The first-line treatment for schizophrenia is antipsychotic drugs. This treatment is especially important for people experiencing active psychosis. Psychosis is the loss of connection with reality. It is one of the main features of schizophrenia. People with psychosis have hallucinations, delusions, and other life-changing symptoms.1
Goals of drug therapy in schizophrenia
Antipsychotics are used to manage psychosis. They are also helpful in managing other schizophrenia symptoms over the long term. Most people with schizophrenia take an antipsychotic drug for years or lifelong. Taking all drugs as prescribed can help improve quality of life. It also can lower the risk of new episodes of psychosis.1,2
Other drugs may be helpful along with antipsychotics to help manage other factors of your mental health. These drugs may include benzodiazepines, antidepressants, or mood stabilizers.1-3
First-generation (typical) antipsychotic drugs
Typical antipsychotic drugs are also called first-generation antipsychotics. They were the first drugs used to treat psychosis. They block dopamine signaling in the brain. Dopamine is a neurotransmitter. Neurotransmitters are chemicals the brain uses to send messages about feelings and actions.4-6
Today, first-generation drugs are not the first choice for treatment. They are more likely to cause side effects. One common side effect is extrapyramidal symptoms (EPS). People with EPS may have tremors, rigid muscles, slow movements, involuntary facial and neck spasms, and more. EPS can be frustrating but are often manageable with a medicine for side effects or by changing medication plan.2,4-6
Another less common condition is tardive dyskinesia, which is similar to EPS but does not stop when changing medicines. Luckily, new medicines are being developed that are treating this condition. You should discuss all medication planning and side effects with your doctor.2,4-6
First-generation drugs treat only what are called the positive symptoms of schizophrenia. Positive symptoms include hallucinations, delusions, and disorganized thinking. While this can be helpful in treating active psychosis, it does not address other symptoms. Symptoms known as negative symptoms, like lack of motivation and pleasure, do not respond to first-generation drugs.4-6
Second-generation (atypical) antipsychotic drugs
Second-generation antipsychotic drugs are a newer group of drugs that treat schizophrenia. They are also called atypical antipsychotics. These drugs affect the balance of dopamine in the brain. They increase dopamine activity in some areas of the brain while decreasing it in others. Atypical drugs also impact another neurotransmitter called serotonin.4-7
As a result, the atypical drugs are more targeted. They cause fewer side effects. And the risk for EPS is much lower than with typical antipsychotics.4-8
Second-generation drugs also seem to help with negative symptoms in some people. This can have a big impact on quality of life. Some experts think that many of these medicines can help with cognitive symptoms, too. Cognitive symptoms involve trouble thinking or concentrating.4-8
One of the biggest concerns with second-generation drugs is metabolic syndrome. When this happens, the body changes the way it processes hormones, fats, and sugars. This can lead to weight gain and high blood pressure. It can also increase a person’s risk of developing diabetes or heart disease.7
Side effects can vary depending on the specific drug you are taking. These are not all the possible side effects of antipsychotic drugs. Talk to your doctor about what to expect when taking one of these drugs and if there are any specific tests you will need. You also should call your doctor if you have any changes that concern you when taking an antipsychotic drug.
Benzodiazepines
Benzodiazepines (also called benzos) are not directly meant to treat schizophrenia. However, sometimes doctors use them to help with anxiety related to the condition.2,9,10
Benzodiazepines are also the first-line treatment for catatonia. Catatonia is a group of abnormal motor and speech symptoms that affect daily functioning. Catatonia can be a symptom of schizophrenia or a separate syndrome by itself.2,9,10
Benzodiazepines are prescribed very carefully. They have major side effects, like strong drowsiness and memory problems. Benzodiazepines also can cause dependence. If a person is dependent on benzodiazepines and stops them suddenly, they can go through withdrawal. Drug withdrawal is difficult and can be very dangerous. If you are prescribed a benzodiazepine do not stop it abruptly without consulting your doctor.9
These are not all the possible side effects of benzodiazepines. Talk to your doctor about what to expect when taking these drugs. You also should call your doctor if you have any changes that concern you when taking benzodiazepines.
Other possible drugs for schizophrenia
Antipsychotics and benzodiazepines are not the only drugs used to treat schizophrenia. Each person’s treatment is different. You and your doctor will work together to figure out a plan that meets all of your needs. Along the way, they will monitor you for any potential risks and side effects.
Some people have other mental health conditions along with their schizophrenia. These may include depression, bipolar disorder, or anxiety. Antidepressants, mood stabilizers, and other similar drugs may be helpful in these cases.7
Certain treatment side effects may need to be managed with drugs, too. These include EPS, metabolic issues, and low blood pressure, among others.7
Before beginning treatment for schizophrenia, tell your doctor about all your health conditions and any other drugs, vitamins, or supplements you take. This includes over-the-counter drugs.