Realizing the Benefits
The decision to take a particular medicine is a balancing act between its benefits and its side effects. Aspirin, for example, has the potential to kill in large enough doses and to cause bleeding in the stomach lining with long-term use. Its ability to treat headache and decrease inflammation at lower doses nevertheless makes it a popular and widely used drug. Cancer medications have a much narrower safety factor than aspirin. That is, their effective doses are close to their dangerous doses. When the stakes are high, greater risk is taken in treatments. Side effects that would not be acceptable for treating a mild headache often are readily accepted when a life is at stake.
Taking Antipsychotic Medications
Antipsychotic medications are usually taken in tablet or liquid form once or several times a day, depending on the specific medication. Depot formulations, which require injections only once every two to four weeks, are available if patients cannot or do not take their daily medications. Some medications are available in formulations that make them disintegrate and dissolve in the mouth within seconds. These are good for people who have problems with swallowing pills or who may hide and not swallow their medication. These medications are also available in injectable formulations that may be given in emergency situations if a patient is acutely upset, hostile, aggressive, paranoid, angry, or severely distressed by acute worsening in their psychotic symptoms. Check with your doctor if you have questions about how and when to take any prescribed medications.
The potencies of drugs vary. A low dose of one medication may be enough to produce a positive effect, while a second drug requires a much higher dose to be as effective. It takes roughly twenty times as much Thorazine, for example, to match the effect produced by Haldol.
The drugs available to treat psychosis have serious side effects. Still, the consensus of the medical community is that the risk of side effects is worth taking if the right drug is found.
Antipsychotics effectively treat psychotic episodes and reduce the chance of recurrence. The Schizophrenia Society of Canada reports that 80 percent of patients will have a relapse within two years without treatment. This drops to less than 45 percent with regular use of antipsychotics. Adding therapy and training classes is believed to reduce the two-year relapse rate even more.
Early Warning Signs of Relapse
Increased sense of unease or discussion of troubling delusions
Change in sleep patterns
Avoidance of other people
Consistent use of medication results in a 50 percent reduction of the chances of rehospitalization. Also, by eliminating the tormenting symptoms of the disease, the risk of suicide can be reduced.
Although these medications may not make psychotic episodes disappear entirely from every patient's life, they are very effective at reducing the number and severity of such episodes. Dosages used for long-term maintenance are typically lower than those used to treat severe, active psychotic symptoms. If a psychotic episode appears to be starting, doses can be increased temporarily under the doctor's supervision.
Antipsychotic Medications in Perspective
The development of antipsychotics was one of psychiatry's most significant advances. Before their introduction, the back wards of state psychiatric hospitals were filled with thousands of patients who had little hope of ever leaving these institutions.
Although the harshest treatments of earlier centuries — including chains and physical abuse — had long been abandoned as “treatment” for the mentally ill, restraints and locked cells were still used routinely before the discovery of antipsychotic medications. That began to change for many patients after chlorpromazine was introduced in 1952.
The introduction of the next generation of antipsychotic drugs further improved the situation. The effectiveness of drug therapy for schizophrenia can be variable, like the symptoms and course of the disease itself. Some people can't tolerate most antipsychotic drugs but are able in time to find one that works well. A few rare individuals get better without medication. Most find significant to satisfactory improvement by using them.
Deciding on a Medication
While there is overlap, side effects produced by the older and newer antipsychotic drugs differ considerably. Today, older antipsy-chotic medications are prescribed much less than they were prior to the mid-1990s. However, they may still be recommended for patients who, for some reason, cannot tolerate the newer drugs. It is therefore very important that you familiarize yourself with the pros and cons of these traditional drugs if they are prescribed.
While the descriptions of the side effects can be discouraging and even alarming, keep in mind that the same drugs that cause them can also eliminate some of the worst and most distressing symptoms of schizophrenia. With effort, the benefits of antipsychotic medication can be realized while the side effects are minimized. But it may take effort and perseverance, depending on the patient's unique metabolism and illness.