The Pharmaceutical Journal
Vol 268 No 7184 p183-184
9 February 2002

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Schizophrenia

Pharmacists, who are also patients, describe in their own words what it is like to have to take a medicine for life

Living with schizophrenia: try alternative treatments

Schizophrenia is a highly stigmatised area. I think that it is hard to be a patient with mental health problems and, in addition to the cognitive impairment and mood and consciousness changes that go with the condition of schizophrenia, one has to deal with the drugs.

None of us wants to be on drugs for the rest of our lives, especially when the drugs are of the type that I have had prescribed — phrases like "keep taking the special tablets" or "he's on special medication" don't make one actually want to continue taking them at all.

If I could identify one thing that might help in this area of concordance and engendering willingness to take medication for schizophrenia (or any condition for which antipsychotic medication is prescribed) it is this — tell the patient that if there are side effects of any given tablet then speak to the doctor/prescriber about trying an alternative.

I believe that the patient is just expected to take a medicine regardless of whether it causes long-term side effects or not.

In reality a patient who has intolerable side effects and who thinks that it is a case of that medicine and nothing else, may well stop taking the medication. Let the patient know there may well be an alternative.

Almost inhuman phrase

Also in schizophrenia, too often the almost inhuman phrase, "You're on the tablets for life" is used without an explanation to soften the blow.

If one understands that relapse is statistically more common in people who don't take their medication and that no one can predict who will relapse without medication and who will not, then perhaps one as a patient will be more inclined to take the medicine rather than kick against an authoritarian order which recalls Shakespeare's words "the insolence of office" and might be spoken by a doctor like a judge passing a life-sentence.

As for the medication itself, it is awful to be on some drugs. People vary so much in how they react to the drugs (which is why it is so important to stress that the patient must speak to the doctor to discuss side effects and alternative drugs). I found I reacted badly to fluphenazine (Modecate) and flupentixol (Depixol). I experienced humiliating drowsiness, massive weight gain because of an overwhelming increase in appetite, a sort of restlessness that made a mockery of my sedation (what you might call a "restive" state), hyperventilation and bad breath, difficulty speaking, slurred speech, difficulty going to the toilet, constipation, and last but not least a decreased libido.

I give thanks that I am no longer prescribed these antipsychotics and that I now take sulpiride, which basically suits me. My side effects are currently relatively mild.

One of the issues in psychiatry is the use of the newer atypical antipsychotics which are more expensive than the older ones but have few side effects by and large. One point I believe that is greatly overlooked is the relative lack of the new atypicals in injection/ depot form.

This is not an issue of compliance for some but much suffering might be relieved if the depots were available as drugs with fewer side effects. It is sad to think of people with a history of psychoses suffering from the side effects of currently available depot medication.