Specific Antipsychotic Medications
The aim of antipsychotic treatment is to reduce and control symptoms while keeping side effects at a minimum. Combining antipsychotic medication with other therapy and support can help people to manage symptoms and improve quality of life. Counselling, peer support, family therapy, and housing and employment supports can all be helpful.
Any prescription or non-prescription treatment (e.g., over-the-counter treatments including herbal supplements, pain relievers, vitamins, cold and flu remedies) has the potential to interact with antipsychotic medications. It is important to always consult a doctor or pharmacist to check these interactions before taking the medications.
It is very important for you to carry a complete list of ALL of your medications – prescription and non-prescription medications; herbal products and vitamins. This list is very helpful if you are hospitalized for any reason and/or need treatment in an area other than where you live (e.g. vacation, visiting family or friends).
The issue of street/recreational drug and alcohol use and/or misuse is another important subject. A good rule of thumb is that it is never a good idea to mix alcohol or street drugs with prescription medications. Mixing alcohol or using drugs like cocaine or marijuana with antipsychotics can be dangerous. It is important to discuss any recreational drug or alcohol use with your physician and pharmacist to determine the risk of drug interactions. Taking your antipsychotic medication regularly is very important, hence anything that may interfere with that should be discussed with your healthcare providers.
Ultimately, staying as healthy as possible, both mentally and physically, is the main goal of treatment for people living with schizophrenia and other psychotic illnesses. People with mental illnesses are at an increased risk for heart disease, metabolic syndrome, and diabetes, and some antipsychotic medications can increase the risk. Maintaining a healthy weight, stopping smoking, and getting adequate exercise can help reduce this risk. Individuals should discuss their risks with their health care provider early on and have regular medical checkups to stay as healthy as possible.
How Should Antipsychotics Be Taken?
Having a diagnosis of schizophrenia or other psychotic illnesses often requires long-term treatment with antipsychotic medication, but the experience varies from person to person. What works for one person may not work for another. Your healthcare provider will work with you to determine the type and length of treatment that is best for you.
Antipsychotics are available in a number of different dosage forms, such as tablets, liquid, fast-acting injections, or long-acting injections. Most antipsychotic medications have to be taken daily. However, long-acting injections, also called depot medications, can be given once every few weeks because the medication is slowly released into the body over time. You and your doctor will work together to decide which medication, dosage form and dose is best for you.
In any case, it is very important to take antipsychotic medications exactly as prescribed to help prevent relapse. Medication should not be stopped and the dose should not be changed without first speaking to your healthcare provider. It is also not a good to double up on a missed dose to “catch up.” If you miss a dose of your medication call your pharmacist and ask them what you should do to get back onto your regular schedule.
Keeping appointments and communicating openly about questions or concerns is also very important. It may be useful to keep track of medications using a calendar or pill box, or asking a friend or family member to help with reminders.
How Long Does it Take for Antipsychotics to Work?
Everyone will respond differently to different medications. Some may see some improvement right away, but for many people it can take several months before the full benefit of any antipsychotic medication is seen.
Do Antipsychotic Medications Interact with Other Drugs?
Antipsychotic medications have the potential to interact with many other medications, herbal products, vitamins, recreational drugs, alcohol or food. It is difficult to know the risk of each interaction as there is not a lot of research in this area. It is very important for your doctor and pharmacist to know all of the medications, herbal products and vitamins you take. It is also important that they know how often you drink alcohol, smoke cigarettes and/or use recreational drugs. Having all of the information is important so that your healthcare team can review the potential interactions and the risks and benefits of the treatments for you.
Be cautious if you are using the internet to determine drug interactions. Many individuals are on combinations of medications that could interact, however, with monitoring, they are often safe and the benefits are bigger than the risks. In the sections below on individual antipsychotic medications some potential drug interactions are listed. The list does not include every possible drug interaction. Therefore it is very important for you to have your medications reviewed for interactions regularly by your doctor and pharmacist.
Adults Over 65
Doctors are cautious when prescribing antipsychotic medications for older people. Other age-related illnesses like arthritis, high or low blood pressure, and problems with vision, memory, or balance may also require medications. This can increase the potential for drug interactions. Therefore, planning and implementing medication schedules may require help from healthcare professionals, such as nurses and pharmacists.
How do Antipsychotics Interact with Pregnancy And Breast-Feeding?
It is important to inform your doctor if you become pregnant in order to determine the best treatment for you and your baby. Individuals with schizophrenia and other psychotic illnesses who become pregnant are often treated successfully with antipsychotic medications. You and your doctor will determine the risk of medication versus the risk of your illness being untreated. Untreated illness puts you at risk, but it can also put the unborn baby at risk.
No medication is completely safe and very close monitoring is important throughout pregnancy and after delivery. However, individuals can often continue to take antipsychotic medication during pregnancy and both mom and baby can do very well. Some antipsychotic medications can also be used safely while breastfeeding. If you want to breastfeed your baby discuss the risks and benefits with your doctor.
Some studies suggest, in some rare cases, babies born to mothers taking antipsychotic medications during pregnancy may experience withdrawal symptoms that may cause them to be hospitalized. This is often successfully addressed through treatment.
Antipsychotics can pass into breast milk and may cause similar withdrawal symptoms in some cases. For these reasons, close relationships with your treatment team are important to maximize safety if you choose to breastfeed.
For more information on this topic, you can visit: http://knowledgex.camh.net/primary_care/guidelines_materials/Pregnancy_Lactation/Documents/psychmed_preg_lact.pdf or contact Motherrisk at 1-877-439-2744.
De Hert, M., Dekker J., Wood D., Kahl K., Holt R., & Möller H. (2009). Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). European Psychiatry, 24