TRUST—Treatment Resources for Understanding Schizophrenia Therapy

Switching Antipsychotic Medications

This product information is intended only for residents of the United States.

1. The Basics of Antipsychotic Therapy

• How Do Antipsychotic Medications Help?

• What Kinds of Problems Can Antipsychotics Cause?

2. Is Your Medication Doing a Good Job? Give It a Report Card!

3. Getting the Most From Your Medication

4. Overview of Antipsychotic Medications

• How Are the Atypical Medications Different?

• What Are the Differences in Side Effects Between the Atypical and Conventional Medications?

• What Kinds of Side Effects Do the Atypical Medications Have?

5. Switching Medications

• What Are Reasons to Switch?

• What Medication Should I Switch To? Old or New?

• What Benefits Are Possible When You Switch From an Older Conventional Antipsychotic to an Atypical Antipsychotic?

• Switching From One Atypical Antipsychotic to Another Atypical Antipsychotic

• What Are Some Reasons to Stay on My Current Medication?

• What’s the Downside of Changing Medications?

6. Making the Decisions

• Things to Think About

• Partnering With Your Doctor

7. Getting Ready to Switch

8. Making the Switch

• What Is a Medication Crossover?

• How Long Will It Take for the New Medication to Work?

• After Switching Medication—Now What?

• How Can I Tell If the New Medication Is Working?

• What If the New Medication Doesn’t Work for Me?

• Coping With Getting Better

9. Final Thoughts

More antipsychotic medications are available than ever before. The good news about this is that there are more treatment options to choose from, and more people may find a medication that works better for them. But having more choices also means more decisions to make. This web page presents the pros and cons of changing medications to help you make a well-informed decision together with your doctor about which antipsychotic is best for you.

The Basics of Antipsychotic Therapy

Before talking about changing medications, it is important to be aware of basic information concerning antipsychotic medication. These basics are true for ALL the antipsychotic medications—old and new.

It is well established that antipsychotic medications are necessary for a person who has a diagnosis of schizophrenia or a similar kind of psychotic condition. So, if you have been diagnosed with schizophrenia or a similar psychotic disorder, the question is not whether you need to take an antipsychotic medication. The question is whether you are taking the medication that’s best for you or whether you should consider changing your medication.

How Do Antipsychotic Medications Help?

• Antipsychotic medications treat psychosis—this means they control psychotic symptoms such as hallucinations and delusions.
• Antipsychotic medications are very helpful in keeping psychotic symptoms from coming back.
• Antipsychotic medications help people stick with other kinds of therapy.
• Antipsychotic medications make it easier to handle the stresses of daily living, such as going to school or going to work.

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What Kinds of Problems Can Antipsychotics Cause?

You probably already know that antipsychotic medications are far from perfect. Listed below are some of their drawbacks.

• Antipsychotics do not cure schizophrenia. Rather, they tend to control the symptoms or keep them from coming back (relapse prevention).
• Most of the time, medications are not 100% effective in controlling all the symptoms a person has. Most people still have to put up with some symptoms of their illness.
• All antipsychotic medications have side effects. Some of these side effects can make people uncomfortable. Sometimes antipsychotic medications can make people look “medicated,” which can be embarrassing. Other side effects can even be dangerous. Fortunately, newer medications called atypical antipsychotics have fewer side effects and work to control the symptoms of schizophrenia at least as well as the older conventional medications.

If you’d like to know more about the symptoms of schizophrenia or how antipsychotic medications work, please refer to the TRUST brochures Understanding Schizophrenia and Managing Schizophrenia for more information. The goal is to get the most good (benefit) from your medication with the fewest possible side effects.

Is Your Medication Doing a Good Job? Give It a Report Card!

The first step in deciding about switching medications is to ask yourself how well the medication you are taking now is working for you. It may help to give your medication some grades, just like on the report card shown here.

Use the “report card” below to grade your medication. Give your medication an “F” if it doesn’t help at all or causes terrible side effects. Give it an “A” if it really helps and has very few bothersome side effects. Grades of D, C, and B fall in between. If you don’t know for sure, just put a question mark (“?”) instead of a grade. Feel free to add to the report card any symptoms and side effects that are especially important to you.

