Treatment of Schizophrenia: Medication, Therapy, and More
Schizophrenia is a serious mental health condition that affects how a person thinks, feels, and acts.
Among people with the condition, symptoms like hallucinations (seeing or hearing things that aren’t there), delusions (false beliefs not based on reality), and jumbled speech may make it seem like they’ve lost touch with reality. This detachment from reality is known as psychosis. The symptoms of schizophrenia can make it difficult to engage in usual daily activities.
There’s no cure for schizophrenia, but there are many treatments aimed at reducing or eliminating symptoms of the condition. With effective treatment, many people are able to attend work or school, maintain relationships, and be independent.
Most people with the condition will require a combination of schizophrenia medication, psychotherapy (talking with a trained therapist), and social services. If a person is in a crisis or having severe symptoms, their doctor may suggest that they be temporarily admitted to a hospital to stabilize them.
Antipsychotic drugs are often used to treat schizophrenia. These medications help relieve hallucinations, delusions, and thinking problems.
Antipsychotics work by changing the way certain chemicals, called neurotransmitters, act in the brain. By altering those chemicals, antipsychotics can affect brain circuits involved in thinking, mood, and perception.
There are many different antipsychotic drugs on the market. You may hear your doctor refer to first-generation (or “typical”) antipsychotics, second-generation (or “atypical”) antipsychotics, and muscarinic agonists.
First-generation antipsychotic drugs include:
chlorpromazine (Thorazine)
fluphenazine (Prolixin)
haloperidol (Haldol)
loxapine (Loxitane)
perphenazine (Trilafon)
thioridazine (Mellaril)
thiothixene (Navane)
trifluoperazine (Stelazine)
Second-generation antipsychotics include:
aripiprazole (Abilify)
asenapine (Saphris, Secuado)
brexpiprazole (Rexulti)
cariprazine (Vraylar)
clozapine (Clozaril)
iloperidone (Fanapt)
lumateperone (Caplyta)
lurasidone (Latuda)
olanzapine (Zyprexa)
paliperidone (Invega)
quetiapine (Seroquel, Seroquel XR)
risperidone (Risperdal)
ziprasidone (Geodon)
Long-acting injectable versions of first- and second-generation antipsychotics include:
risperidone (Perseris, Risperdal Consta, and others)
Both first- and second-generation antipsychotics may be about as effective at reducing so-called “positive” schizophrenia symptoms, such as hallucinations or delusions, though second-generation antipsychotics may be better at treating so-called “negative” symptoms, such as depressed mood and social withdrawal.
In September 2024, the FDA approved xanomeline and trospium chloride (Cobenfy) capsules to treat adults with schizophrenia. The first schizophrenia drug approved in decades, Cobenfy is the first in a new class of antipsychotic drugs called muscarinic agonists.
Cobenfy works differently than other antipsychotics by targeting cholinergic receptors in the brain. Other antipsychotics for schizophrenia work by targeting dopamine, which has been the standard of care for decades.
Side Effects of Antipsychotics
Both older and newer antipsychotics can cause serious side effects, including the following:
Uncontrollable movements, such as tics, tremors, or muscle spasms (this risk is higher with first-generation antipsychotics)
Weight gain (this risk is higher with second-generation antipsychotics) and other metabolic effects like development of diabetes and high cholesterol
Tardive dyskinesia (TD), a condition that causes repetitive, involuntary movements (this risk is higher with first-generation antipsychotics). There’s a 5 percent chance of developing TD for every year a person takes antipsychotics.
Drowsiness
Restlessness
Dizziness
Agitation
Sedation
Neuroleptic malignant syndrome, a rare but serious complication usually linked to high doses of first-generation antipsychotics early on in treatment. Fever, delirium, and muscle stiffness are potential symptoms.
Unlike other antipsychotics for schizophrenia, the muscarinic agonist Cobenfy does not cause weight gain as a side effect. The most common side effects of Cobenfy are:
It’s important to speak with your doctor about the potential side effects of antipsychotics, and to let them know if you’re experiencing side effects from your medication. They may be able to make adjustments to your medication to help you feel better.
