Psychiatry-Online

Schizophrenia - These Drugs Are Used!

introduction

The clinical picture of schizophrenia should not be underestimated. If the diagnosis has been made, it should be treated immediately, because the earlier the schizophrenia is treated, the better this affects the further course of treatment.
In the following, drug therapy for schizophrenia will be discussed in particular.

For general information we recommend our website: Therapy for schizophrenia

Overview

The main drugs used to treat schizophrenia are:

Antipsychotics (formerly neuroleptics)
Benzodiazepines (special sedatives)
Antidepressants

In addition, alternative substances can be used, e.g .:

Homeopathic remedies
Herbal medications
Others, e.g. sleeping pills

What are neuroleptics?

Neuroleptics is an outdated term for the group of antipsychotics.
These are drugs that intervene in signal transmission via messenger substances in the brain. They bind to receptors for these messenger substances and reduce their effect, so that the brain is subdued in a figurative sense and typical schizophrenia symptoms such as delusions subside.
The older and so-called typical antipsychotics, e.g. Haloperidol, act mainly on influencing the receptor for dopamine. They are highly effective even in small doses. Unfortunately, these substances lead to severe side effects in many patients, especially problems with motor skills, i.e. muscle movement. In the case of severe schizophrenia, the typical antipsychotics are still the drug of choice due to their good effect.
The newer and so-called atypical antipsychotics, e.g. Risperidone, act on several receptors at the same time, but less strongly, so that the side effects are also less pronounced. They are therefore used in milder forms of schizophrenic disorders and, with good accompanying therapy, can replace typical antipsychotics even in more severe cases.

Read more on this topic at: Neuroleptics
You might also be interested in: Can schizophrenia be cured?

Risperidone

Risperidone is a so-called atypical antipsychotic, so it does not (only) work by inhibiting the neurotransmitter dopamine and therefore rarely triggers motor disorders as a side effect. It is therefore preferred to typical antipsychotics whenever possible. Nevertheless, even taking risperidone can lead to motor restrictions in the context of extrapyramidal motor disorders (EPS) and other side effects, and the patient must therefore be monitored closely.

Find out more about this topic at: Risperidone - you should know that!

What are antidepressants?

Antidepressants are substances that are used to treat symptoms of depression. In the context of a schizophrenic illness, this makes sense insofar as many patients develop depression as a concomitant illness.
Antidepressants work by increasing the concentration of messenger substances in the brain that are important for mood and drive. These are mainly serotonin and norepinephrine. The drugs inhibit the breakdown of these messenger substances (neurotransmitters) at the synapses, i.e. the contact points between the nerve cells, so that they have a longer and stronger effect.
The selection of antidepressants is very large and each substance has an individual effect profile. In addition to lightening the mood, some of these herbs have a calming (sedating) effect, while others have a stimulating effect. But there are also side effects with antidepressants. Treatment with these drugs therefore requires an experienced doctor and a little patience to find the right substance.

Find out more at: Effect of antidepressants
You might also be interested in: The role of serotonin in depression

What are sedatives?

Sedatives are all substances that have a calming, anxiety-relieving and sedating effect, i.e. they make you tired.
The most effective sedatives are the so-called benzodiazepines, such as Diazepam (Valium ®), which are used in extremely excited patients, for example in the schizophrenic madness. Although they are very effective, they also have a high potential for dependency. If possible, other drugs are used, such as soothing antidepressants to avoid habituation.
Herbal medicines such as valerian can also be used in less pronounced cases.

Further information on this topic can be found at: Sedatives - You should know that!

What side effects are to be expected?

The symptoms of schizophrenia are more severe than most other mental illnesses. The drugs that are supposed to work against such symptoms must also be correspondingly effective. Unfortunately, side effects are often bought at the expense of this powerful effect.
How strong these are, varies from person to person and can therefore hardly be predicted. In the case of very severe schizophrenia, these side effects must be accepted, as the symptoms must be contained for your own and for the protection of others.
Once the strongest symptoms are under control, the search for the right drug at the right dose can begin. Because once the schizophrenic episode has been contained, the medication usually has to be taken for a long time and any side effects tolerated. Exactly which side effects are involved differs from product to product.

