Schizophrenia: Medication for Schizophrenia
Guest: Dr. Christopher Pelic – Psychiatry & Behavioral
Host: Dr. Kevin Gray - Psychiatry & Behavioral
Dr. Kevin Gray: Hello.
This is Dr. Kevin Gray, from the Medical University of South
Carolina. I’m speaking with Dr.
Christopher Pelic, an inpatient psychiatrist here at MUSC. We’ve been talking about schizophrenia
treatment. I wanted to, specifically,
get into medications for schizophrenia.
This has really expanded in recent years, could you tell the listeners a
little bit about some specific medicines that are being used to treat
Dr. Christopher Pelic: Thanks, Dr. Gray. Well, as I said in an earlier recording,
we’ve had medications for schizophrenia out for approximately 50, 55
years. And we have come along way in
treating various symptoms. The older
medications, there are probably, on the market, about 10 to 15 older
medications that have been around since the 50s, 60s, 70s. Those medications were quite effective for
treating the primary symptoms of schizophrenia, of psychosis. They also had some potential side effects,
which is why we developed some of the newer drugs. Those side effects included things like stiff
muscles or symptoms of shaking arm, or shaking leg, or feelings of
restlessness. And so, really, in the
last 20 years or so, we’ve developed some newer medicines that are hopefully
less likely to do that.
Dr. Kevin Gray: Tell me about some of those newer medicines.
Dr. Christopher Pelic: Well, a lot of the newer medicines that
people may have heard about, either from friends, family, or on commercials,
are medications like Zyprexa, Risperdal, Geodon, Abilify, Seroquel, or even a medicine called
Clozaril. And these medications are what we call
atypical antipsychotics or newer generation antipsychotics. And they’re called that because not only do
they address the primary symptoms of schizophrenia, like voices and
hallucinations and paranoia, but they also target some of what we call negative
symptoms of schizophrenia, like poor grooming and hygiene and amotivational
syndrome, or not taking care of one’s self.
So, they address other symptoms, in addition, and they have some benefit
over the older medications.
Dr. Kevin Gray: How do these medications work?
Dr. Christopher Pelic: Well, again, these medications work primarily
on two brain chemicals. And, without
getting overly detailed, the two brain chemicals are dopamine and
serotonin. And we know that these
chemicals, in various places in the brain, can sometimes be either too high or
too low. And by giving medications that
can block or increase some of these chemicals in certain areas of the brain,
they can help reduce symptoms.
Dr. Kevin Gray: If I’m a patient that’s coming to you with
schizophrenia, how do you choose which of these medications you’ll use to help
Dr. Christopher Pelic: That’s a great question. In this day and age, most psychiatrists will
start with the newer medications when treating psychosis. They will start with what we call the
atypical antipsychotics, as mentioned earlier.
However, which medication we choose does vary for each patient. We often look at a lot of different factors
in choosing a medication. Things that we
often look at are, what other symptoms do they have? What medical problems do they have? What side effects might be helpful for them,
make them sleepy or increase their desire to eat? Or, which side effects might
be harmful to them? And, what they can
afford? We put all of these things
together and we come up with a specific medication that we think will be most
helpful for that person.
Dr. Kevin Gray: So, it sounds as though there’s not necessarily
a flow chart or an algorithm you go by, medication by medication, but it’s a
complex decision for each and every patient.
Dr. Christopher Pelic: It is, and oftentimes we, as doctors, would
like to have an easy answer and an easy choice, and frequently we have to use
all of these factors to come up with a medicine that we think would be most
helpful. And sometimes we’re wrong. Sometimes we need to try a different medication
if one doesn’t work or intolerable side effects develop, so we’ll try something
different. Sometimes we don’t get it
right on the first try.
Dr. Kevin Gray: Is there any sense that, we spoke in an
earlier podcast about some of these illnesses running in families, if I had a
relative who had responded well to a certain type of medication, does that make
me more likely to respond to that? Or,
on the converse, if they had adverse effects from a certain medicine, am I more
likely to have that than other people?
