Antipsychotic medications are a fundamental part of successful treatment for many people with serious mental illness. For people living with schizophrenia or schizoaffective disorder, full recovery will likely be impossible without the use of antipsychotic medications. In spite of this, a majority of people with serious mental illnesses will stop using their antipsychotic medications at least once during their lives.
People have many different reasons for stopping their medications. Some people might have difficulty remembering to take their medications or problems obtaining—or paying—for them. Other people may not want to take their medications and will stop them out of choice. Still other people may not think that there is any need for them to take medications and will simply stop their antipsychotics because they have limited insight into the nature of their illness. Whatever the reason is for stopping treatment, one of the most common reasons for symptom relapse and rehospitalization for people living with chronic mental illness is medication discontinuation (also called medication non-compliance and medication non-adherence). Stopping one’s medications can be particularly dangerous when it is done rapidly or without the assistance and supervision of the prescribing clinician.
Given these issues, many individuals will elect for treatment with long-acting injectable antipsychotic medications (LAIs). In the U.S., a number of long-acting injectable antipsychotic medications exist and are often referred to as “depot formulations.” These include haloperidol (Haldol), fluphenazine (Prolixin), risperidone (Risperdal Consta), olanzapine (Zyprexa Relprevv), palperidone (Invega Sustenna) and Aripiprazole (Abilify Maintenna). In general, the specifics of each of these medications are beyond the scope of this review; however, it is important to note that whether by injection (e.g., getting a shot in one’s shoulder or thigh muscles) or by mouth, the antipsychotic medication delivered works in the same way and carries the same risk of side effects. “Depot formulations” are administered by a trained healthcare professional (e.g., doctor or nurse) once every one to four weeks depending on a person’s specific illness and medication requirements.
People who elect for treatment with long-acting injectable antipsychotic medications are more likely to continue their medications than people who take their medications on a daily basis by mouth. This may be because some people find it easier to remember to go to an appointment to receive a shot (once or twice each month) than remembering to take a pill (once or twice each day). Multiple large scientific studies have shown that people who elect for treatment with long-acting injectable antipsychotic medications are less likely to be hospitalized for their illness. This is likely because people who are on a stable antipsychotic medication regimen are less likely to experience symptom relapse.
People who take their medication by injection are unable to overdose on their antipsychotic medication, something which can be a significant concern for people living with chronic mental illness and suicide risk.
Long-acting injectable antipsychotics are not only for people with schizophrenia and schizoaffective disorder. People with other serious mental illnesses—such as bipolar disorder and major depression—may also benefit from treatment with long-acting antipsychotic medications.
For many people, the idea of getting any kind shot at the doctor’s office brings up bad feelings. Some people might feel like this takes away their rights, others might find getting the shot is too physically uncomfortable.
For other people, long-acting injectable antipsychotic medications might not be a practical option. Some people might be doing well on a medication that doesn’t have a long-acting injectable formulation (e.g., clozapine [Clozaril] or ziprasidone [Geodon]). Other people will not have any problems taking their medications as prescribed by mouth on a daily basis. Although the implementation of assertive community treatment (ACT) has made this less of a problem, some people might have difficulty getting to regular appointments in order to receive their medications by injection.
The specifics of all of these issues should be discussed with one’s medical treatment team as well as one’s family and other loved ones. This can help people living with severe mental illness to make the best informed decisions possible.
For any individual with chronic mental illness and a history of symptom relapse due to medication discontinuation, treatment with long-acting injectable antipsychotic medications should be discussed. Antipsychotic medications are not the only important part of treating severe mental illness, but they remain a necessary ingredient for many people. For many people, this may be the intervention—along with psychosocial treatments such as psychotherapy, including cognitive behavioral therapy (CBT), and ACT—that leads to full recovery.
Families, friends and others can be most helpful in providing empathic and non-judgmental support of their loved ones. With this support, the proper medications and effective psychosocial treatments, many people with severe mental illness will be able to actively participate in their recovery journey.
Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., May 2013
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