BUCK

After a couple of months I went home and attended the day program. It was going pretty good. I used to go to all of my groups. Then I was taking my medication steadily. After a couple of months I stopped taking my medication, and I got sick again. I started to think people were following me. I started hearing voices again, and I ended up back in the hospital. The doctor told me that I was diagnosed with schizophrenia and that it was a mental illness. That’s when I realized that something had been wrong with my mind. So I finally recognized that it was something in my mind I could not control. It was very scary.

The third time I went into the hospital the same thing happened. That’s when I finally realized I had to take the medication.

I hate the feeling that pills give me. Medication makes me tired, sleepy. Makes me feel I don’t want to do anything. Makes me gain weight. Sometimes it makes me nauseated. It’s just the whole idea of taking pills turns me off. I hate waking up knowing I have to take pills in the morning and at night. I hate taking pills because I think I don’t need them. I thought the problem was something in my mind that I could control without taking anything. When I was growing up my family told me that you don’t have to take medicine. None of my family used to take pills. I didn’t even know there were pills for such things as schizophrenia.

MEREDITH: It makes you feel sicker the more you take. People complain about taking Tylenol. I pop seven pills every night.

ROMAN: The pills make me sleepy and they make me sleep late. At the beginning there are a lot of side effects—I broke out in rashes on my arms and chest. Weight gain—it makes you eat a lot.

I really don’t want to stay on the medication, but I have to. I went off my medication for three months—I couldn’t get the blood tests anymore because I couldn’t get to the lab. I was working. Three months later I started to get sick again. I was hearing voices. I was getting emotional messages—I’d watch TV and then I would concentrate on one thing and constantly think about that one thing. I called the doctor and I came in. She put me on a different medication so I wouldn’t be getting blood tests every week. That was the only time I stopped.

GARY: In the hospital I didn’t want to take pills because I thought they were trying to give me illegal substances to make me stay there longer. Later it was the side effects I didn’t like.

ZELDA: I feel like I am on a leash. It dictates to me when I should go to sleep and how much rest I’ll need in order to wake up on time. And no drinking at all. Getting used to having a needle in my arm every week is something I would never do. Now it’s every other week.

ANTIPSYCHOTIC MEDICINES AND SCHIZOPHRENIA

At this point there is no cure for schizophrenia, but it is treatable with medication and therapy. Medications are necessary to manage symptoms and to improve your ability to enjoy life. Technology is developing rapidly, and hope exists for improved medications and, possibly, a cure for schizophrenia.

Antipsychotic medications are used to treat psychotic symptoms in schizophrenia as well as in other psychotic disorders of the brain. These medications have been available since the 1950s. The first medication ever used, in 1950, was Chlorpromazine (thorazine). Since then many others have been developed. Within just the past few years there have been a number of new ones put on the market, and others are in the process of being tested.

The precise mechanism by which antipsychotic medicine works is unknown. This is a major area of current research. One belief is that psychotic symptoms are related to overactivity in the brain of the neurotransmitter dopamine. It is thought that antipsychotic medications reduce the activity of dopamine in the synaptic cleft (see figure 3.5 on page 35). They do this by blocking the dopamine receptors—that is, by preventing dopamine from attaching to the receptors. These medications may also affect several other neurotransmitters in the brain, such as serotonin, norepinephrine, and glutamate. The overall purpose of antipsychotic treatment is to restore the disturbed chemical balance of the brain.

Different medications affect different receptors and, because everyone is unique, they affect each person differently. People may need different doses of the same medicine, and some may respond better to certain medicines than to others.

Too much dopamine activity may be the cause of symptoms. Some medicines act as blockers. They stop dopamine from getting through to the receiving neuron.

First-Generation Medications

Since 1950, many antipsychotic medications have been developed. The first-generation group is called the typical or conventional medications. There are many first-generation antipsychotic medications. Some of the more popularly used include Haldol (haloperidol), Prolixin (fluphenazine), Navane (thiothixene), Trilafon (perphenazine), and Moban (molindone). Haldol and Prolixin can be given by injection, like an antibiotic shot, one to two times a month, instead of orally. Some common side effects of “typical” medications like Haldol and Prolixin include prolonged but reversible muscle stiffness; muscle cramping of the neck, fingers, or eyes; tremors; dry mouth; weight gain; and tardive dyskinesia (involuntary muscle movements). Tardive dyskinesia may be permanent despite discontinuation of the medication. The risk of tardive dyskinesia is 4 percent per year of exposure to typical antipsychotic medications. The doctor will regularly do exams to check for this side effect.