If you are not happy with the grades you gave your medication, check with your doctor or treatment team to try to figure out whether the problem is from the medication or from something else. Also check whether there are some easy things the doctor can do to improve your medication report card.

This report card is just a starting point. If you give your current medication bad grades, this doesn’t mean that you should stop or change your medication. It means that you should TALK WITH YOUR DOCTOR about what’s wrong and possible ways that you might be able to do better. For example, if the report card shows that your medication is falling short, it may be that the dose is not right, that you may not be taking it properly, or that something else (like alcohol or illegal street drugs) is keeping your medication from working. The next section gives some reasons why your medication might not be working as well as it could.

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Getting the Most From Your Medication

OK, you’ve done a report card on your medication. If it got straight A’s, congratulations! It means that your medication is working. But, just as most people don’t get straight A’s in school, it’s more likely that your medication didn’t get straight A’s. If it didn’t get good grades in every area, you and your doctor need to figure out why. You can then decide what, if anything, can be done to improve the situation and whether it’s worth trying to make it better.

For antipsychotic medications to do their job properly, they have to be given and taken in the right way. Other things that can affect the way antipsychotic medications work are listed below:

• Diagnosis. It is important to match the medication with the diagnosis. Since you are reading this web page about antipsychotic medications, it is assumed that this kind of medication is appropriate for your illness. If you have any questions about your diagnosis, ask your doctor or treatment team.
• Drinking and Drugs. Avoid drinking alcohol and using illegal street drugs. They can prevent your antipsychotic medication from doing a good job. Even just “once in a while” drinking or drug use can make your symptoms worse. If you are drinking or using drugs, it is very hard for your doctor to know what problems are being caused by the drugs or alcohol and what problems are being caused by your illness or by the medication not working well.
• Medicine (antipsychotic medication) choice. There are many different antipsy-chotic medications, and they are not all the same. You will hear more about the different medications later in this web page.
• Dose (of the antipsychotic medication). How much medication you are taking (the dose) is very important. For many people, higher doses control symptoms better. But higher doses can also cause more side effects.
• Duration. This means how long you’ve been taking the medication. It usually takes some time for antipsychotic medications to work. For example, when you switch from one antipsychotic to another, it can take a couple of months to find out how well the new medication will work.
• Compliance. For your medication to work, you need to take it! The medical word for this is compliance. Even if the medication isn’t perfect, chances are you’ll have more problems if you stop the medication on your own. If you feel like stopping the medication, be sure to talk to your doctor and discuss your feelings. Maybe you and your doctor can work something out!

Overview of Antipsychotic Medications

The following tables list the brand names and generic names of some of the most commonly prescribed antipsychotic medications in the United States today. You’ll notice that the antipsychotics are listed in two groups.

Newer antipsychotic medications: The first group contains the newer antipsychotics. These medications are sometimes called atypical antipsychotics. Atypical means something different or unusual. These medications usually don’t cause the same kinds of side effects, particularly movement problems, that the older antipsychotic medications do. The atypicals also seem to work better on negative symptoms.

Older antipsychotic medications: The other type of antipsychotic is called a conventional (typical) antipsychotic. These medications have been around for a long time. The oldest one (Thorazine®) has been used since the 1950s. All the conventional antipsychotics have similar effects on brain chemistry.

† These antipsychotic medications are also available in long-acting injections (shots), called “depot” therapy, which are given once or twice a month. Injections can be helpful for people who have trouble taking pills every day.

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How Are the Atypical Medications Different?

The older, conventional antipsychotics are more likely to cause a variety of neurologic side effects that often make people feel uncomfortable. Because the atypical medications are less likely to cause the same kinds of side effects, particularly movement problems, many people feel more comfortable when they take the atypical medications. While the newer medications aren’t perfect, their better side effect picture may make them much easier to take for many people.

What Are the Differences in Side Effects Between the Atypical and Conventional Medications?

