medications
 
 
Common Side Effects of Antipsychotic Medication Introduction The risks associated with the medications used to treat schizophrenia are best understood if we think of them as side effects; the effects of the drug that are not a part of the desired (or therapeutic) effects. The information provided in this article is best considered along with the entries that define these terms in the glossary. Severity of Side Effects Most of these side effects are merely annoying and not typically dangerous. When they are sufficiently bothersome, other medications may be added to reduce or eliminate these side effects, the dose of the offending medication may be reduced, or an alternative agent may be explored. A discussion of some potential side effects that are more dangerous is offered in a companion article: More Serious Side Effects. Side Effect Medications Another category of medications that patients with schizophrenia may be taking are those used to treat the side effects of antipsychotic medications. They have their own side effect profiles. They are reviewed in: Side Effect Medications. Classes of Antipsychotic Medications Schizophrenia medications can be divided into two classes, the typical, or first generation, drugs and the atypical, or second generation, drugs. Both classes are capable of producing most of the common potential side effects of antipsychotics; but as a class, atypical drugs are less likely to produce some of them. There is also a considerable difference between how likely individual drugs in either class are to produce a specific side effect. Medication Selection Drugs are often selected based upon the fact that they are less likely to produce a specific side effect. This may be a side effect that is particularly dangerous for a given patient or one that the patient is known to be very sensitive to. Side Effects The side effects that drugs used to treat schizophrenia are not as complicated as they might seem to be, if we can just get beyond the terms. Those side effects include EPSE (extrapyramidal side effects), sedation (drowsiness), anticholinergic side effects (dry mouth, blurred vision, constipation, problems emptying the bladder, and confusion), sensitivity to sunlight, weight gain, and hormonal side effects (effects from changes in hormones, most notably testosterone and prolactin). Hormonal side effects may produce absent or missed periods, the production of breast milk, a reduction in libido (sex drive), and problems ejaculating. EPSE Simply think of extrpyramidal side effects as involving movement. They include dystonias, dyskinesias and Parkinsonism. Dystonias are spasms of muscles. Dyskinesias are purposeless movements that often appear bizarre. These movements may involve any muscles of the body, but often are limited to the muscles of the face. Examples include lip smacking, protruding the lips or tongue, or grimacing. Parkinsonism is a condition where the patient has the same symptoms as someone who suffers from Parkinson’s Disease. They have trouble starting and continuing movements or have movements that are erratic (tremors). Anticholinergic Side Effects Usually, these side effects are only annoying, but in some patients they can be more of a problem. Dry mouth may increase cavities or lead to ulcers of the gums or the inside of the cheeks. The effects on the eye may produce serious problems in people with a certain eye condition, called “narrow-angle glaucoma”. While very rare, severe effects of this kind can lead to seizures, coma and death. A companion article, Anticholinergic Side Effects, offers a more in depth review of these side effects. Sedation Sedation (drowsiness or sleepiness) is probably the easiest side effect to recognize and content with. Sedation is generally instantly evident to both the patient and the doctor, but it may not represent cause for alarm or prompt an immediate change in medications. If the medication is otherwise tolerated and seems to be effective, doctors may encourage the patient to continue the offensive medication for a short time to see if the sedation improves. It often will with time. There is also the possibility that the patient may continue to improve and subsequently require lower doses of this medication, doses that may not cause significant sedation. Doctors may also be able to combine another less sedating drug with the first one and reduce this side effect (see combined therapy). Light Sensitivity Sensitivity to sunlight can usually be easily resolved with the use of sunscreen. Weight Gain Weight gain may be pose a more serious concern (see More Serious Side Effects). It is well established that all schizophrenia medication have the capacity to contribute to weight gain. It is not always easy to determine whether or not a given drug is contributing to weight gain, but we as physicians are obligated to try. Obesity adds significant risks for other illnesses in this population of patients who typically do not receive thorough or continuous medical care. People with schizophrenia may also make life style choices that further increase these risks, such as smoking and avoiding regular exercise. The addition of excessive weight to their list of risk factors is unacceptable if it can be avoided. Hormonal Changes Antipsychotic medications my alter the levels of some hormones. Increases in prolactin and the resulting changes in testosterone levels are related to the production of breast milk and breast enlargement in men and women, osteoporosis, reduced sex drive and problems with ejaculation. Changes in prolactin levels may increase the risk for breast cancer. Hyperthermia Antipsychotic medications can impair temperature regulation and result in hyperthermia. Statistics There are vast differences in terms of which drugs are most likely to produce each side effect, but it is generally not very helpful to know what these statistics are. For a complete discussion of the issue of statistics as they pertain to medication side effects please review Statistics: Medications and Side Effects. Conclusion The bottom line is that the drugs used to treat schizophrenia are not without some risks. They have numerous potential side effects. Some of them are relatively minor and easily managed. Some are much more serious. This should lead us to use these medications cautiously and to apply a level of vigilance that causes us to scrutinize every patient for the development of any side effects, however trivial they may seem. On the other hand, these drugs have revolutionized the treatment of schizophrenia. We simply could not do without them. Countless sufferers of this disease would live their lives in institutions if they were denied access to them. Many others would be forced to live lives of lessor quality. (Sources: The author’s knowledge base, unless otherwise noted.) _________________________________________________________________________________ Related Articles: Associated Risks More Serious Side Effects Anticholinergic Side Effects Medications to Control Side Effects Motivation Cognitive Impairment _________________________________________________________________________________ Glossary_of_Terms_AM.htmlAssociated_Risks.htmlmoreserioussideeffects.htmlanticholinergicsideeffects.htmlmedicationsthatcontrolsideeffects.htmlmotivation.htmlcognitiveimpairment.htmlshapeimage_2_link_0shapeimage_2_link_1shapeimage_2_link_2shapeimage_2_link_3shapeimage_2_link_4shapeimage_2_link_5shapeimage_2_link_6