Second-Generation Medications

More recently, a new generation of medications sometimes called atypical (not typical) antipsychotics has become available. These were designed to have fewer side effects and appear to be more effective at treating the negative symptoms of schizophrenia. The risk of tardive dyskinesia associated with atypical antipsychotics is lower than with typical antipsychotics.

Weight gain is a significant side effect of several of these newer medications. Related to this weight gain is an important health issue called metabolic syndrome. Metabolic syndrome is a group of conditions that include increased insulin levels, excess fat around the waist area, high cholesterol levels, and elevated blood pressure. Together these health problems increase the risk of heart disease, stroke, and diabetes. Although it is less likely, it is possible that even without weight gain these medications may put you at higher risk for diabetes and elevated cholesterol.

Be sure to have a checkup every six months with your medical doctor to make certain you are not developing metabolic syndrome. Also, be aware of the warning signs of diabetes and get checked immediately if you are experiencing possible symptoms.

The warning signs of diabetes are as follows:

• urinating a lot more than usual

• being very thirsty

• losing weight without reason

• feeling exceptionally tired

• patches of velvety dark, thick skin under your arms.

See chapter 9’s section on healthy eating and staying active to help prevent metabolic syndrome.

Some notes about side effects: All antipsychotic medications can cause NMS (neuroleptic malignant syndrome). NMS is very rare, but if you develop the symptoms—high fever, stiff muscles, and confusion—you must get medical help quickly. All medicines can cause sexual side effects, restlessness, and a variety of other problems not mentioned previously. Your doctor and pharmacist can provide additional information. All pharmaceutical companies also have Web sites with a great deal of information as well as telephone numbers you can call for more details.

Abilify (aripiprazole) is an antipsychotic medication that causes less weight gain and less tiredness for many people. It can cause a feeling of restlessness, which can make you feel quite uncomfortable, as well as muscle stiffness.

Clozaril (clozapine) was the first of the atypical medications to be introduced. Clozapine is the only antipsychotic that does not cause tardive dyskinesia at all. It also works well for people with schizophrenia that has not been very responsive to other medications. Common side effects include tremors of the arms, hands, and legs; restlessness; muscle stiffness; sedation; drooling (which usually occurs at night); weight gain; and constipation.

There is also a 1 percent chance that a person taking clozapine will develop agranulocytosis, which is a decrease in the number of infection-fighting cells in the body. This is a risky situation. Blood tests are done weekly for six months in order to watch closely for the occurrence of this side effect. If the tests have been negative, the risk of having a seriously low white cell count becomes extremely low. After the six-month period is passed successfully, blood tests are performed only once every two weeks. If all continues to go well, at twelve months blood testing is only once a month. If the cell count becomes too low, the doctor may discontinue the medication briefly, do blood tests more frequently, or consult with a hematologist. Some doctors add lithium to bring up the white blood count. If you have a sore throat or fever while taking clozapine, call your doctor.

Be extra careful to take clozapine daily because it leaves your body very quickly. Just missing a day or two can lead to a full return of symptoms.

Fanapt (iloperidone) is the newest medication at the time of this writing. The company reports possible side effects of dizziness, dry mouth, fatigue, nausea, orthostatic hypotension, tachycardia, nasal congestion, and weight gain. It may also affect heart rhythm, which you will want to discuss with your doctor.

Geodon (zaprasidone) has the benefit of low weight gain. Some common side effects are tiredness, headache, nausea, constipation, cough, and runny nose. For some people it can cause changes in heart rhythm, which you should discuss with your doctor.

Risperdal (risperidone) was the first of the atypicals that could be used without weekly blood work. It works on both the dopamine and serotonin systems of neurotransmitters. Possible side effects include weight gain, sedation, tremors, muscle stiffness, low blood pressure, dizziness, insomnia, and anxiety. Some people also develop problems with sexual functioning; females may develop breast milk and stop menstruating. Invega (paliperidone) is related to Risperdal. It works much the same but uses a time-release method so that the medicine is delivered over a twenty-fourhour period.

Saphris (asenapine) is an atypical antipsychotic approved for use in 2009. Possible side effects are the inability to sit still or stop moving around (akathisia), drowsiness, and decreased oral sensitivity. It is not recommended for use by elderly people with dementia.