• Atypical medications are less likely to cause neurologic side effects called extrapyramidal symptoms (EPS). One of the things doctors know for sure is that the atypical antipsychotics cause fewer EPS, which affect normal body movement. EPS include tremor (shakiness), tight muscles, and joint stiffness. Some kinds of EPS can make people have very unpleasant sensations, such as feeling “like a zombie” physically, or they can cause feelings of restlessness known as akathisia. While EPS can still happen on the atypical medications, they are much less common and, when they do happen, they are usually not as bad as with the old medication.
• With atypical medications, patients are less likely to need to take side effect medications to counter these EPS. The medications that are used to treat EPS are called anticholinergics (an example of this kind of medication is benztropine [Cogentin ®]). Although anticholinergics are very good at reducing EPS, they can cause side effects of their own! Anticholinergics can make it harder to remember things, or make it harder to pay attention. Being able to go off of anticholinergic medication may help your memory and concentration. Anticholinergics can also cause other side effects like blurry vision, dry mouth, constipation, and trouble urinating. Be careful—going off of anticholinergic medication too quickly can cause withdrawal problems! Don’t stop taking your anticholinergic without discussing it with your doctor. Most of the time, you should go off of it SLOWLY!
• The atypical medications may be less likely to cause tardive dyskinesia (TD) than the conventional medications. TD is another kind of movement disorder side effect. TD can cause unusual kinds of mouth, tongue, or hand movements. It often looks like a kind of wriggling or writhing. TD usually happens after someone has been on antipsychotic medication for a long time. Sometimes these movement problems are permanent. The atypical antipsychotics appear to be less likely to cause TD.
• Most of the atypical medications do not cause significant prolactin problems. Prolactin is a hormone in the bloodstream that comes from a part of the brain known as the pituitary gland. Some antipsychotic medications can raise the level of prolactin in the bloodstream. In both men and women, high prolactin levels can cause sexual problems. High prolactin levels can stop a woman from having menstrual periods and can even cause milk to leak from her breasts. In men, high levels of prolactin may cause enlarged breasts and a lower sex drive. The good news is that most of the atypical antipsychotic medications do not increase prolactin levels enough to cause side effects.
• The atypical antipsychotics cause less sedation or none at all. The daytime drowsiness caused by the older medications can be very bothersome. For many people this side effect goes away after a while. But for other people, it may not. Some of the newer atypical medications don’t cause any drowsiness.

What Kinds of Side Effects Do the Atypical Medications Have?

By now you may be thinking, “If everything’s so great about the atypical medications, there must be a catch.” Well, you’re right! All antipsychotic medications, including the atypical medications, do have side effects. So it’s not realistic to think that you won’t have any side effects after you change medication. It’s realistic to hope that the new medication may not have as many side effects, or that the side effects may not be as bad. The kinds of side effects that can happen with the atypical medications are discussed below.

• The atypical medications can still cause EPS and TD. While EPS occur less often with the atypical medications, they haven’t completely disappeared. You can still have EPS when you take the atypical medications—and this is more of a problem with some of the atypical medications than with others. But remember that EPS are much less likely to happen on the atypical medications. The same is true for TD. It can still happen, but it is much less likely with the atypical medications than with the older ones.
• Some of the atypical antipsychotics can cause sedation (sleepiness). Both the conventional antipsychotics and the atypical antipsychotics can make people feel tired and sleepy. But some of the atypical medications are much less sedating than other atypical medications or than conventional antipsychotics.
• Most of the atypical antipsychotics can cause weight gain. For some people who are underweight, weight gain can be a good thing. However, most of the time weight gain is a problem. Unfortunately, most of the atypical medications cause more weight gain than many of the older, conventional medications, so some people will gain more weight when they try an atypical medication. This is more of a problem with some of the atypical medications than it is with others. If weight gain is a concern for you, you can ask your doctor about differences in weight gain caused by different medications.

  It has to be remembered that atypical anti-psychotics are not all the same. Each one has different potential side effects. It is also important to remember that different people experience different side effects.

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Switching Medications

What Are Reasons to Switch?

The basic reason to switch medications is that you or your doctor hopes that the new medication will be better for you than the one you are taking now. For example, your doctor might recommend changing antipsychotic medications to try to find a medication that might be more helpful in reducing the symptoms of your illness. Or the doctor may want to try to find a medication that is safer for you or has fewer bothersome side effects. Of course, you may not be used to thinking about your problems as “symptoms” or “side effects,” and that’s OK. Be sure that you and your doctor talk about these problems and have realistic expectations.

