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The Use of Medication in Treating Schizophrenia

© Ian Chovil

Medication is an essential component in a treatment strategy for schizophrenia. Without medication there can be no long term recovery. With a first psychotic episode psychiatrists are generally reluctant to make a diagnosis of schizophrenia. They do treat the psychotic episode with an antipsychotic and try to keep the individual on a maintenance dose of an antipsychotic for a year or two. After that time they will reassess the need for medication.

Generally people respond to medication best during the first psychotic episode and to a very low dose of medication. These people are generally 16-25 years old and really a population unto themselves, separate from people who have had multiple psychotic episodes and/or a longer history of schizophrenia. The maintenance dose of antipsychotics was originally to prevent another psychotic episode, but the atypicals offer some relief from other symptoms of schizophrenia as well.

You might think there is a wide choice of antipsychotics to treat first psychotic episodes and to prevent further psychotic episodes. There isn't. Depending on where you live there are only three approved atypicals available, Risperidone, Olanzapine, and Seroquel. Olanzapine has recently become the first choice for first episodes but it does cause weight gain in about 30% of people. Risperidone has been available longer and had earlier market penetration. It is less expensive than Olanzapine, and a first episode responds well to 2-3 mg. of risperidone. An older person with a longer history of schizophrenia would typically be taking 4-6 mg of Risperidone. An older person with a longer history of schizophrenia would also be prescribed Olanzapine or Seroquel, again at a considerably higher dose than a first episode psychosis. A first psychotic episode responds well to 5 mg of Olanzapine but after a twenty year history of schizophrenia people are taking 10-40 mg of Olanzapine.

The response to medication is quite variable. Someone may respond better to one medication and not as well to another. Generally if someone doesn't respond well to Risperidone then they are started on Olanzapine or vice versa. Seroquel, Olanzapine, and Risperidone, are each quite different from the other and one can work where the other might not. If none helps control the psychotic symptoms of schizophrenia Clozapine is usually available. Clozapine is still considered the best medication for schizophrenia generally, but because of a potential lethal side effect it has be monitored quite closely. Someone taking Clozapine would have to have their blood tested once every two weeks in order to keep taking Clozapine. The lethal side effect, agranulocytosis, is pretty rare, but because of it Clozapine is a last resort in the treatment of schizophrenia.