Anyone living with schizophrenia or who has a loved one with the illness knows that it’s a complex mental health condition to manage.
The condition, which affects thinking and can cause a person to lose touch with reality, can have heavy emotional, physical, and financial tolls. Schizophrenia is a common cause of disability, according to the National Institute of Mental Health. People with schizophrenia have a higher risk of suicide than the average person. They may also have other conditions, such as depression.
Starting an effective treatment plan—and staying on it—can help someone with schizophrenia manage daily life, says Anil Malhotra, MD, director of psychiatry research at Zucker Hillside Hospital in Glen Oaks, New York, and a Genomind Scientific Advisory Board member.
“Schizophrenia is a lifelong illness,” Dr. Malhotra says. “Those who have it usually require treatment for the majority of their lifetime.”
Here’s what you should know about long-term treatment for schizophrenia and how pharmacogenetic (PGx) testing can help.
Getting the Right Diagnosis
One of the first steps to getting help for any health condition is recognizing you are ill. For someone with schizophrenia, who may have a hard time distinguishing between what’s real and what’s not, this can be especially difficult.
Schizophrenia can cause psychotic symptoms that affect how a person perceives the world. These psychotic symptoms may include:
- Delusions: Believing things that are not based in reality
- Paranoia: Having irrational fears or suspicions, such as fearing that someone is “out to get you”
- Hallucinations: Seeing or hearing things that don’t exist
Schizophrenia can also cause:
- “Negative” symptoms: Loss of motivation, lack of pleasure, or difficulty expressing emotions
- Cognitive symptoms: Trouble thinking, concentrating, or remembering
These symptoms, especially psychotic symptoms, can contribute to a delay in diagnosis. It often takes more than a year for someone who develops schizophrenia symptoms to seek medical care, Dr. Malhotra says.
If you or someone you love has these symptoms, reach out to your primary care doctor or a mental health clinician.
Starting Treatment and Medication
Early treatment is critical. Once schizophrenia is diagnosed, treatment can start. Because schizophrenia is complex, treatment usually includes multiple approaches:
- Medication, such as antipsychotics
- Therapy, such as cognitive behavioral therapy (CBT)
- Social support, such as family education programs
Antipsychotics, which help relieve psychotic symptoms like delusions and hallucinations, are the most common medications used for the treatment of schizophrenia. They reduce excess levels of the neurotransmitter dopamine by blocking dopamine receptors in the brain.
While there are a variety of antipsychotics to choose from, there are two main routes of administration:
- Oral antipsychotics, which are pills or liquids you take by mouth
- Long-acting injectables, which are injections that a healthcare provider will give you
If you have schizophrenia, your clinician will typically recommend oral antipsychotics first. But if you have trouble following your medication plan, your clinician may prescribe long-acting injectables.
Maintaining Treatment and Medication
For any medication to work properly, it’s important to take it exactly as prescribed. This is known as medication adherence.
Many people with schizophrenia, however, struggle with medication adherence. In fact, about 50 percent do not follow their medication plan, according to a review in Patient Related Outcome Measures.
Not following a medication plan consistently puts you at risk for relapse, and it’s a common reason that patients with schizophrenia are hospitalized, Dr. Malhotra says.
Other consequences of medication nonadherence in patients with schizophrenia can include:
- Persistent or worsening symptoms
- More medical appointments
- Poorer mental functioning
- Lower quality of life
- Higher risk for substance abuse
There are many reasons why people with schizophrenia might not follow their medication plan. For example, as medication improves symptoms, some people with schizophrenia may believe they no longer need treatment, Dr. Malhotra says.
The social stigma of taking antipsychotic medications also contributes to medication nonadherence.
One of the main reasons people with schizophrenia stop taking their medication, however, is experience with side effects, Dr. Malhotra says.
Common Side Effects of Antipsychotic Medications
Though antipsychotic medications can be effective in relieving psychotic symptoms of schizophrenia, side effects can occur. “Each antipsychotic has a different side effect profile that has to be taken into account—and tailored for each person individually,” Dr. Malhotra says.
Antipsychotics that are prescribed first are known as first-line therapy. Some of the more common side effects of these drugs include:
- Drowsiness
- Dry mouth
- Upset stomach
- Constipation
Some antipsychotics may be more likely to cause weight gain. Others may be more likely to cause uncontrollable movements, such as muscle contractions or tremors.
How Pharmacogenetic Testing Can Help
Side effects can happen for a variety of reasons. For example, they can be a sign that your body isn’t metabolizing, or breaking down, a particular medication well.
“If someone isn’t metabolizing a drug in the usual way and it leads them to have higher blood levels of the drug, that may result in more side effects,” Dr. Malhotra says. “In such cases, the simplest way to reduce those higher blood levels is to reduce the dose of the drug.”
But how can you tell if someone is a poor metabolizer? It turns out that your genes may offer clues. How we react to medications—for example, how we metabolize them—is partly influenced by our genes. Pharmacogenetic testing can help reveal this information.
For patients with schizophrenia who are experiencing continual side effects, Dr. Malhotra recommends Pharmacogenetic (PGx) testing.
Some clinicians may also recommend PGx testing at the start of treatment. The results can provide information to help them personalize a medication plan sooner rather than later.
Genomind’s Pharmacogenetic test looks at 24 genes related to mental health treatment. It provides guidance across 10+ mental health conditions and 130+ medications to help clinicians determine:
- Which medications will likely be the most effective
- Which medications may have side effects
- How you metabolize medications for personalized dosing guidance
For schizophrenia, the Genomind test can provide insights on genes that may affect treatment with antipsychotics:
- COMT
- MC4R
- 5HT2C
- DRD2
- ABCB1
The Genomind test requires a prescription. Wondering if it can help you? Learn more about Genomind here.
What to Do If You Continue to Have Symptoms or Problems with Medication
Some cases of schizophrenia are especially difficult to treat. These cases are known as treatment-resistant schizophrenia.
If psychotic symptoms don’t improve after taking at least two first-line antipsychotic medications, your clinician may prescribe clozapine. “It’s been studied head-to-head with some first-line medications, and in the treatment-resistant population, clozapine shows superiority,” Dr. Malhotra says.
Clozapine can lower your white blood cell count, so regular checks are part of this treatment.
Still worried about side effects or have other concerns about schizophrenia medication? Talk to your clinician, and work together to find a treatment that relieves your symptoms with minimal side effects.
“The risks associated with side effects are far less than the risks associated with not taking medication,” Dr. Malhotra says. “For the most part, people who stay on their schizophrenia medications do far, far better than those who don’t.”
Does Your Medication Work for You?
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