There are three ways that a new medication might do a better job for you:

• It might do a better job of keeping you stable and preventing relapses (keeping you from getting sick again).
• It might do a better job of controlling the day-to-day symptoms you may have—those that stay with you even if you are stable and are not relapsing.
• It may have fewer distressing side effects than the medication you’re taking now.

It is a lot easier to predict what may happen to your side effects than what will happen to your symptoms if you change medications. Therefore, on this web page, more time will be spent discussing how changing medication may change your side effects.

What Medication Should I Switch To? Old or New?

Most of the time, the doctor will recommend that you try one of the atypical antipsychotics. There are only a few situations in which an older antipsychotic medication would be recommended first. Your doctor might decide to stay with the older conventional antipsychotics:

• If you need to be on a long-acting depot medication (none of the atypical medications are yet available in long-acting injections).
• If you’ve been on one of the older medications before and did well and want to go back on a medication that you know worked for you.

What Benefits Are Possible When You Switch From an Older Conventional Antipsychotic to an Atypical Antipsychotic?

• Your EPS are likely to get better. As discussed earlier, the atypical medications cause fewer EPS than the older medications and are probably less likely to cause TD. Therefore, many doctors recommend that their patients try one of the atypical medications if they want to change medications. If you have EPS on your older conventional antipsychotic, the chances are good that your EPS will go away or get much better on the atypical medication. If you are changing medications because of EPS, keep in mind that it will take some time for the EPS to get out of your system. In fact, if you stop your side effect medications too soon, EPS can get worse because of withdrawal effects. It’s uncomfortable if EPS suddenly develop, so most doctors recommend continuing side effect medications for a while until the old medication is completely out of your system. Usually, EPS symptoms get better after about a month on the atypical medication alone.
• There is less risk of getting TD. Doctors aren’t 100% sure, but there is some research that shows that the atypical medications are less likely to cause TD.
• Your negative symptoms might get better. Schizophrenia and other psychotic disorders can cause people to have negative symptoms. These symptoms are called “negative” because they refer to a loss of things that should be there, such as normal emotions and energy. If someone has negative symptoms, he or she may not have much energy or motivation and may not be interested in doing things or interacting with other people socially. One of the most important differences between the older conventional antipsychotics and the atypical medications is that the atypical antipsychotics often do a better job of improving negative symptoms. Many people with schizophrenia find that their negative symptoms aren’t quite as bad on the atypical antipsychotics as when they were on an older medication. It is important to remember that even the atypical medications may not totally work for negative symptoms. What might happen is that your negative symptoms might improve from a grade C to a grade B. For example, although you may not feel like running a marathon, you may find that you have more energy.
• Your positive symptoms might get better. Schizophrenia and other psychotic disorders also cause people to have positive symptoms. In this case the term “positive” refers to distortions in perception and thinking that occur in people with schizophrenia that others do not experience. Positive symptoms are often called psychotic symptoms. They include symptoms like hallucinations (seeing, hearing, feeling, smelling, tasting something that doesn’t exist) and delusions (false beliefs not shared by others). Some people may find that the atypical antipsychotic medications do a better job of treating positive (psychotic) symptoms than the older medications. There is no guarantee that this will happen, and sometimes the older medications do a better job with positive symptoms.
• Your cognitive symptoms might improve. When compared with conventional antipsychotics, the atypical medications may improve your ability to speak clearly, to concentrate, and to plan ahead.
• Your mood or outlook might improve. If you are depressed, your mood or outlook might improve. The atypical medications seem to be better at improving depressive symptoms, which are quite common among patients with schizophrenia.

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Switching From One Atypical Antipsychotic to Another Atypical Antipsychotic

The atypical antipsychotics are different not only from the conventional antipsychotics, but also from each other. In addition, the atypical antipsychotics do not work equally well for all people with schizophrenia. They often have different effects in different people. So if you are currently taking one of the newer antipsychotics, use the report card to see how well it is helping you. If it turns out that you still have symptoms that bother you or problems with side effects like weight gain or sedation, you may want to talk to your doctor about switching to another atypical medication.

