NICE Guidance Medication [63]

Medicines to help recovery

Antipsychotic medicines by mouth

Oral antipsychotic medicines (those taken by mouth) help to stop you breaking down and help you to have a more stable life. Also, if you want psychological help, you will need antipsychotic medicines at the same time. Remember, the decision about which medicine to take is best made by you and your doctors together.

If you are happy with the antipsychotic you are already taking and you are not experiencing troublesome side effects, then carry on with the medicine you are taking. If you are having a conventional antipsychotic and this has not suited you, you should be offered an atypical antipsychotic. If you are having an atypical that makes you put on weight, gives you diabetes, or causes sexual problems or excessive tiredness, you may be offered a different antipsychotic.

Your doctors should keep a close eye on the side effects, as they are common and sometimes unpleasant. The lowest dose that keeps you stable is best.

Depot antipsychotics

If you find it hard to remember to take your medicines, or you stop taking them and break down more often, you may be offered regular injections of a long-acting antipsychotic. There are a number of different types that can be used. These are called ‘depot antipsychotics’ and are given every 2 to 4 weeks, depending on which type you take. The doctors and nurses helping you should talk to you about how and where (for example, in clinics or at home) depot injections can be given and ask you about your preferences. If you do decide to try a depot antipsychotic the doctors will give you a test dose first to check that it suits you. Once you are taking a depot you should have your treatment reviewed regularly.

When the usual medicines do not work (‘treatment-resistant schizophrenia’)

If you have tried two different antipsychotics, including an atypical one, each for at least 6 to 8 weeks and are still getting ill, it’s likely that your illness is resistant to the usual treatments. Your doctors will make sure that you are taking your medicines properly and re-assess you and your situation to check there aren’t other reasons for you not getting better, such as drinking too much alcohol or taking illicit drugs, which can stop the medicines working properly. They may suggest having (further) psychological treatment.

You may be offered another atypical (olanzapine or risperidone) if you haven’t tried them already. If these don’t work, you should then be offered a medicine called clozapine. This is a special type of atypical antipsychotic, which can only be given when a person’s illness doesn’t respond to the usual treatments. You will have to have some blood tests before and while you are taking this medicine. Your doctors will discuss this with you and give you written information about clozapine.

Sometimes clozapine may not get you properly better even after several months at proper doses. Your doctors may then suggest that you take another antipsychotic as well as the clozapine. This is the only situation when two antipsychotics should be prescribed together over a long period of time. If this doesn’t work very well you shouldn’t carry on taking two antipsychotics. Your doctors may suggest adding other medicines instead (these are called ‘adjuncts’ and are not covered here). They will need to discuss this with you at length before giving you other medicines.

Helping you get work

The overall aim of mental health treatment is to help people to get back to living an ordinary life as far as possible. This includes getting work of some kind. Unfortunately, people with schizophrenia find it very hard to get jobs, at least partly because of the stigma associated with schizophrenia. Your assessments by the mental health team should include a detailed assessment of your work history, skills and work potential, as well as what you really want to do. If ‘supported employment schemes’ are available, they should be offered to you if you want this. There are other types of work schemes that may also be locally available. If you want to try to get a job through these schemes, your mental health team will help you join one. Your local mental health and social care providers should also be helping develop local employment opportunities for people with schizophrenia.

Further information

You have the right to be fully informed and to share in decision making about your healthcare. If you need further information about any aspects of your schizophrenia or treatment, please ask your specialist, GP or a relevant member of your health team. You can discuss this guideline with them if you wish, especially if you aren’t sure about anything in this booklet they will be able to explain things to you.