Antipsychotics (Antipsychotic Medications)
Antipsychotic medications have been available since the mid-1950s beginning with the phenothiazines and Thorazine was the mainstay of treatment for many years. They do improve the outlook for patients, although side-effects discourage many patients from taking them. These medications reduce the psychotic symptoms of schizophrenia and usually allow the patient to function more effectively and appropriately. Antipsychotic drugs do not cure schizophrenia or ensure that there will be no further psychotic episodes. Most people with schizophrenia show substantial improvement when treated with antipsychotic drugs. Some patients are not helped very much by the medications and in a few they provide no benefit. It is difficult to predict which patients will fall into these groups.
A number of new antipsychotic drugs, the so-called “atypical antipsychotics,” have been introduced since 1990. The first of these, clozapine (Clozaril), has been shown to be more effective than other antipsychotics, although the possibility of severe side effects – especially agranulocytosis (loss of the white blood cells that fight infection – requires that patients be monitored with blood tests every one or two weeks. Even newer antipsychotic drugs, such as risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), and olanzapine (Zyprexa), are safer than the older drugs or clozapine, and they also may be better tolerated.
Antipsychotic drugs are usually effective in treating hallucinations and delusions but may not be as helpful with other symptoms, such as reduced motivation and emotional expressiveness. The older antipsychotics, medicines like haloperidol (Haldol) or chlorpromazine (Thorazine), may even produce side effects that resemble the more difficult to treat symptoms. Lowering the dose or switching to a different medicine may reduce these side effects. The newer medicines, including olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and aripiprazole (Abilify) appear less likely to have this problem. Sometimes when people with schizophrenia become depressed, other symptoms can appear to worsen. The symptoms may improve with the addition of an antidepressant medication, but this may also make the schizophrenia worse.
Patients and families sometimes become worried about the antipsychotic medications used to treat schizophrenia. In addition to concern about side effects, they may worry that such drugs could lead to addiction. However, antipsychotic medications do not produce a “high” or addictive behavior in people who take them. Another misconception about antipsychotic drugs is that they act as a kind of mind control, or a “chemical straitjacket.” Antipsychotic drugs used at the appropriate dosage do not remove free will. While these medications can be sedating, they are not used to produce sedation but because of their ability to diminish hallucinations, delusions, agitation, and confusion of a psychotic episode. Antipsychotic medications should eventually help an individual with schizophrenia to deal with the world more rationally.