A cautionary note about switching FROM clozapine TO another antipsychotic
If you are on clozapine, you should know that many doctors believe that it is harder to switch from clozapine to another antipsychotic drug because there are more risks. So if you are taking clozapine and think you would like to switch to another antipsychotic, please talk to your doctor about what kinds of problems may occur.

What Are Some Reasons to Stay on My Current Medication?

There are a number of good reasons for staying on your current medication. You should stay on your current medication:

• If you are satisfied with how well you’re doing now
• If none of the side effects from your current medication really bother you
• If you’ve already changed medications and are doing better
• If you prefer getting your medication in long-acting injections (depot therapy)
• If you aren’t willing to go through the hassle of switching medication (see “The hassle factor” below)
• If you are very worried about the uncertainties of trying a new medication
• If your doctor thinks you’re better off staying on your current medication
• If your partner or family member doesn’t want you to change medication
• If you are about to go through a stressful situation that would make switching difficult at this time, for example, starting school or a new job

What’s the Downside of Changing Medications?

Any major change in your treatment will have its downside. In medical terms, these are known as risks. The risks of changing medication can be thought of as short-term problems and long-term risks. Short-term problems happen in the first few months after switching medication and should stop being a problem after you’ve been on the new medication for a few months. The long-term risks have to do with the fact that no medication is guaranteed to be better. It is always possible that the new medication won’t work well for you or will cause troublesome side effects.

• The hassle factor. Changing medications can be a hassle. If you’ve been on your current medication for a while, you’re used to your medication routine. When you change medications, it usually means extra visits to the clinic, pharmacy, or doctor.

  Switching often means taking doses of the new medication while you’re tapering down on your old medication. You’ll have to be willing to deal with all the hassle for a while and maybe find someone to help you deal with it if it is a problem. Just remember that if you try a new medication and it works for you, pretty soon things should settle down again and you’ll become used to your new routine!

  Another possible hassle is that your doctor might need to get some medical tests. You may need medical tests or you may not need them, depending on the medication and your own medical history. Your doctor will talk to you about these issues and review them with you before you switch.

• The idea of switching can make people nervous. It’s normal to feel anxious when you try something new. When people are used to their medication protecting them from psychotic symptoms, the idea of making a change can make them very nervous—it can feel like giving up your safety net. Some people have terrible memories of their last psychotic episode (relapse or “nervous breakdown”) and have learned that taking their medication regularly keeps their symptoms from coming back. You may feel anxious about the idea of changing medications because you’re worried about symptoms coming back. There are no guarantees that the new drug will work better. However, by switching, you may improve the control of your symptoms or minimize or eliminate troublesome side effects.
• Sometimes symptoms can come back for a while. Many people worry about the possibility that their symptoms may get worse if they change their medication. This is a realistic concern. Probably the biggest risk in switching antipsychotic medications is that your symptoms could get worse. Old symptoms that have been controlled by your current medication could reappear. Sometimes it might feel like the changes in medication are shaking up your whole system. Fortunately, doctors have learned that these kinds of flare-ups are usually temporary, if they occur at all. When they do occur, they usually go away with time and further medication adjustments.
• You may have to deal with new side effects. Sometimes there are new side effects that occur. Some of these side effects may show up soon after you start the new medication, but then go away on their own. The best thing to do about these temporary side effects is to try to stick with the medication and wait for the side effect to go away. For example, a new medication may cause sleep problems at first. You may feel sleepy during the day or have trouble sleeping at night (insomnia) for a little while after you start the new medication. These kinds of effects usually go away in a few weeks.

  Other side effects may not be as likely to go away. Weight gain is an example of one problem that may not go away quickly. It turns out that weight gain is more of a problem with most of the atypical medications than with most of the older ones. If you are already overweight or have a medical condition that can get worse if you gain weight (like diabetes), ask your doctor about how you can prevent gaining any more weight when you switch medications. Just keep in mind that not everyone gains weight when they switch to an atypical medication. Also, some of the newer atypical antipsychotics cause less weight gain than others.

