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If you or a loved one has been living with schizophrenia, understanding the condition — and how to move forward after diagnosis — can be overwhelming.
It’s not unusual to feel worried, or perhaps even dismissive, about your need for care. But schizophrenia is a lifelong condition that requires — and deserves — attention and support in addition to a realistic, comprehensive treatment plan. Demystifying exactly how schizophrenia is treated, both in day-to-day life and long term, can help keep you proactively on track with your symptoms and needs.
There are a number of effective treatment options to manage schizophrenia, including medication, social and familial interventions, and talk therapy. And the good news is that with the right care, at least 1 in 3 people with schizophrenia will be able to fully recover from symptoms.
To help you understand the basics, Jonathan G. Leung, Pharm.D., R.Ph., BCCP, a Mayo Clinic expert and psychiatric clinical pharmacist, goes over the core strategies for schizophrenia management and what to expect from treatment.
Medication — the first line of treatment
According to Dr. Leung, medication will likely be the first, and most important, part of your treatment plan. The exact medications depend on the person and the type of schizophrenia, but antipsychotics, mood stabilizers and antidepressants are commonly used to treat and manage symptoms.
Although the exact cause of the condition isn’t yet understood, researchers do know that schizophrenia is a brain disease that impacts the brain structure and the central nervous system. Dopamine and glutamate — two neurotransmitters, also known as messengers, that help the brain and central nervous system communicate — are thought to play a part in schizophrenia. As a result, many antipsychotic medications work by blocking certain dopamine receptors in the brain.
“Most antipsychotic medications for schizophrenia currently focus on reducing excess dopamine and addressing symptoms, such as hallucinations, delusions and disorganization,” says Dr. Leung.In clinical trials, antipsychotics have been shown to effectively treat symptoms and behaviors associated with schizophrenia. With the right medication and care, it’s possible to experience remission of psychosis.
However, it’s important to understand that not everyone will respond the same — or as well — to first line antipsychotic medications. Treatment-resistant schizophrenia occurs when symptoms persist or don’t improve enough despite treatment. In these situations, Dr. Leung says your healthcare team may recommend clozapine, a Food and Drug Administration (FDA)-approved antipsychotic used for treatment-resistant schizophrenia. In general, clozapine is reserved for those who haven’t responded well to prior medications, as it can come with a range of side effects.
Likewise, Dr. Leung says there is much progress to be made when it comes to treating other symptoms, such as lack of motivation, inability to feel pleasure, flat affect and speech issues. There’s also progress to be made with cognitive schizophrenia symptoms, including attention and memory issues. All of the symptoms above can have significant impact on daily functioning and quality of life. At the moment, there are no specific FDA-approved medication options for these symptoms. However, Dr. Leung says your healthcare team may recommend certain antipsychotics, antidepressants or supplements to manage these symptoms.
Finally, your healthcare team may recommend mood stabilizers or antidepressants. Often, mood stabilizers are used when someone has the bipolar type of schizoaffective disorder, a type of schizophrenia that can include episodes of mania and depression. As the name implies, mood stabilizers can help “level out” your mood and help treat bipolar symptoms.
For people with the depressive type of schizoaffective disorder — or those who experience depressive episodes, but not mania — your healthcare team may recommend antidepressants to help improve sleep, focus and feelings of hopelessness.
Bringing in therapy, social support and other holistic care
Although medication is critical to managing schizophrenia, most people do best when they combine the right medications with psychological, personal and social support.
Since schizophrenia can impact many aspects of life — including personal relationships, employment and basic task management — Dr. Leung says an integrated approach to care is often most effective for long-term management. Integrated care emphasizes holistic, whole-person support in addition to medication.
This type of comprehensive care can involve family intervention and education, community outreach services, and talk or group therapy. You may also consider social skills or work rehabilitation training, which focus on communication, learning to navigate daily tasks and interactions, and improving job skills and retention.
Some therapies combine different methods to address multiple symptoms and concerns. Cognitive behavioral therapy (CBT) blends talk therapy with social skills training and behavioral intervention to reduce the intensity of hallucinations and delusions, improve social skills, and lower the risk of relapse.
If you’re unsure of what support you may need or what free or low-cost services exist in your area, consult with a case manager, a social services representative or a member of your healthcare team.
Setting expectations for schizophrenia treatment
Schizophrenia is a serious, often debilitating, condition — and it’s important to have realistic expectations around treatment. First and foremost, schizophrenia requires continuous, lifelong care. And in many cases, it can take some trial and error before finding out exactly what treatment methods work best for you.
For example, Dr. Leung says it’s not uncommon for people with schizophrenia to go through a few different medications, combinations of medications or different dosages to find the right balance. This process can take weeks or months as symptoms and side effects are monitored. Additionally, antipsychotics can cause a number of side effects and some, such as the movement disorder called tardive dyskinesia, may be permanent.
Between cycling through medications and navigating side effects, it can be incredibly frustrating to stick with your treatment plan. But Dr. Leung says it’s never a good idea to discontinue your medications or taper off without consulting with your healthcare team. Instead, let your healthcare team know your concerns and decide together how to best move forward.
Finally, it’s important to understand that at some point your symptoms may become severe enough that you need to stay in the hospital or an in-treatment facility. Receiving this type of care is not a failure on your part. Always reach out to a loved one, case worker or your healthcare team if you are noticing changing or worsening symptoms or simply need help.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
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