If you or a someone you know 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 addressing 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, many people improve significantly, and some are able to experience long periods with minimal or no symptoms.
To help you understand the basics, Jonathan G. Leung, Pharm.D., R.Ph., BCPS, 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 a treatment plan. The exact medications depend on the person and the type of schizophrenia, but antipsychotics are the primary type of medication used to treat and manage symptoms. Mood stabilizers and antidepressants also may be prescribed, depending on the symptoms.
Although the exact cause of the condition isn’t yet understood, researchers do know that schizophrenia is a complex brain condition that impacts how the brain processes information. Dopamine and glutamate are thought to play a part in schizophrenia. The two neurotransmitters, also known as messengers, help the brain and central nervous system communicate. As a result, many antipsychotic medications work primarily by blocking certain dopamine receptors in the brain. A newer medication option — a combination of xanomeline and trospium (Cobenfy) — works on muscarinic acetylcholine receptors rather than directly blocking dopamine, which may help reduce some side effects seen with traditional antipsychotics.
“Most antipsychotic medications for schizophrenia currently focus on blocking 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 appropriate 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 (Clozaril), 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 two prior medications.
Likewise, Dr. Leung says there is much progress to be made when it comes to treating what are called negative symptoms, such as lack of motivation or inability to feel pleasure. There’s also progress to be made with cognitive schizophrenia symptoms, including attention and memory issues. All of the symptoms above can have a significant impact on daily functioning and quality of life. At the moment, there are no FDA-approved medications specifically for negative or cognitive symptoms of schizophrenia. However, Dr. Leung says your healthcare team may still recommend certain antipsychotics, antidepressants or supplements to address these symptoms.
Finally, your healthcare team may recommend mood stabilizers or antidepressants, in combination with antipsychotics, to help manage mood symptoms. Mood stabilizers are used for people with the bipolar type of schizoaffective disorder, which can include episodes of mania and depression. As the name implies, mood stabilizers help address mood and treat bipolar symptoms.
For people with the depressive type of schizoaffective disorder — or those who experience depressive episodes, but not mania — the healthcare team may recommend antidepressants to help improve symptoms such as low mood, low energy or 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 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 also may consider social skills or work rehabilitation training, which focuses 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 for psychosis (CBTp) is often used alongside medication. This is a form of talk therapy that helps people better understand and cope with hallucinations and delusions. It can reduce distress related to symptoms and improve daily functioning. CBTp is often combined with other supports, such as social skills training and rehabilitation services as part of comprehensive care.
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. 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 to find 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 doses 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, which may be permanent. Side effects can include fatigue, weight gain and the movement disorder called tardive dyskinesia. Each antipsychotic medication carries a different risk of certain side effects. Talk with your healthcare team about side effects that concern you the most and how side effects will be monitored or managed.
Between cycling through medications and navigating side effects, it can be incredibly frustrating to stick with a 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 about your concerns and decide together how best to move forward.
Finally, it’s important to understand that some people have periods where symptoms worsen enough that a stay in the hospital or an in-treatment facility is needed. Receiving this type of care is not a failure. Always reach out to a loved one, a case worker or your healthcare team if you are noticing changing or worsening symptoms or you simply need help.
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