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The majority of people who experience the symptoms of psychosis are treated with antipsychotic drugs. Some types of antipsychotic drugs are also used to treat depression and mania. Therefore people who have been given a diagnosis of schizophrenia, schizoaffective disorder or bipolar disorder may all be prescribed an antipsychotic at some time. Some people take antipsychotic medication for a number of years to prevent relapse.
People who have been given a diagnosis of bipolar will often be prescribed a cocktail of medication (see Medication for bipolar disorder). As well as an antipsychotic, they may take mood stabilising drugs, anticonvulsants and an antidepressant. The different types of drugs will be prescribed at different times, depending on the symptoms they are experiencing. People may also be prescribed a mood stabiliser in the longer term to help keep them well.
People who have a serious mental illness may also experience other problems that need treatment by medication. Doctors may also prescribe antidepressants and/or drugs that tackle anxiety to people who have a diagnosis of schizophrenia, for example, or sleeping tablets to people who have a diagnosis of bipolar disorder. Being on antipsychotic medication can cause side effects that demand treatment – heart problems or type 2 diabetes, for example.
Your relative should be given information about all the drugs they are prescribed, including potential side effects and any health risks and possible interactions between the different medications, and with alcohol, tobacco or recreational drugs. The person who is taking the prescribed medication should be involved in discussions and decisions about their drug regime. Family members and other carers should also be included in these discussions, unless the person who is unwell does not want them to be.
Researchers around the world continue to search for different sorts of drugs to treat the symptoms of psychosis and serious mental illness.
A large number of people (up to 40 per cent) do not respond to existing antipsychotic medication and researchers are particularly keen to find effective drugs to treat the 'negative' symptoms of schizophrenia (apathy, difficulty concentrating and lack of motivation, for example) that may continue between episodes of psychosis. A lot of work still needs to be carried out however, before new drugs are routinely available.
Antipsychotics work by changing the effect of chemicals (called neurotransmitters) in the brain. Most existing antipsychotics 'dampen down' the effect of the neurotransmitter dopamine and target the system that dopamine uses to travel around the brain. Research has shown that the abnormal production of too much dopamine can lead to hallucinations, delusions and confused thinking. People who may be at risk of developing the symptoms of psychosis also have increased levels of dopamine in their brain.
Researchers are interested in testing drugs that affect other neurotransmitters that may somehow be involved in the development of the symptoms of psychosis and serious mental illness. These include glutamate (that stimulates the brain) – scientists are investigating the effects of drugs that might target this neurostransmitter.
Trials have shown that the antibiotic minocycline can help improve negative symptoms experienced by people who have a diagnosis of schizophrenia. Researchers continue to test this drug to try to work out why minocycline makes a difference – whether it works within the system that supports glutamate in the brain, or whether the drug's anti-inflammatory properties are important.
There are also trials testing the effectiveness of other anti-inflammatory agents such as aspirin. This is because some scientists think inflammation might play a role in the development of schizophrenia.
There are studies examining many other substances and compounds – whether adding folic acid and other vitamins to someone's prescription might be worthwhile, for example, and what difference the hormone oxytocin might make. Because oxytocin has been shown to boost trust and empathy, some researchers think it might help make social interaction easier for people who are experiencing the negative symptoms of schizophrenia.
Several drugs licensed to treat other illnesses and conditions have been/continue to be tested in trials to see if they can help people with schizophrenia concentrate better and improve their thinking skills and memory.
Modafanil is a stimulant sometimes prescribed off licence to people with schizophrenia who are experiencing fatigue as a result of the antipsychotics they are taking. Some researchers think this drug may improve people's attention and concentration skills.
Other researchers are testing drugs used to treat Alzheimer's disease (acetylcholinesterase inhibitors) to see if they can improve memory in people with schizophrenia.
The 2014 report 'Medicines in development for mental health' from America's biopharmaceutical research companies says there are 36 new medicines for schizophrenia at different stages of development. However, many potential new medicines often get no further than the earliest stages of development, and it takes a very long time for the few successful compounds to become available on the market.
Researchers are also investigating new medications that could be used to treat bipolar disorder, particularly as some people do not respond to lithium, the most effective mood stabilizer. So for example, some researchers have memantine, a drug used to treat Alzheimer's disease, may help with mania and prevent relapse in the longer term.
Or visit the UK Clinical Research Network Portfolio Database where clinical trials being carried out within NHS organisations in England, Wales, Scotland and Northern Ireland are listed.
When people are in hospital and very unwell, they may be sedated with drugs if they behaved in a violent or disturbed way. Rapid tranquillisation is always given by injection and NICE recommends two types of medication are used: the sedative and anti-anxiety drug lorazepam on its own, or the antipsychotic haloperidol combined with the sedative promethazine. The recommendation is included in the NICE guideline 'Violence and aggression: short-term management in mental health, health and community settings' (NG10, published May 2015).
If rapid tranquilisation is used, there should be a discussion afterwards to find out what happened leading up to the sedation, and during the tranquilisation. Family members and other carers should be involved in this discussion, unless the individual who was sedated does not want that to happen.
For more information, read what the NICE guideline says.
This page was last updated 5 October 2015
Links on this page last checked: 5 October 2015
Next links check due: March 2016
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