Seroquel (quetiapine) is another new antipsychotic medication. Possible side effects include sedation, memory problems, stomach upset, and agitation. Doctors recommend that consumers taking it have special eye examinations, because an animal study showed that beagles taking high doses developed cataracts.

Zyprexa (olanzapine)’s most common side effects include sedation, weight gain, and restlessness. Muscle rigidity, muscle twitches, and stiffness are additional possible side effects.

NEW FORMS OF MEDICATION Antipsychotic medications now come in several forms. Instead of the usual pills, some medications are available as injections, liquids, or in dissolving formats. The liquid medications and medications that dissolve in your mouth can be great if you do not like swallowing pills or have had problems with taking your medication in the past. Injectable medications have been around for years, but now several of the newer medicines are also available (or will be in the near future) in injectable forms. Injectables have the advantage of lasting for several weeks. This can be a big help for people who really do not want to take pills or have a hard time remembering to take their medicine. Some doctors and consumers even think that injectables may work better than pills.

Additional Medications

Your doctor may notice that you have developed some mood symptoms, such as depression. Therefore, he or she may prescribe lithium, Tegretol (carbamazepine), or Depakote (valproic acid) to boost the response of your antipsychotic medications, or to help stabilize mood problems and impulsive, unpredictable, or violent behavior caused by the schizophrenia.

Lithium is a salt used to stabilize mood symptoms. For people taking clozapine, lithium is sometimes used to keep white blood cell counts up. If you are taking lithium, it is important during hot weather to drink enough fluids. Dehydration can lead to increased levels of lithium, which can be dangerous. Other signs that there is too much lithium in your system include stomach upset, diarrhea, severe tremors, confusion, and lethargy. Don’t worry—your doctor will go over this with you. Blood tests to monitor for therapeutic levels of lithium and to monitor for any potential toxic effects on the thyroid or kidneys should be done on a regular basis.

Tegretol (carbamazepine) is an antiseizure medication that is also used to stabilize moods or impulsive behaviors. Side effects include decrease in blood cells or platelets (cells that help blood clots form). Routine blood counts and platelet level tests will be ordered, though these problems are not common. Other side effects include motor coordination problems, stomach upset, drowsiness, and, less frequently, blurry or double vision. Tegretol renders birth control pills ineffective.

Depakote (valproic acid) is another medication that stabilizes moods and treats impulsive behaviors. Some common side effects are drowsiness, stomach upset, diarrhea, and changes in liver functions and cell counts that require occasional monitoring.

Cogentin (benztropine) is a medication used to help with side effects of stiffness, restlessness, and muscle rigidity. Too much benztropine can cause a “spacey” feeling and troubled thinking. It is important to take the prescribed dose.

Inderol (propranolol) is also used to help with side effects of restlessness.

The list of side effects is frightening, but many people experience only a few side effects, and some people have none at all. If you do experience side effects, tell your doctor so your medications can be adjusted.

There are various additional medications that may be prescribed for problems with mood, anxiety, side effects, and other symptoms. Your treatment team will be able to provide information about these.

SIDE EFFECTS ARE NO FUN

BEN: The first time at the hospital I don’t remember much—at first I didn’t realize where I was. When it came to me that I was at a place where they try to get mental patients to recover, it didn’t bother me. What bothered me was the medication. I’m really sensitive to the antipsychotic drugs. I get so restless I can’t sit still. The medicine, Prolixin and Risperdal, bothered me so much.

The first time I came out of the hospital I just stayed out of school, and I was having a problem accepting that I was sick. It hits you. Like, damn, I’m a mentally ill person. And there’s a stigma. When I got home I had a problem with the medication. Again, I was too restless. I couldn’t live. When I look back on it now, they gave me the wrong medicine. So I was hospitalized three or four times. But each time it had to do with the medication. I didn’t take it. I would rather get sick than get the side effects.

I’m a person in unlucky circumstances who got lucky because I was surrounded by people who cared a lot. The doctors communicated very well. I think that was very important, because if you don’t communicate with your doctors they don’t know how you feel. You need to give them insight into yourself so they really can help you. You have to talk to them, let them know because your treatment is dependent on the doctor, and if you can really make that communication work you have a much better chance of finding a treatment that is suited to you. The chances of controlling your illness are much, much better.

