Medications

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 a main feature of schizophrenia. People with psychosis may have hallucinations, delusions, or other life-changing symptoms.¹

Goals of drug therapy for schizophrenia

Antipsychotics are used to manage psychosis. Symptoms of psychosis are called positive symptoms. Newer drugs may also manage negative symptoms, which include social withdrawal and lack of enjoyment in life.^1,2

Most people with schizophrenia take an antipsychotic drug for years or for their whole life. Taking these drugs as prescribed can help improve quality of life. It also can lower the risk of new episodes of psychosis.^1,2

The US Food and Drug Administration (FDA) has more recently approved an alternative to antipsychotics called muscarinic agonists. These drugs can help manage both positive and negative symptoms. Other drugs, too, may help manage other factors of your mental health. These drugs may include benzodiazepines, antidepressants, or mood stabilizers.^1-4

First-generation (typical) antipsychotic drugs

Typical antipsychotic drugs are also called first-generation antipsychotics. They were the first drugs used to treat psychosis. They reduce the activity of dopamine in the brain. Dopamine is a type of neurotransmitter, which is a chemical the brain uses to send messages about feelings and actions.^5-7

Today, first-generation drugs are not the first choice for treatment. This is because they are more likely to cause side effects. These drugs also treat only the positive symptoms of schizophrenia. These symptoms include hallucinations, delusions, and disorganized thinking. But they do not address other symptoms. For example, negative symptoms do not respond to first-generation drugs.^2,5-7

One possible side effect of first-generation antipsychotics is extrapyramidal symptoms (EPS). People with EPS may have tremors, rigid muscles, slow movements, and involuntary facial and neck spasms. You may be able to manage EPS with another type of drug or by changing your treatment plan.^2,4-6

Second-generation (atypical) antipsychotic drugs

Second-generation antipsychotic drugs are a newer group of drugs. They are also called atypical antipsychotics. These drugs affect the balance of dopamine in the brain. They increase dopamine activity in some areas while decreasing it in others. Atypical drugs also impact another neurotransmitter called serotonin.^5-8

These drugs are more targeted than first-generation antipsychotics. And they cause fewer side effects. For example, the risk of EPS is much lower than with typical antipsychotics.^5-9

Second-generation drugs also may work better to treat negative symptoms. This can have a big impact on quality of life. Some experts think that many of these drugs also help with cognitive symptoms. Cognitive symptoms involve trouble thinking or concentrating.^5-9

However, a concern with second-generation drugs is the possibility of 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 your risk of diabetes or heart disease.⁸

Benzodiazepines

Benzodiazepines (also called benzos) do not directly treat schizophrenia. However, doctors use them to help with anxiety related to the condition.^2,10,11

Benzodiazepines also are the first-line treatment for catatonia. Catatonia is a group of abnormal movement and speech symptoms that affect daily functioning. It often entails a lack of movement, rigid posture, and silence or unresponsiveness. People with catatonia also may be agitated or confused. Catatonia can be a symptom of schizophrenia or a separate syndrome.^2,10,11

Doctors use caution when prescribing benzodiazepines. These drugs can have side effects, like strong drowsiness and memory problems. Benzodiazepines also can cause dependence. People who become dependent on them may have serious withdrawal symptoms after stopping them. If you are prescribed a benzodiazepine, do not stop taking it without first talking to your doctor.¹⁰

Muscarinic agonists

Muscarinic agonists work by activating proteins called muscarinic receptors. These proteins are regulated by a neurotransmitter called acetylcholine. Activating muscarinic receptors in the brain can improve both positive and negative symptoms of schizophrenia.⁴

Muscarinic agonists also activate receptors outside the brain, which can lead to side effects. But there are other drugs that can reduce these side effects when taken with muscarinic agonists.⁴

For example, some muscarinic antagonist drugs cannot enter the brain. Combining these drugs makes it so that only muscarinic receptors in the brain are activated. The FDA has approved this combination medicine to treat schizophrenia.⁴

The most common side effects of these drugs are digestive issues, high blood pressure, and fast heart rate. More serious side effects may include problems urinating, liver damage, and slowed stomach emptying. People with a history of these problems may not be able to use these drugs, or may need careful monitoring.⁴

Other things to know

Each person’s treatment plan for schizophrenia will be different. Work with your doctor to find a plan that meets your needs. Along the way, they will monitor you for any potential risks and side effects.

Some people with schizophrenia also live with other mental health conditions. Antidepressants, mood stabilizers, and similar drugs may be helpful in these cases.⁸

Side effects can vary depending on the specific drug you are taking. Those mentioned here are not the only possible side effects. Talk to your doctor about what to expect when taking one of these drugs. Call your doctor if you have any changes that concern you.

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.