• There is always the chance that you might be disappointed. When you switch medications, you and your doctor hope that you will do better—either by having fewer symptoms or fewer side effects. This is where the long-term risks of switching come in. Unfortunately, there isn’t any guarantee that an atypical medication will work better, or even as well, for your symptoms. There is a chance that you might need to go off your new medication because it isn’t working. Of course, before that happens, your doctor will want to make sure that you have been taking enough of the medication for a long enough time. Remember that it takes some time for any antipsychotic medication to work. The doctor may also need to change the dose to see if this will help. Don’t stop your medication on your own, even if you don’t think it is helping. Talk to your doctor about what is happening and what might help you do better.
  
  Overall, the atypical antipsychotic medications may be safer than the older ones because EPS can cause serious problems. Atypical antipsychotic medications cause fewer EPS.

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Making the Decisions

Things to Think About

Making decisions about things that affect your future is tough. People struggle with these kinds of decisions in all areas of life: Where should I live? Should I go back to school? Should I change jobs? Of course, no one can make the decision for you, but there are things to consider when making a decision about changing medications.

Think about your goals in life. Are there symptoms or side effects that are keeping you from reaching your goals?

Think about your ability to accept some risk and uncertainty. Are you someone who might be willing to take some chances or are you someone who hates uncertainty?

Finally, think about your priorities right now. If you decide to switch medications, you will need to make switching a priority in your life until you’ve gotten used to the new medication.

Partnering With Your Doctor

It is important for you and your doctor to consider all parts of your situation and to reach a decision together.

Be sure to give your doctor all the information you can about what is going on with your illness and your life at the moment. For example, let your doctor know if you are planning any big changes in your life that might make it hard for you to focus on switching, such as going back to school or starting a new job. Listen carefully to what your doctor has to say, too. He or she may have information you have not thought about or concerns you have not considered. If the doctor says that now is not the right time for you to switch medications, be sure you understand why. You and your doctor can then make a plan for the future. For example, if you are in the middle of a big change in your life, such as moving, you and the doctor may decide it would be better to wait for a while before switching. Or if you have just recently recovered from a relapse or have only been on your current medication for a short time, the doctor may suggest waiting a little longer before trying a different medication.

Getting Ready to Switch

Let’s assume that you and your family have already met with your doctor and treatment team and have decided that it’s time to change your medication. You’ve discussed the pros and cons of each medication and picked the one you’re going to switch to.

Now it’s time to make the switch! It’s impossible to know ahead of time exactly how your body and brain will react to going off your old medication and starting the new one. While you’re going through this switch, you need to make it the most important thing in your life—your top priority. Remember that it only has to be a top priority for now. You can usually get back to your other priorities in a few months—you may have to think about postponing other goals, but not canceling them altogether. Avoid letting other things get in the way of making a successful switch. The good news is that most of the short-term problems of switching can be managed.

Before you make the switch, you and your doctor will probably make a switching plan that is sometimes called a “medication crossover.”

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Making the Switch

What Is a Medication Crossover?

Your doctor will probably recommend staying on your old medication for a while rather than going off it “cold turkey.” Most of the time, you’ll start switching by taking the new medication along with your old medication. Your doctor will probably have you slowly raise the dose of the new medication, while slowly lowering the dose of the old medication.

This process of overlapping medications is called a medication crossover. It means that you will be taking two antipsychotic medications at once for a while. This is to give the new medication time to “sink in” while the old one is still working for you. Other reasons for doing a medication crossover are that it makes it less likely you’ll have withdrawal reactions from going off your old medication too quickly and less likely you’ll get bothersome side effects from your new medication. After a while, the doctor can decrease your old medication a little at a time. The hope is that you will be able to stop taking your old medication and just take the new one without having any increase in symptoms.

How Long Will It Take for the New Medication to Work?

There is a delay between the time when you start a new antipsychotic medication and the time when benefits start to happen. Generally, it takes about 4 to 6 weeks after you get to an adequate therapeutic dose for most antipsychotic medications to begin to help. However, it can sometimes take as long as a couple of months for some conditions and some medications. It is as if your brain chemistry doesn’t really “figure out” that it is receiving a new medication until then. Unfortunately, this is less true for side effects— you will often feel the side effects of a medication before its benefits.