JEFF: I had some problems when I took the Prolixin. It used to make me really tired and sleepy, and I almost crashed my car going to work. Now I take olanzapine. One thing I don’t like with this medicine is the weight gain. I’m trying to get rid of the weight I’ve gained, but it is not easy. For a while there, after the problem was over, I thought maybe I didn’t need to take as much because I was not having as bad a time.

SAMANTHA: I hate it. It makes me realize that I really do have a mental illness. There are many side effects that I dislike. I’ve struggled with weight gain, blurry vision, caustic digestion, crabby disposition.

MIKE: I didn’t know what the pills were for at first because I didn’t know what was wrong with me. The side effects are just the worst—weight gain; my mind was kind of slow, I couldn’t think fast enough; sleeping a lot. I couldn’t take that. I felt that I could get better on my own so I didn’t need the pills. I felt that if I prayed enough, God would take care of everything and I wouldn’t need all this medicine. Being in denial of my whole illness was another reason I didn’t want to take the pills.

SAM: I always felt clozapine was going to be a burden. And it is, with taking the blood test every two weeks. Somebody said it’s not such a big deal, it’s like brushing your teeth. People with AIDS take forty tablets. Three tablets are okay with me. Also, my uncle has diabetes and he takes a pill every day.

VAN: I hated the drooling, the constipation, the low libido (sex drive); and the high appetite was the worst. But I would rather spend the rest of my life out of the hospital and have no symptoms ever again. Stopping the medication affected my sleep, and that concerned me. I didn’t want to have symptoms again, so I decided to continue drug treatment with a more suitable medication.

ABBY: One time I had tremors, so they gave me Cogentin. The Cogentin gave me other side effects. Also, the medicine increased my appetite and I gained weight.

MARCUS: The first time I took risperidone, and in a way it made it worse. I had the shakes in my hands, I wasn’t eating, and I couldn’t sleep; I still felt paranoid. It didn’t help. Then I went to clozapine and that helped. You have to take the time to see which one works. It doesn’t feel right in the beginning, but you have to find one that works. Clozapine works for me.

GENEVIVE: I hate pills because the medication is an illness of its own with the side effects. That’s what I think about the medication. I’ve seen people with tardive dyskinesia, people with stiff limbs. It’s another thing you have to deal with. You have to take the medication to feel better. You have no choice. Without it you’ll have the symptoms. So you have to deal with the illness and with the medication. I have side effects: my menstruation does not come regularly, I’m lactating, I feel dizzy, and I can’t stay up as late as I want. That’s what I hate about it.

I don’t like it one bit, but I need to stay on my feet. I need to go on with my life to accomplish my goal. In order for me to do that I have to take my medication or else I run the risk of relapsing, of getting sick again. And I don’t want that because it’s a setback.

RICHIE: The side effects I got were weight gain, drooling, feeling sluggish, stiffness. But it’s like taking asthma medicine. If you have a disease with your lungs you have to take it. It’s the same.

MEDICATION FOR THE REST OF MY LIFE?

Since everyone is different, you need to discuss with your doctor how long you will have to continue medication. The research done on the first episode of schizophenia shows that there is a high rate of relapse, which is usually related to discontinuing medication. The rate is five times higher in people who stop taking their medication.

This makes sense when you recall that schizophrenia is a chronic illness. That means—like diabetes or high blood pressure—it needs ongoing treatment to prevent symptoms from returning.

LUCINDA: I was about twenty-four when I got sick the first time. I always felt I was a very quiet person, quiet and normal, but very wary of people. I always found it very hard to trust people. I felt that people didn’t like me, that people were against me except for close friends and my family. I don’t want to think about the first time I got sick. It was a horrible experience. I felt very light. I felt like I was floating on air, like I wasn’t part of the world. I just felt like I was floating. That was really the main feeling I had at the time, and it was scary.

My mother was diagnosed with manic depression. She had eleven children. She was hospitalized many times in her life, maybe every two years. But she found a good medication and she has been well—she hasn’t been hospitalized the past eight years. I have never looked at my mother as “different.”

When you are in the hospital with a mental illness, you don’t feel good about it. You hope that things will get better when you get out, but having to take pills confirms, “Yes, you have a mental illness.” This can be difficult. Taking pills is a reminder every day that “Yes, I am a sick person.” Depending on the side effects of the medication, it can change your lifestyle. It can change what type of work you can do, and if people know you have this disease it can change the way they look at you. The sleepiness can change the job you have, or you may not be able to work as many hours as you had been. This can change your standard of living. I was fired from a couple of jobs because I wasn’t on time.

