify)
- Paliperidone (Invega).
The
antipsychotics listed here are some of the medications used to treat
symptoms of schizophrenia.
Note: The
FDA issued a Public Health Advisory for atypical antipsychotic
medications. The FDA determined that death rates are higher for elderly
people with dementia when taking this medication. A review of data has
found a risk with conventional antipsychotics as well. Antipsychotic
medications are not FDA-approved for the treatment of behavioral
disorders in patients with dementia.
What are the side effects?
Some
people have side effects when they start taking these medications. Most
side effects go away after a few days and often can be managed
successfully. People who are taking antipsychotics should not drive
until they adjust to their new medication. Side effects of many
antipsychotics include:
- Drowsiness
- Dizziness
when changing positions
- Blurred vision
- Rapid heartbeat
- Sensitivity
to the sun
- Skin rashes
- Menstrual problems for women.
Atypical
antipsychotic medications can cause major weight gain and changes in a
person's metabolism. This may increase a person's risk of getting
diabetes and high cholesterol.1
A person's weight, glucose levels, and lipid levels should be monitored
regularly by a doctor while taking an atypical antipsychotic
medication.
Typical antipsychotic medications can cause side effects
related to physical movement, such as:
- Rigidity
- Persistent
muscle spasms
- Tremors
- Restlessness.
Long-term
use of typical antipsychotic medications may lead to a condition called
tardive dyskinesia (TD). TD causes muscle movements a person can't
control. The movements commonly happen around the mouth. TD can range
from mild to severe, and in some people the problem cannot be cured.
Sometimes people with TD recover partially or fully after they stop
taking the medication.
Every year, an estimated 5 percent of
people taking typical antipsychotics get TD. The condition happens to
fewer people who take the new, atypical antipsychotics, but some people
may still get TD. People who think that they might have TD should check
with their doctor before stopping their medication.
How are
antipsychotics taken and how do people respond to them?
Antipsychotics
are usually pills that people swallow, or liquid they can drink. Some
antipsychotics are shots that are given once or twice a month.
Symptoms
of schizophrenia, such as feeling agitated and having hallucinations,
usually go away within days. Symptoms like delusions usually go away
within a few weeks. After about six weeks, many people will see a lot of
improvement.
However, people respond in different ways to
antipsychotic medications, and no one can tell beforehand how a person
will respond. Sometimes a person needs to try several medications before
finding the right one. Doctors and patients can work together to find
the best medication or medication combination, and dose.
Some
people may have a relapse—their symptoms come back or get worse.
Usually, relapses happen when people stop taking their medication, or
when they only take it sometimes. Some people stop taking the medication
because they feel better or they may feel they don't need it anymore. But
no one should stop taking an antipsychotic medication without talking
to his or her doctor. When a doctor says it is okay to stop
taking a medication, it should be gradually tapered off, never stopped
suddenly.
How do antipsychotics interact with other medications?
Antipsychotics
can produce unpleasant or dangerous side effects when taken with
certain medications. For this reason, all doctors treating a patient
need to be aware of all the medications that person is taking. Doctors
need to know about prescription and over-the-counter medicine, vitamins,
minerals, and herbal supplements. People also need to discuss any
alcohol or other drug use with their doctor.