But what happens when those symptoms are successfully treated and go away? Is it better to stay on your medication or try to discontinue it? What happens if your symptoms come back? Does this mean medication for life? As a psychiatrist, I have long discussions with my clients to weigh the risks and benefits of long-term mental health treatment with medication. The unfortunate truth is that most of the research on the effectiveness of psychiatric medication is related to short-term treatment. In many studies, experts have looked at the use of medication to treat present, active, and significant symptoms of psychiatric disease but not at how well these medications prevent future symptoms over time. And, when there is evidence that these medications help prevent future mental health episodes, the evidence hasn’t yet shown what doses are best for prevention, how long these treatments are effective, or what the long-term, health-related trade-offs may be.
Schizophrenia Treatment: Short-Term Versus Long-Term Effects
When it comes to treating schizophrenia with antipsychotic medication, many people are initially prescribed antipsychotic medication for their acute symptoms. Once they experience improvement with medication, they are sometimes urged to continue taking that same dose of medication in the long term to prevent future symptoms. However, current evidence doesn’t make clear that this is how the medication should be used. Research on the short-term effects of antipsychotic medication shows significant improvement in schizophrenia symptoms among those who take these medications compared with those who don’t. Some research also suggests that staying on these medications over time helps prevent future symptoms and hospitalizations. But antipsychotic medications can also have significant long-term side effects such as movement disorders. These are often referred to as extrapyramidal symptoms and can include parkinsonism, extreme restlessness, and tardive dyskinesia (a condition of involuntary movements). Other side effects of these medications may include weight gain, metabolic issues like diabetes, and heart problems. RELATED: Newly Approved Antipsychotic for Schizophrenia and Bipolar I Disorder Lessens Weight Gain, Studies Show What does this mean? It may be clear that for many people, the benefits of antipsychotic medication outweigh the risks when treating active symptoms in the short term. But the balance of risks and benefits becomes trickier once those symptoms are successfully treated and the use of medication shifts toward preventing symptoms from returning in the long-term. Now a recent analysis has tried to address this issue.
Antipsychotic Medication for Schizophrenia: What Was Studied?
Researchers who performed the analysis, published in the journal JAMA Psychiatry in August 2021, looked at how effectively different doses of medication prevented symptoms of schizophrenia over time. They also studied how common side effects were among people taking these medications and how frequently people wanted to stop taking the medications due to side effects.
How Was This Studied?
The researchers performed what’s called a meta-analysis. This means they combined and studied the results of many different clinical trials. Twenty-six clinical trials were included in the analysis. All of these trials had compared how effectively different doses of antipsychotic medication prevented future symptoms of schizophrenia among people with stable schizophrenia who did not currently have significant symptoms of their illness. The researchers also kept track of side effects associated with treatment. Since the researchers wanted to look at the long-term effects of these medications, they included only studies that lasted at least three months in their analysis. The average length of these studies was about one year.
What Did the Researchers Find?
The studies showed that the effectiveness of antipsychotic medication in preventing symptoms of schizophrenia levels off at what experts consider relatively low doses of medication. For example, the antipsychotic drug Risperdal (risperidone) is approved by the U.S. Food and Drug Administration (FDA) for use in doses of up to 16 milligrams (mg). When someone comes to a psychiatrist for help with active symptoms of schizophrenia, the dose most psychiatrists aim for to treat ongoing symptoms is 4 to 8 mg, based on currently available research. However, the researchers found that, although doses of up to 8 mg may help in treating active symptoms of schizophrenia, a dose of Risperdal didn’t provide much additional benefit in preventing symptoms after surpassing the equivalent of 5 mg. Additionally, even lower doses — the equivalent of 2.5 mg of Risperdal — were effective in preventing significant symptoms for some people. It’s also important to note that the number and severity of side effects people experienced increased with higher doses of antipsychotic medication. As a result, more people on higher doses stopped taking their medication due to side effects than people on lower doses. The researchers concluded that higher doses of antipsychotic medication may have limited usefulness in preventing symptoms of schizophrenia when compared with lower doses. And lower doses of medication came with lower long-term risks and were better tolerated by the body than higher doses.
Beyond Schizophrenia: What Does This Mean for Other Mental Illnesses?
Although this analysis was limited to people with schizophrenia, it has implications for how we view long-term treatment of other mental illnesses, too. In my own practice, I’ve found that for a range of mental health diagnoses — including schizophrenia, depression, and anxiety — the doses of medication needed to treat the initial symptoms versus long-term maintenance of the illness are different. I’ve also had some clients who prefer to manage a few mild symptoms of their illness on a lower dose of medication rather than deal with long-term side effects of a higher dose. In my experience, some of the most common long-term side effects include feeling groggy or less mentally sharp, sexual problems, weight gain, and feeling anxious or restless. Additionally, most of my clients receive talk therapy along with medication. As a result, they may need less and less medication over time as the benefits of therapy become more apparent. This means that my clients and I are constantly reevaluating the potential benefits of different doses of medication (and their need for medication in general) and comparing the potential benefits to any side effects they’re experiencing. This study highlights just how important this constant reevaluation is and suggests it should be a key part of long-term mental health care. RELATED: Depression Medication: Which One Is Right for You?
What Does This Mean for People on Long-Term Psychiatric Medication?
If you take psychiatric medication, you may be wondering, “I’ve been on the same dose of medication for years. What should I do?” The simple answer is there isn’t just one answer. An important part of this study was how variable the results were. While some people required very little medication to prevent significant symptoms, other people required more. Everyone’s illness differs in severity and how it impacts their lives. And not everyone will experience the same medication side effects. This means that balancing the risks of the medication and the risks of psychiatric symptoms returning will look very different for everyone. It’s essential to have a detailed discussion about your treatment with your doctor.
The Bottom Line
Ultimately, I hope this knowledge empowers you to talk about this with your doctor, if you haven’t done so already. Mental illnesses are dynamic — they change over time due to many factors, including social and psychological ones like financial stress and relationships. Similarly, side effects of medication can shift. You may get used to any side effects that you experience when starting a medication, while others may pop up later. And some side effects may be more impactful during specific life stages like if you are planning a pregnancy. As all of these changes happen, know that you can and should be asking your doctor about the ongoing benefits and risks of your medication. This study shows that medication is not all or nothing, and you can work with your doctor to find your own ideal balance. RELATED: How to Get Help After Attempting Suicide, From Someone Who’s Been There