Common side effects with typical neuroleptics

By far the most restrictive side effects are the typical antipsychotics, such as haloperidol, namely the so-called extrapyramidal motor disorders (EPS).
These are problems with executing movements, similar to those known from Parkinson's disease. Patients experience involuntary cramps and twitches, their hands shake, and it is difficult for them to take their first steps while walking. These EPS are difficult to treat and do not always go away completely even after you stop taking the medication.
Nevertheless, the typical antipsychotics remain the most effective weapon against the symptoms of schizophrenia and are used at least initially, but if possible with other substances such as atypical neuroleptics such as risperidone or clozapine replaced.

General side effects of neuroleptics

Other side effects that can occur with both typical and atypical antipsychotics are sedation, impaired metabolism, dry mouth, constipation, cardiac rhythm disorders, circulatory problems and disorders of sexual function. Although these are by no means pleasant, they can be treated well.
Another possible, albeit rare, side effect is the so-called neuroleptic malignant syndrome (NMS), in which there is a potentially life-threatening dopamine deficiency. This manifests itself in fever, palpitations, clouding of consciousness, confusion, tremors and changes in some laboratory parameters, such as. e.g. an increase in liver values. The MNS is an absolute emergency, but luckily it rarely occurs.

What should be considered when stopping the medication?

Schizophrenia is a long-term condition that often relapses. Thus, schizophrenia accompanies some patients for a lifetime.
Medicines must therefore be taken over a longer period of time, even if the symptoms have already subsided, so that relapses can be avoided. If they are stopped too soon or too quickly, the risk of relapse is very high.
If the patient no longer wants to take his medication, he should definitely discuss this with his doctor. If this agrees, the withdrawal must take place very slowly and over a longer period of time. The dose is reduced further and further and the drug is “tapered”, as the doctor calls it. If the patient remains symptom-free, the remedy can ultimately be omitted entirely. However, this does not mean that the patient should no longer be treated at all.
Psychological support in particular should be retained; the person affected should repeatedly present themselves to controls in order to record a possible relapse as quickly as possible.

While schizophrenia is a long-term treatable condition, in some cases the medication can be tapered off over time. Find out more at: Can schizophrenia be cured?

Can I also refuse medication?

According to the law, every patient is entitled to his or her free will, so he can refuse any treatment.
Only if he poses a danger to himself or to others may he be detained and treated against his will. However, this is only very rarely the case, even in schizophrenia patients. The doctor can therefore only suggest that you undergo the treatment including taking medication, but first of all not force anyone to do so. This is another reason why a good doctor-patient relationship is essential in order to make the person concerned understand the importance of regular medication.

How is the course without medication?

The course of schizophrenia is very difficult to predict, especially at the beginning of the disease. What is certain is that it is a so-called periodic disorder, so the symptoms are sometimes worse and sometimes better.
It is known that the early prevention of massive schizophrenia symptoms, such as delusions, with medication has a positive effect on the further course.
Without medication, the risk of permanent disability due to the disease is higher. This is because these massive symptoms do not usually go away on their own and only medication can bring about sufficient improvement. In addition, the so-called negative symptoms, such as apathy and flattening of emotions, are more pronounced in patients without drug treatment. As a rule, these do not go away by themselves and permanently affect the person affected.

Also read: Can schizophrenia be cured?

How quickly do the drugs work?

The onset of action depends on the type of medication.
Benzodiazepines such as Valium® as sedatives usually work very quickly. If they are administered into the vein, the effect is even immediate.
Antipsychotics and antidepressants, on the other hand, need a few days to weeks for their full effect to develop. However, side effects can occur earlier, about which the patient must be informed.
In addition, the medication must often be adjusted in the course of the illness in order to achieve the best possible and individual therapy for the patient. Medication cessation of a schizophrenic patient is therefore usually a lengthy process.

Read more on this topic at: Therapy for schizophrenia