Dr. Christopher Pelic: Well, Dr. Gray, it isn’t the be-all end-all,
but it certainly is a good place to start.
There have been a lot of cases, and in my practice, I’ve seen several
cases where patient’s family members who did well on a medicine really predict
how that person is going to do on the medicine.
But it isn’t a be-all end-all.
It’s a good starting place. And
that’s why we take a good, thorough family history, not only of mental illness
but also the treatments that people in the family received.
Dr. Kevin Gray: So, say I’ve come to you, you’ve started me
on a medication for schizophrenia and I go home and begin taking it, what sorts
of things should I be looking for in terms how long it should take for it to
begin working, or what sort of side effects would I most commonly be seeing?
Dr. Christopher Pelic: Well, usually it isn’t for a week to two weeks
that we really start to see significant benefit in terms of the symptoms of
schizophrenia. Sometimes people can see
benefits earlier than that, and sometimes it takes a much longer period, four,
six, eight weeks, and maybe even longer, if dosage increases are
necessary. Oftentimes, patients will
start to experience some side effects before they actually notice significant
benefit from the medicine. Specifically,
some of the newer medicines which are good at helping, both, the positive and,
as I said earlier, those negative symptoms of not taking care of one’s self,
have increased potential to cause problems with things like weight gain and
cholesterol, and sugar, and glucose in the blood, so we have to have careful
monitoring with patients that are on these medicines. They’re good medicines, but it just means
that we have to monitor for these things while they’re taking them.
Dr. Kevin Gray: So, if I’ve come back to you after a month,
or two months, and I’ve actually noticed that my symptoms have gotten a lot
better, would I typically stay on this medication for the long term or, what
kind of happens to people down the road?
Do people stabilize and stay on the same medicine, or do they have to
change medicine over time?
Dr. Christopher Pelic: Well, generally speaking, if you came back in
a few weeks to months and you were doing well, we would most likely keep you on
the medication indefinitely, until either intolerable side effects developed or
your symptoms worsened, or returned. In
general, patients with schizophrenia, because it’s a chronic illness, require
life-long treatment. As of now, we don’t
have a cure. There are some patients
that do well on a medication for a period of time and their symptoms come back,
and the medication kind of loses its effectiveness, in which case, we will
switch. But, if you’re doing well on it
and you haven’t developed any significant side effects, our recommendation
would be that you’d stay on it indefinitely.
Dr. Kevin Gray: One of the things you mentioned, Dr. Pelic,
was side effects with the newer medicines, or atypical antipsychotics, you
mentioned things like weight gain and problems with blood sugar or lipids. How are those things watched for, how are
they managed, and how serious of a problem is this?
Dr. Christopher Pelic: That’s a great question. I think most people have seen in the media,
and on the news, there were a lot of concerns with these kinds of medications. The thing that I would stress is that they
can be very effective at reducing the symptoms of schizophrenia. And, for someone who isn’t able to leave the
house because they’re so paranoid or that they’re hallucinating and they’re a
danger to themselves or others, these medicines help, but we have to balance
that out with the risk of side effects.
And, in many cases, the benefits of these medications well outweigh the
risks. Specifically, the concerns about
weight gain and diabetes development, and problems with cholesterol are very
real concerns, and they should be monitored closely, but most likely, in many
cases, the medications are so helpful that we do our best to closely monitor
and treat those conditions without having to necessarily stop them.
So, in summary, we do need to
monitor for these things. They’re very
real concerns, and your doctor should be monitoring for these things. But we know that they’re very helpful and
they can really improve the quality of life of most patients.
Dr. Kevin Gray: Thank you so much, Dr. Pelic.
Dr. Christopher Pelic: Thank you, Dr. Gray.
If you have any questions about the services
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Carolina or if you would like to schedule an
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