I don’t mind having to take medication for the rest of my life if I don’t have the side effects. It’s the side effects that are my main concern. I don’t mind because there is always a chance of a cure for the illness, and then I won’t have to take it.

MARCUS: I don’t really like taking medication, but it helps me. I don’t want to be on it forever. I want to get it reduced.

LINDA: The doctor said, “Well, in some instances people could come off in a year, but in most cases they stay on the medication.” I felt good before I got sick, so I thought I was going to be one of those rare people. When I did get off the medication, I lost the weight that I gained and I had another nervous breakdown. They never told me it was for life.

AMBER: I feel that I don’t want to take medication for the rest of my life. I hope that after a few years of not having symptoms I will talk with my doctor, and if I don’t have any symptoms she will tell me I don’t have to worry about taking medication. Right now it’s like a habit, like popping a vitamin in the morning. Right now there is no hassle. I take it after dinner.

I don’t think anybody wants to be on medication forever. I think I would like to have children one day. It might damage my chances of having a healthy baby. I don’t know if that is true. Also, it would be great if I didn’t have to remember to take medication all the time. It would be one less thing to think about.

VAN: It’s not easy to remember to take the medication. It can make you feel like a patient. Ashamed. But the effects can be positive and can keep you out of the hospital.

I experienced drooling, sedation, and constipation. Besides getting the blood taken every week, I informed my doctor of my side effects and tried to do the best I could and realized that the medicine was doing its job. Mostly I was thankful that it was working, and I kind of accepted the side effects. I used to get so sedated I actually fell in the hospital a few times. I would not walk down stairs or drive.

MARK: Complaining about medication is good. I think the stupid thing is not taking it. You should ask your doctor. I don’t like to be punished. I’m a very stubborn person. What the doctor did, he just gave me the percentages of relapse. If you look at that, your decisions are more emotion free, based on logic and common sense. You don’t want to admit that you have a mental illness. Listen to your doctor’s statistics—not his advice that your life is no different than it was before.

BEN: Taking medication becomes just part of your daily routine. I don’t think about it. The way I figure it is that if the side effects hurt me in a really negative way, then I’ll deal with it. I’m taking medicine now that totally doesn’t affect me. I’m lucky now. All I have is a little tremor.

BETH: While I was upstate I stopped taking my medicine. Then I went to Texas and I was taking my medicine maybe one to three times a week. The last day I got full-blown paranoia, the full bit, and I wound up having to come home. Now I realize that I have to take it for the rest of my life. I would rather do that than deal with the consequences.

AUDREY: Someday I wish to be off the medication, but in a safe way. Sometimes I wonder how it is affecting me physically and what my life would be like without it. Sometimes I feel that it’s somewhat unnatural to be changing the chemical makeup of my brain.

LAURIE: I like taking my pills. They make me better. I don’t get upset about the weight. I just don’t want to increase my medication or change it. I don’t want to be sick. I don’t want to have problems.

SAMANTHA: Unfortunately, the sad truth is that I’m going to have to be on medication for the rest of my life because I really do have the symptoms that I am taking the medication for.

BEAUX: Don’t like it. Just sometimes I worry about side effects even though I’ve been lucky. You wonder if you are going to be on pills for the rest of your life. I guess if it doesn’t do any physical harm to me it’s okay. My goal is to try to be off in a couple of years. It’s like a strategy. You want to move on; at the same time you don’t get cocky that it won’t happen again. You just hope it won’t happen again. If I can’t get off, I want to get down to the base minimum. I can accept that.

ALEXANDRA: Medication is awful because you have to take it all the time. It tastes awful. It’s a hassle to remember when to take it and not take it. I’m gaining weight from it.

It’s frightening because someday I would like to get married and I don’t know if I can have children. If I don’t have children in my life I will get very upset. I think the medications are bad for the baby.

THOMAS: Taking medication reminds me I am ill. Sometimes it bothers me because I don’t feel like I am really sick. It just bothers me to take medicine.

VANESSA: I love pills. I don’t think I would do without the medication. I take them every day. I don’t miss a day. I was wondering if I will have to take medication for the rest of my life. If I have to I’ll just do it, because I don’t want to get sick again. I have two children, and I don’t want them to see me in the hospital again.

