The Dilemma:
Have you ever listened to the side-effects that medication advertisements list at the end of commercials? It seems like the narrator is turbo-talking for two minutes, listing off hundreds of side effects that make you wonder: is taking the medication even worth it?
This is a reality that many people with mental illness, especially schizophrenia, face. It’s a decision between living life with the symptoms and stigma of schizophrenia, or reducing their symptoms but gaining a long list of other health risks. To someone with limited experience with schizophrenia, it seems like a simple decision between sanity or insanity, with the obvious choice being sanity.
However, according to the American Academy of Family Physicians, some of the many side effects of common antipsychotics are:
- sedation
- low-blood pressure
- constipation
- dry mouth
- blurred vision
- cognitive impairment
- pseudo-parkinsonism
- spastic contractions of the muscles
- facial ticks
- sexual dysfunction
- acne
- osteoporosis
- immune problems
- cardiac arrhythmias
- seizures
- metabolic issues such as rapid weight gain
On top of this, many medications treat the positive symptoms of schizophrenia (audio/visual hallucinations, delusions, racing thoughts), but do not treat – or even worsen – negative symptoms (difficulty concentrating, lack of emotion, lack of interest in previously enjoyable activities) Makes the decision a little more complicated, huh?
The Science: 
So why do antipsychotics do this? It is because the chemical way in which they work is difficult to control.
For example, on a very basic level, schizophrenia was believed to be caused by an excess of a neurotransmitter called dopamine. So, medications were developed that prevented dopamine from working.
However, more recent research tells us that too much dopamine only occurs in certain parts of the brain; in other parts of the brain, there is not enough dopamine. So, when we get rid of all dopamine, it helps some symptoms but makes others worse.
On top of this, dopamine doesn’t only work in the brain, so getting rid of it can lead to some of the other bodily symptoms listed above.
As if things weren’t bad enough already, studies have found that there are many other brain chemicals involved in schizophrenia that present the same dilemma as dopamine, so trying to treat them all without producing a ton of side effects is really tough.
Why it Matters: 
The nasty side effects of antipsychotics are a primary reason that people avoid treatment or taking their medication. I have had the really great opportunity to work in the mental health field, and when I heard the reasons people had for not taking their medication, it all made a lot of sense.
For many of them, they just wanted one day where they weren’t sleep-walking through life, and then it took a bad turn and their psychotic symptoms returned. For others, they developed heart problems that forced them to stop taking a particular medication, and they were in the process of finding a new regimen that works for them.
The scientific mechanisms of antipsychotics shed light on all the factors that people with schizophrenia have to think about every time they take their medication. So next time you meet or hear about someone with schizophrenia, or any other mental illness, please be empathetic. Remember that they are a person, and that treatment is a complicated decision that profoundly affects their health and quality of life, not a simple choice between sanity or insanity.
