Strategies for better adherence to schizophrenia treatment

Neuroleptic medications, also called antipsychotic medications, are the main treatment for schizophrenia.

Neuroleptic medications work by acting on specific neurotransmitters, chemicals that enable signaling and communication between nerve cells. More specifically, neuroleptic medications act on dopamine and/or serotonin, two neurotransmitters that help regulate how a person thinks, feels, and behaves. The exact mechanism varies between different drugs.

Schizophrenia can cause a variety of signs and symptoms that include hallucinations, delusions, disorganized behavior, and difficulties with thinking, communication, and motivation. While the exact causes of schizophrenia are not fully understood, abnormal neurotransmitter activity is a central feature of the disorder. By inhibiting specific neurotransmitters, neuroleptic medications can help control these symptoms.

In order for treatment to work, a person must take these medications as prescribed. This means taking every dose and taking every dose on schedule. This is known as adherence.

Nonadherence is when a person does not follow a treatment plan. This is a common challenge among people with schizophrenia, for several potential reasons.

A person may not feel that a medication is working or may not like the way they feel when taking a medication. Many people are prescribed more than one medication, which can make dosing schedules complex and more challenging to follow. Schizophrenia affects the way a person thinks, feels, and behaves, which can all make adherence challenging.

If you have schizophrenia and have struggled with medication adherence, know that you are not alone.

What to do if adherence is a challenge?

If you are having difficulty taking a neuroleptic medication for any reason, talk to your healthcare provider as soon as possible.

Nonadherence to treatment can have serious consequences and complications, including worsening symptoms, psychosis relapse, hospitalization, and risk of harm to oneself or others.

Your healthcare provider is there to help you find solutions.

Long-acting injectable (LAI) medications

You may want to talk to a healthcare provider about different treatment options, including the possibility of treating with a long-acting injectable (LAI) neuroleptic medication.

LAI neuroleptic medications contain the same drugs as their oral medication counterparts but are administered with an intramuscular injection. The dose is slowly released into the bloodstream over weeks or months (depending on the specific drug being used). A person will still need to attend every appointment to receive an injection from a healthcare provider, but adherence can improve when treating with a long-acting injectable neuroleptic.

However, LAIs have their limitations. LAIs are typically more expensive and dosing adjustments are less flexible compared to oral medications.

Strategies for adhering to an oral medication

Oral neuroleptic medications must be taken on schedule in order to work as intended. These medications are effective, but they can also require a high degree of organization and consistency.

If you are managing schizophrenia with an oral medication, these strategies may help you follow your dosing schedule:

• Have clear instructions from your healthcare provider about how and when to take the medication.
• Set an alarm or reminder on your phone to take the medication. There are also apps that have medication reminders, including apps for some pharmacies.
• Have a backup reminder, such as a note left in a visible place.
• Keep your medication in a designated spot. If possible, it can be helpful to link taking a medication with another routine, such as brushing your teeth.
• Use a pill box that organizes medications into individual doses labeled with the days of the week. If you use a pill box, set a reminder to refill the pill box each week.
• If you have an irregular work schedule or will be away from home when you normally take your medication, have an extra dose or two with you in case you are delayed.
• If you are going to travel, plan ahead for how you will take your medication while away from home.

It’s important to remember that treating and managing schizophrenia are different experiences for every individual.

There are many reasons why a person and their healthcare providers might choose one medication over another. If you have questions, your healthcare provider will be your best source of information.