7 Signs Your Schizophrenia Medication May Not Be Working

Finding the right schizophrenia medication isn’t always a straight path. Even if your medication seems to work well at first, it may become less effective with time. Sometimes a new medication may not feel right from the beginning. In other cases, you may not realize your medication isn’t working until after your mental health symptoms worsen.

People with schizophrenia don’t always respond to antipsychotic medications in the same way. While it’s crucial to talk to your doctor before making any changes to your medication routine, your schizophrenia treatment plan may need adjusting or fine-tuning over time. Recognizing when your medication isn’t working is an important step to getting the care you need. Learn more about the signs that could mean it’s time to reassess your treatment.

1. Your Symptoms Aren’t Improving or They’re Getting Worse

One of the most important signs that your medication isn’t working is if your symptoms aren’t improving or if they’re getting worse. Medication takes time to work, and no one’s symptoms get better overnight. Antipsychotic medications may make you feel calmer within a few hours. However, most antipsychotic medications take several days to weeks to improve the psychotic symptoms of schizophrenia.

If symptoms return, they may return gradually. It may not be immediately obvious. Tracking your schizophrenia symptoms can help you see patterns that may be difficult to spot otherwise. You can work with your mental health care team to develop a checklist of symptoms. Your checklist should be specific to your symptoms.

Some symptoms of schizophrenia that you can add to your checklist may include:

• Noticing changes in your sleep patterns
• Hearing unusual sounds or voices
• Seeing things other people can’t see
• Feeling that familiar surroundings are strange or threatening
• Feeling mistrustful or suspicious of people
• Worrying about the motives of other people
• Having difficulty concentrating

Sometimes, it can be hard to recognize these symptoms in yourself. You may want to ask a loved one to keep track of these symptoms or other changes in your behavior. Recognizing when your symptoms are getting worse can help you get the extra support you need.

2. You Feel Emotionally Flat or Disconnected

Antipsychotic medications may not be effective for all of your schizophrenia symptoms. In general, antipsychotic medications are more effective at treating positive symptoms than negative symptoms. Positive symptoms of schizophrenia, such as hallucinations and delusions, involve changes in thinking and behavior. These symptoms are called positive not because they are good but because they involve the added presence of unusual thoughts or behaviors. On the other hand, negative symptoms can involve reduced emotional expression and impaired functioning. They refer to a decrease or loss of normal behaviors.

According to Dr. Robert Channon, a board-certified psychiatrist with over 40 years of experience treating people living with severe mental illness in Chicago, “The negative symptoms are the ones that medications in the past have not been very effective in managing. Those are symptoms like your loss of executive functioning, being unable to problem solve, your loss of motivation, your loss of will to do things, your comfort in being with people. Those are all the kinds of things that drive your appetite for life.”

When you start a new antipsychotic medication, you may notice that hallucinations and delusions gradually improve. However, since negative symptoms can be harder to treat, you may still have difficulty expressing or feeling emotions.

If you’re feeling emotionally disconnected, it may be a sign that your medication isn’t addressing all of your symptoms. Talk to your healthcare provider about every symptom you have. There may be other treatment options that can help.

3. You’ve Pulled Back From Therapy, Social Activities, or Daily Life

In addition to affecting your emotions, negative symptoms of schizophrenia can also lead to withdrawal from therapy, your loved ones, or your daily activities. If you or a loved one are withdrawing, here are the symptoms you can look for:

• Lack of motivation
• Loss of enjoyment
• Trouble participating in daily activities
• Avoidance of social interactions
• Difficulty taking care of basic needs
• A dull voice when speaking

Negative symptoms usually occur gradually, so they may be difficult to notice. Negative symptoms also tend to occur before positive symptoms.

4. You Frequently Miss Doses

If you’re not taking your medication the way your doctor prescribed, it probably won’t be as effective. You’ll likely still experience some symptoms if you frequently miss doses. This can make it more difficult to tell if your treatment plan is working.

Many people with schizophrenia struggle to take their medication exactly as they should. Some people may forget or feel unsure if they really need it. Additionally, symptoms like depression, disorganization, and substance use can make it harder to stick to a medication routine.

According to Dr. Channon, “For some people, they can tell after they miss their medicine for a day. They can already notice the voices coming back or they're starting to feel more paranoid. But for a lot of people, skipping the medicine for a day isn’t going to be obvious to them.”

5. You’re Struggling With Side Effects

Schizophrenia medication side effects (also called adverse effects) play a big role in how you feel day to day. Many people taking antipsychotic drugs have side effects. These may include:

• Weight gain
• Dry mouth
• Restlessness
• Tiredness or drowsiness
• Constipation

Dr. Channon shared, “Unfortunately, side effects often precede benefits of schizophrenia medications.” Some people find that side effects get better with time, but others may have lasting side effects. In some people, antipsychotic medication side effects can mimic schizophrenia symptoms, such as negative symptoms or agitation.

The best medication for you is one you’ll continue to take. If your side effects impact your quality of life or make it difficult to stick with your treatment plan, talk to your healthcare team about making adjustments.

6. You’re Facing Increased Stress or Life Changes

Stressful situations — like moving, job changes, or a breakup — can make your symptoms harder to manage. Major stress or changes in your routine may worsen schizophrenia symptoms, which could affect how well your medications work.

Lifestyle habits, like smoking, lack of sleep, and alcohol and drug use, can also change how well antipsychotic drugs work for you. If you’re facing major changes to your life and habits, talk to your mental health care team about how these changes can affect your medication.

7. You Suspect Your Medication Isn’t a Good Fit

If you’ve been taking a new schizophrenia medication for several weeks and something feels off, trust your instincts and speak up. It can take up to six weeks to see if a new medication is working. However, it’s important to let your healthcare team know if your symptoms aren’t getting better, they’re worsening, or you have unbearable side effects.

You may have to try several schizophrenia medications before you find the best fit for you. Some people may not respond to standard schizophrenia treatments. Treatment-resistant schizophrenia is when you don’t respond to at least two different antipsychotic medications taken at the right dose and for the right amount of time.

If you feel like schizophrenia medications aren’t working for you, you’re not alone. About 1 in 3 people with schizophrenia have treatment-resistant schizophrenia. Although this can be frustrating, there are other medications and supportive interventions that can help.

What Should You Do if Your Schizophrenia Medication Isn’t Working?

If you feel like your medication is not working for you, talk to your healthcare provider. It’s important to keep taking your medication until you get medical advice. Suddenly stopping your medication or skipping doses can lead to serious side effects or worsening symptoms.

There isn’t a one-size-fits-all approach to the treatment of schizophrenia. It can take some time to find the right treatment or combination of treatments that work best for you. If your current treatment plan isn't helping, know that there are still options. Switching medications, changing your dose, or finding additional support like talk therapy can make a meaningful difference.

Find Your Team

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

Do you think your schizophrenia medication isn’t working? What signs are you noticing that signal your medication may not be working? Share your experience in the comments below.