Medication

• Medication
• Rapid tranquilisation
• Searching for new drugs

Medication

The symptoms of psychosis are treated with antipsychotic drugs.

Antipsychotics may be prescribed to someone who has a diagnosis of schizophrenia for a number of years, to prevent relapse. Antidepressants (and/or drugs that tackle anxiety) may also be prescribed to help with the depression and other 'negative' symptoms (like apathy, difficulty concentrating and lack of motivation) that people with schizophrenia may experience.

People with bipolar disorder will often be prescribed a cocktail of medication, which may include an antipsychotic drug, anti-manic drugs and antidepressants at different times, depending on symptoms. They may be prescribed antipsychotics and/or mood stabilisers in the longer term to prevent another episode.

Your relative should be given information about all the drugs they are prescribed, and they should be involved in discussions and decisions about medication. Family members and other carers should also be included in these discussions, unless the person who is unwell does not want them to be.

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Rapid tranquilisation

When people are in hospital and very unwell, they may be sedated with drugs if they behaved in a violent or disturbed way. Guidance from the National Institute for Health and Clinical Excellence (NICE) details when and how this should happen.

‘Rapid tranquilisation’ can be achieved using different medications, including benzodiazepines, antipsychotic medication or antihistamines. If people have psychosis, doctors will normally use antipsychotic medication and a benzodiazepine. The medication will by given orally or injected.

If rapid tranquilisation is used, there should be a review of what happened leading up to the sedation, and of the tranquilisation itself. Family members and other carers should be involved in this review, unless the individual does not want that to happen.

For more information, read the NICE guideline, Violence: Information for the public.

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Searching for new drugs

Researchers around the world continue to test different sorts of drugs to treat psychosis. Not everyone responds to existing antipsychotic medication and researchers are particularly keen to find effective drugs that treat the 'negative' symptoms of schizophrenia (like apathy, difficulty concentrating and lack of motivation) that may continue between episodes of psychosis.

Antipsychotics work by changing the effect of chemicals (called neurotransmitters) in the brain. Most of the existing antipsychotics target the neurotransmitter dopamine and the system that it uses to travel around the brain to dampen down its effect.

Research has shown that the abnormal production of too much dopamine can lead to hallucinatory experiences, delusions and disordered thoughts. People who may be at risk of developing schizophrenia also have increased levels of dopamine in their brain.

Some researchers are interested in testing drugs that affect other neurotransmitters that they think may somehow be involved in the development of the symptoms of psychosis and/or schizophrenia. These include glutamate (that stimulates the brain) and GABA (that slows down brain activity).

Other research teams are looking at other sorts of medication.

For example, in England, the National Institute for Health Research is funding a trial of the antibiotic minocycline as a treatment for the negative symptoms experienced by people with schizophrenia.

A study led by researchers at Imperial College London aims to find out whether the antidepressant citalopram can help people manage the negative symptoms of schizophrenia more effectively when it is prescribed at the same time as an antipsychotic.

Another trial led by researchers at the University of Oxford is investigating what difference the antidepressant mirtazapine makes, and whether adding folic acid to the prescription might be worthwhile.

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, though there hasn't been enough research to prove whether that is the case. One study is investigating the use of modafinil together with brain training exercises.

Other researchers are testing drugs used to treat Alzheimer's disease (acetylcholinesterase inhibitors) to see if they can improve memory in people with schizophrenia.

Visit the NHS Choices website to find out more about different clinical trials testing medication for schizophrenia and bipolar disorder.

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.