SMOKEY: It sucks to have to take pills for the rest of my life. It makes you drowsy; you want to sleep.

MIKE: I didn’t want to hear about taking medicine for the rest of my life—the fact that this illness is long term, that you don’t know what to expect. It’s kind of scary because you don’t want it to come back. The fact that you have to take this medication for a long time means that it can come back.

It doesn’t really bother me now. As long as I just keep taking the medicine and I don’t get sick again. That’s the main thing.

JACKIE: For the first couple of years taking medication,I hated the idea that I needed this pill to keep me stable. I hated that, so there were a few times that I stopped the medication on my own and got sick again. I hated the weight gain from the medication—that was another reason for stopping without the doctor’s consent. I finally learned a little bit about medications, and my doctor allowed me to go on one that’s weight neutral. I haven’t lost any weight. But I really have just come to terms with it and accepted that I need it for the rest of my life. Now if I miss it I get nervous. I’ll go out of my way to go home to take it because the last thing I want is to get sick again.

PATRICK: When I first started taking the medication I was a little discouraged because I thought I could get by with the least amount. But I watched some other people’s side effects and thought, “I’m not so bad off ”—drooling and drowsiness. Twenty minutes after I take it I fall right to sleep. It’s good to take it right before bedtime. My appetite increased and I gained sixty or seventy pounds.

I wish someday I would be able to get off it. Be able to go back to my old self, trim. I wish I could get off it.

SHARON: Even in my younger years I didn’t like taking pills, but thinking about having to take pills for the rest of my life—just the taste of them, the nasty aftereffect in your mouth. It tastes disgusting. Sometimes they are too big to swallow.

JAMES: I know I have to take it, so I take it. I get sick of swallowing those pills every day, but it’s something you have to do. Just knowing that it’s going to keep me healthy is the reason I like taking those pills. I’ve had weight gain, drooling on my pillow, constipation. At the beginning I couldn’t wake up or it was hard to wake up, and I had to go to work. My reflexes at the beginning weren’t like they were. And I used to get a lot of headaches, but taking the medicine took that away too.

It makes me feel better knowing the reason I take the medicine is that I won’t be right otherwise. I don’t really think about it. It’s helping me out. It’s like a habit, just taking it once a day. The blood work, though, is a pain in the neck.

LUCINDA: I stopped the medication because I was fired from my job. I was very tired and I wasn’t getting up early in the morning to get to work. Work is very important to me. So I felt work came before medication, that it was better for me than medication. I believed I would be able to work without it. Not being able to hold a job was as much a fright as having a mental illness. I felt I wouldn’t have been able to go on if I wasn’t able to work. It was like a double blow. I decided to stop my medication. A lot changed in my life. My best friend went back to Scotland just then. I just started feeling very depressed, and I ended up back in the hospital. When I went home, I stopped it again. I was suicidal. I took overdoses.

ALEXIS: I love pills. I can lead a normal, functioning life. I went to college. I got a teaching job. I have forty children all day and eighty parents. I am getting my master’s degree. I’m getting married. I’m able to maintain relationships with people. Without the medicine, I wasn’t able to go to class. I would skip classes because I wasn’t able to concentrate. I was not able to hold a relationship. I spent a lot of money that I didn’t have. The doctor said I was unpleasant, not myself. I would talk so much I wouldn’t let anybody get a word in, and people don’t like that. Anybody who told me something I didn’t want to hear, I wouldn’t listen.

Complementary and Alternative Treatments

People sometimes look to other remedies for schizophrenia. Talk therapy, vitamins, and special diets are the major approaches people have tried—without much success.

TALK THERAPY Not so long ago people believed that “talk therapy” could cure schizophrenia. That made some sense when we believed schizophrenia was caused by the family environment. Now that we know that what causes schizophrenia is a biological problem, it is clear that we must help the brain recover with medicine. Although talking helps people cope with symptoms of schizophrenia, many well-done research studies tell us that talking does not take the place of medicine.

VITAMIN THERAPY Can vitamins take the place of medications? Some people, and even some doctors, think vitamins may be used to treat schizophrenia. Up until this writing there is no evidence to show that vitamins can replace antipsychotic medications for stopping hallucinations and delusions. But vitamins and minerals may be helpful for your overall health and possibly for mental functioning in general.

