Ask The Psychiatric Pharmacist #16
Part of my mental illness makes me hear voices. I started to take an antipsychotic to help with my symptoms. The medication helps, but sometimes I still hear the voices. Does this mean the medication is not working anymore?
Antipsychotic medications can help reduce positive and negative symptoms associated with schizophrenia. Hearing voices (having auditory hallucinations) is what is called a positive symptom of schizophrenia. Other positive symptoms that may occur include disorganized thoughts, visual hallucinations (seeing things that aren’t there), delusions (strongly held false beliefs) and acute anxiety (pacing, restlessness, agitation). Negative symptoms of schizophrenia include lack of self-care, decreased thoughts or speech, inability to feel pleasure, social withdrawal and the inability to express emotion.
Antipsychotics reduce auditory hallucinations primarily by blocking the brain chemical dopamine from working in specific parts of your brain. After one to two weeks with the correct medication, voices begin to decrease and may continue to improve throughout the length of treatment. It may take four to six weeks to receive the full benefit of the medication. Many patients describe the voices as having stopped or being “muted” after several weeks; however, it is possible to continue to hear voices after an adequate trial with your medication. If you still hear voices while on the medication, it doesn’t necessarily mean that the medication isn’t working anymore. If you feel you are not getting adequate relief from your symptoms, tell your doctor or pharmacist as there may be a need for a dosage or medication change. It is important to take your medication as prescribed and return to your doctor for regular follow-up appointments. Other strategies, such as cognitive behavioral therapy, can be helpful to manage persistent voices. If you feel like the voices are unbearable or urging you to harm yourself or others, seek medical attention immediately.
When using medicines as part of your treatment, make sure to stay up to date on warnings, alerts and recalls at the U.S. Food and Drug Administration website, www.fda.gov.
Stahl SM, Muntner N. Antipsychotic agents. In: Essential psychopharmacology: Neuroscientific basis and practical applications. Cambridge, UK: Cambridge University Press; 2000:401-458.
Stahl SM, Muntner N. Psychosis and schizophrenia. In: Essential psychopharmacology: Neuroscientific basis and practical applications. Cambridge, UK: Cambridge University Press; 2000:365-400.
Donna Givone, Pharm.D., BCPP
Jennifer Splawski, Pharm.D. candidate
Dr. Ken Duckworth
NAMI Wishes to thank the College of Psychiatric and Neurological Pharmacists for their participation in writing our medication fact sheets and for writing our "Ask the Psychiatric Pharmacist" questions and answers.