6 Schizophrenia Treatment Options

Schizophrenia is a serious mental disorder that changes how a person thinks, feels, and experiences the world. Getting a diagnosis of schizophrenia, or having a loved one with this condition, can feel overwhelming. But with the right treatments, many people with schizophrenia have minimal symptoms and lead rewarding lives.

How Is Schizophrenia Treated?

People living with schizophrenia often try many different treatment options. Medication is almost always prescribed first to control symptoms. However, combining medication with other types of therapy often provides the most benefit.

It takes time to find the right treatment fit. Also, not everyone has access to the same programs and treatments. Your treatment options and their availability might vary. Check with your healthcare team.

Schizophrenia treatment can happen in different settings. Some people can be treated while living at home and going to appointments and programs in outpatient clinics. When a mental health professional feels that someone with schizophrenia might harm themself or others, hospital-based treatment is recommended. This is called inpatient care. Your healthcare team will work to find the care setting that is the safest and least restrictive. Below, we describe six common treatment strategies for schizophrenia.

1. Antipsychotic Medications

Antipsychotic medications are a type of drug for treating mental health conditions like schizophrenia. They are usually the first type of medication your healthcare team will recommend. Antipsychotics work by changing the balance of chemicals in your brain that control your thinking and behavior. Studies have shown that antipsychotics can be very effective in treating the positive symptoms of schizophrenia (symptoms that add something to one’s usual perception of reality, such as hallucinations or delusions).

As with all medications, antipsychotic drugs come with side effects. Your healthcare team will help you develop some strategies to manage these side effects.

There are many types of antipsychotic medications. Which antipsychotic a person is prescribed depends on a few factors. Your healthcare team will consider:

• Any other medical conditions you might have
• The pattern of your symptoms
• How you might handle potential side effects

In general, the newer second-generation antipsychotics are tried first. If the side effects are too uncomfortable or the treatment isn’t controlling symptoms well, your clinician will try other antipsychotic options, like a first-generation antipsychotic.

How Long Are Antipsychotic Medications Prescribed For?

In general, it depends on a person’s symptoms and response to treatment. Usually, someone will be on antipsychotics for at least two to three years. If their healthcare team feels they have recovered from the first episode, a gradual decrease in medication dosage might be suggested. However, many people with schizophrenia continue to take medication even after this time.

Side Effects of Antipsychotic Medications

Antipsychotics can cause some side effects that affect your quality of life. People over the age of 70 are more likely to feel side effects from antipsychotics.

In the first few days and weeks of starting an antipsychotic, the most common side effects are:

• Sleepiness
• Restlessness
• Low blood pressure when moving from lying or sitting down to standing up

Over a longer period of time, possible side effects of antipsychotics include:

• Abnormal movements and movement disorders
• Heart problems
• High blood sugar and type 2 diabetes
• High cholesterol
• Disruption of the immune system
• Weight gain

Having side effects doesn’t mean your medication isn’t working or that it’s making your condition worse. It’s important to keep taking the medication at the recommended dose unless your healthcare team tells you not to. Let your doctor know about the side effects you’re experiencing, as they may be able to offer treatment adjustments or other therapies to help.

When Antipsychotic Medications Don’t Work

When you first start an antipsychotic, your healthcare provider will gradually change the amount you take. This is to find the smallest dose that works for you. In general, you’ll start to see improvements in your symptoms within a few days if the medication dose is right for you. It might take four to six weeks to feel the maximum effects.

If the medication hasn’t helped your symptoms after two to four weeks, your healthcare team might suggest putting you on a different antipsychotic or increasing the dose of the one you are currently taking. If someone doesn’t respond to two or more different antipsychotics, their condition is considered treatment-resistant. In this case, there are different treatment options to try.

2. Clozapine

When people don’t respond to antipsychotics, there are a few other options to try next. First, your healthcare team will likely try a drug called clozapine (sold under the brand names Clozaril and Versacloz). Clozapine is an atypical antipsychotic. It can cause a serious decrease in immune cells, making it much easier to get sick. Your healthcare team will discuss the risks of clozapine before you try it.

Clozapine is not the best treatment for everyone. Some people may decide not to take clozapine, while others aren’t able to take it because of an underlying medical condition. Some people also don’t respond to clozapine after the standard 24-week treatment course. About half of people with treatment-resistant schizophrenia fall into this category. If any of these situations are the case for you, electroconvulsive therapy (ECT) is another treatment option to try.

3. Electroconvulsive Therapy

During an electroconvulsive therapy treatment session, small electrical signals are sent through your brain. During this process, you’ll be asleep under general anesthesia, so you won’t feel anything. ECT is safe and effective for treating treatment-resistant schizophrenia. It’s usually recommended when antipsychotic medication doesn’t help control symptoms.

It can take several ECT sessions before you can see any progress. How long you continue with ECT treatment depends on whether it’s working for you. After each session, you’ll have to follow some guidelines to stay safe. This includes not driving for a period of time and having someone stay with you for 24 hours after treatment. Your healthcare team will give you more details if you decide to try this form of treatment.

4. Cognitive Behavioral Therapy

The goal of cognitive behavioral therapy (CBT) is to help a person change their thinking patterns. This process might include:

• Recognizing unhelpful ways of thinking
• Identifying unhelpful patterns of behavior
• Finding strategies to cope with unhelpful thoughts and actions

A mental health professional will guide you through CBT over the course of many sessions. There might be “homework” after the sessions to help you apply what you learn to your daily life.

In schizophrenia, CBT is helpful when someone’s condition doesn’t respond to antipsychotic medication. The goal is to help people recognize when they’re experiencing delusions or hallucinations and reduce their effects.

5. Family Therapy

Family therapy is a treatment approach where a person’s loved ones are involved in therapy sessions. The goal is to help family members work together to support a person with schizophrenia. This might involve learning more about:

• What causes schizophrenia
• What types of symptoms a person with schizophrenia can have
• How to recognize relapses
• How the treatment of schizophrenia works
• Why substance use is especially harmful for people with schizophrenia

A course of family-based therapy lasts about six to nine months, with sessions once a month. It’s recommended in addition to individual talk therapy and any other schizophrenia treatments.

6. Social Support and Skills Training

People living with schizophrenia often have a hard time with social situations and independent living. For example, the negative symptoms of schizophrenia can make it hard for people to build relationships, and they may experience social withdrawal.

Social support and social skills training can help people rebuild the skills they need to care for themselves and be part of a community. These types of programs usually run for three to six months and involve sessions several times a week. A mental health professional usually leads the sessions.

Talk With Others Who Understand

On MySchizophreniaTeam, the site for people with schizophrenia and their loved ones, members come together to ask questions, give advice, and share their tips with others who understand life with schizophrenia.

Have you or a loved one been diagnosed with schizophrenia? Do you want to share how your treatment plan is working? Share your experiences in the comments below.