Also, be sure to discuss all other medications or supplements that you take with your doctor before starting on an antipsychotic. That’s because antipsychotics can also cause interactions with certain medications and supplements.
This includes over-the-counter (OTC) drugs, supplements, and illegal and recreational drugs, including marijuana, which has been shown to worsen psychotic symptoms in those with and susceptible to schizophrenia.
Medication Adherence
It's hard for some people with schizophrenia to take medications correctly (called “medication adherence”). An estimated 63 to 74 percent of people with schizophrenia use their meds incorrectly or skip them altogether, according to a systematic review and meta-analysis.
Several factors may play a role in nonadherence, including:
Having to take multiple medications
Bothersome side effects from the medication
More severe disease
Coexisting health conditions
Alcohol or drug abuse
Lower insight, or awareness that they have schizophrenia
In addition to medication, your doctor may recommend other interventions to help you cope with the everyday challenges of schizophrenia. They may include:
Psychotherapy In individual psychotherapy (talk therapy), you’ll meet with a therapist to work on your thinking and behavior. The therapist may teach you how to test the reality of your thoughts or perceptions, and help you develop ways to ignore the voices in your head. Commonly used types for schizophrenia include cognitive behavioral therapy, supportive therapy, and cognitive remediation therapy (also known as cognitive enhancement therapy).
Family therapy Family therapy involves seeing a therapist along with members of your family. It’s important that your family knows as much about your schizophrenia as possible. Therapists can help your family develop coping strategies and problem-solving skills.
Social skills training This intervention helps people with schizophrenia learn skills for better communication and social interaction so that they’re more equipped to take part in daily activities.
Vocational rehabilitation and supported employment This involves helping people with schizophrenia get ready for, find, and maintain jobs.
Coordinated specialty care involves early intervention with a coordinated, team-based approach after the onset of a first episode of psychosis. First-episode psychosis is often an indicator of schizophrenia.
A research initiative called Recovery After an Initial Schizophrenia Episode (RAISE), which was initiated by the National Institute of Mental Health, showed that coordinated specialty care can help decrease the burden of first-episode psychosis and better the lives of people with schizophrenia.
People with schizophrenia who are having severe symptoms or are in crisis may need to be hospitalized to help keep them safe and ensure they’re eating, sleeping, and bathing regularly.
Doctors may recommend some people with schizophrenia for electroconvulsive therapy (ECT). ECT can be an effective option for people whose symptoms haven’t responded well to medication treatment. During an ECT session, a person goes under general anesthesia. While they’re asleep, doctors use a tool to pass electrical currents through their brain to cause a small and short therapeutic seizure.
Along with medication and psychosocial interventions, there are several lifestyle, self-care, and support strategies that can help.
Get educated about schizophrenia. Learn as much as you can about your condition so you can understand the importance of sticking to your treatment plan. It can also help for friends and family to learn about schizophrenia to better understand and support you.
Ask about social services. You may be able to get help with housing, transportation, and more through social services.
Set goals. Setting goals with your care team can help you stay on track with your treatment plan.
Get enough sleep. It’s common for people with schizophrenia to have sleep problems. If you have difficulty sleeping, let your doctor know. They can recommend strategies that can help or refer you to a sleep professional if you need one.
Manage stress. Stress-relieving techniques like yoga, meditation, or tai chi could better help you manage your symptoms alongside your treatment plan.
Avoid drugs and alcohol. Nicotine, recreational drugs, and alcohol can make symptoms of schizophrenia worse. If you’re having difficulty quitting any of the above, let your doctor know. They can help you find substance use treatment if you need it.
Find peer support groups. These are safe places where you can meet people who are going through the same things as you. Professional therapists are usually not involved.
Treating schizophrenia typically involves a combination of medication, psychosocial interventions, and lifestyle changes to help manage symptoms and improve daily functioning. While there’s no cure, many people with this condition can lead fulfilling lives with regular and effective treatment. If you or someone you love has schizophrenia, commitment to treatment can make a significant difference in managing the condition.