OMEGA-3 Fish-oil supplements containing omega-3 fatty acids (DHA and EPA acids) may have some real benefits in increasing focused thinking and in reducing depression. Omega-3 also may assist in reducing memory loss. Although research in these areas is not complete, there is reason to believe that taking fish-oil supplements, especially those with large amounts of EPA acid, can have positive effects on overall mental health. The direct benefit for symptoms of schizophrenia is not clear at this time, but it might help. The important thing to remember is to stay within recommended doses. Check with your doctor. Just because fatty acids and vitamins are sold without prescriptions does not mean they are always safe to take. In fact, fatty acids and vitamins are not regulated, so the best thing to do is to ask your doctor if fish oil is a good idea for you and, of course, how much to take. It is a good idea to show your doctor the bottle of fish oil so that he or she can check on the ingredients and advise you about the safest dose for you.

ANTIOXIDANTS A diet high in antioxidants is also thought to be good for everyone. Most fruits and vegetables contain antioxidants; berries and spinach have especially high amounts. Also, there are supplements that are good sources of antioxidants, such as Vitamin E and Vitamin C.

Remember, vitamins and other supplements sold without a prescription are not a cure for schizophrenia. Taking too much of a vitamin can be dangerous to your health. Get your doctor’s advice before beginning vitamins and other supplements.

SPECIAL DIETS A healthy diet is essential for the optimal functioning of your whole body, including your brain. Diet fads are always around and this is no different for people with schizophrenia.

One new diet people are trying is the diet for people with celiac disease. Celiac disease is a disease of the digestive system. People who have it cannot tolerate the intake of gluten, a protein mostly found in wheat but also in barley and rye. The celiac diet does not cure schizophrenia or eliminate hallucinations and delusions. Still, some people believe there is a connection between celiac disease and schizophrenia and have tried this. The celiac diet is difficult to follow because it means eliminating all wheat products from your diet. Since there is no solid scientific evidence to show a connection between schizophrenia and celiac disease, it is best to speak to your doctor before you begin the celiac diet.

ELECTROCONVULSIVE THERAPY (ECT) Electroconvulsive therapy (ECT) has a long history. Many people think it is absolutely inhuman because of things they heard about it or saw in movies. Actually today it is very different: it is considered a very safe treatment for severe mood symptoms. Sometimes, when medicine is not working effectively for psychotic symptoms, doctors recommend ECT. ECT causes changes to the chemistry of the brain that can help with many symptoms. Some people say it is like pressing a reset button in the brain.

What actually happens when you have ECT?

ECT today is different from the old days. First you are given anesthesia so that you sleep through the treatment. You will be given oxygen during the procedure. Electrodes that conduct electricity are placed on the head. A very small amount of electric current is applied to the brain for about thirty seconds so that you have a small, short seizure. For many people the seizure is so minor that all that happens is the big toe moves. That’s it. The anesthesia is stopped, oxygen is removed and you go back to your room or home. Usually people sleep for a while afterward.

How many ECT treatments will I have?

How many treatments you will need varies. Usually it takes at least six treatments to see any changes. Your doctor will be the best judge of when to stop. If ECT helps you, your doctor may suggest you continue to have “booster” ECT, possibly once a month, to maintain the good effects of the treatment.

What are the side effects of ECT?

People often have some memory loss, especially memories around the time of the treatment. This is not fun but it is usually temporary. Some people do complain of memory loss for events going back several months. While this is not common, it does happen. Some people also complain about problems with their thinking, especially confusion. Again, for most people this disappears over time. Other possible immediate side effects are nausea, headache, and muscle ache—all of which are short-term problems your treatment team can help with.

Discuss ECT with your doctor to get more details.

For additional information about medications:

Medline Plus: www.nlm.nih.gov/medlineplus/

Check pharmaceutical company Web sites for detailed information regarding medications, side effects, and prescription assistance programs.

SafeMedication.com: www.safemedication.com/

NIMH: www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml

Schizophrenia.com: www.schizophrenia.com provides a link to complementary treatments. Go to the main Web site and click on “schizophrenia treatment.” From there click on “complementary therapies.” This link will bring you to information about studies of complementary treatments. BEWARE: No one has yet proven that any of the complementary medications are beneficial. Speak to your treatment team and be very careful when considering complementary medication.

Partnership for Prescription Assistance: www.pparx.org/