After Switching Medication—Now What?

In general, it’s best to be cautiously optimistic when you are trying a new medication—but don’t fall into the trap of being overconfident that the medication will work for you. Unless you’ve been on the medication before, there’s no way to know for sure if a particular medication will work for you. Another trap is expecting too much from a new medication. Sometimes a good result will be a reduction in symptoms rather than having them go away completely. So if you expect 100% symptom control, you’ll be disappointed. On the other hand, if you’re sure nothing is going to work, it’ll be a lot harder to stick with the medication plan. You might give up too early and miss out on benefits you might have gotten later on.

How Can I Tell If the New Medication Is Working?

It is helpful to know ahead of time what you want the new medication to do. You may want the new medication to control your symptoms better or you may want it to have fewer side effects. You can monitor yourself to see if there has been any change in the level of your target symptoms or side effects. Be aware that early signs of improvements are often subtle—they may just appear as a reduction in the intensity of a symptom or side effect.

It is also important to be cautious about jumping to conclusions too soon. Everyone has good days and bad days, and this is true for symptoms as well. It can be easy to misinterpret a few good days to mean the new medication is working, or to misinterpret a few bad days to mean that the new medication is not working. That’s jumping the gun. It’s more accurate to watch for trends in symptoms over longer periods of time. It is like the changing of seasons—you can’t tell from any single day that winter is changing to spring. Rather, it’s the trend in temperature over time that really matters!

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What If the New Medication Doesn’t Work for Me?

If the new medication just isn’t working, there are other things you and your doctor can try. While you are bound to feel disappointed, don’t become discouraged. Remember, there are other options that you haven’t tried! Here are some of the strategies that your doctor might recommend if a new medication has not worked as well as you hoped it would:

• Adjusting the dose
• Adding other medicines
• Going back to the medication you were on before trying this one
• Trying another one of the newer atypical antipsychotics
• Trying one of the older antipsychotics
• Trying a long-acting depot injection if taking oral medication has been a problem
• Trying clozapine (Clozaril®)

The pros and cons of these options will not be dealt with here, but you and your partner or family should discuss them with your doctor or treatment team.

If the new medication has helped your symptoms but has caused some new side effects, you will need to consider the pros and cons of staying on the new medication or trying another new medication.

Be sure to give yourself credit for trying a new treatment. It takes courage! Even though you didn’t get what you hoped for, you’ve shown your commitment to trying to get better. Don’t become discouraged. The next medication you try may work much better for you.

Coping With Getting Better

You may find that the switch has worked well for you. You may find that you are doing better in a number of different ways. You may have more energy, your thinking and concentration may be better, or you may feel less scared because of frightening or strange thoughts. Congratulations! These improvements can help you get more out of your life.

Remember, though, that change can bring new challenges and stresses. And getting better can be stressful.

Be aware that you may have some setbacks from doing better. For example, if you have more energy and start to get busier, you’ll experience more stress. You may have no trouble handling this and it will be smooth sailing. But sometimes stress can bring out the symptoms of schizophrenia.

The best advice to people who get a lot better very quickly is to take your time and not rush! Adapting to an improvement in symptoms is a big challenge in itself. Give yourself time to adjust and don’t try to take on too many new things all at once. It is better to move gradually. Also, try not to be too disappointed if setbacks happen, and be ready to accept help from others if you need it.

Final Thoughts

The atypical antipsychotic medications that are now available are helping many people do better in ways that were simply not possible with older antipsychotic medications. But the only way to see whether an atypical medication will be better for you is to try it. To make sure that you get the most out of a new medication, you need to give it a chance to work. This means taking enough of the medication for a long enough period of time.

Going over the pros and cons of switching medication can be a very important experience, no matter what you decide. You’ll learn more about yourself, your goals in life, and what’s good and bad about the antipsychotic medication you’re taking now. You’ll also learn about other options and what’s good and bad about them. May you have very good luck in finding the very best treatment for you!

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Source: The Pfizer Health Library, Switching Antipsychotic Medications

Knowledge is power. The more you know about your health, the more power you have to take control of it and to improve your quality of life. The Pfizer Health Library offers information on many health-related issues and conditions.

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