Patient information from BMJ

Schizophrenia: what are the treatment options?

Last published:May 02, 2025

Having schizophrenia means you go through periods where you think and feel differently from how you normally would. It sometimes makes it hard to tell what is real.

Living with schizophrenia can be challenging, but the right treatments can help control your symptoms.

This information is about the different treatments for schizophrenia. You can use this information to talk to your doctor and decide which treatments are right for you.

Antipsychotics

The main treatments for schizophrenia symptoms are medicines called antipsychotics. You might also hear these called neuroleptics.

What are antipsychotics?

Antipsychotics are medicines that help calm you down during episodes of psychosis. They can reduce symptoms like distressing thoughts or hearing voices. Once your symptoms are under control, you will likely need to keep taking antipsychotics to prevent these episodes coming back. When episodes come back, it’s called relapse.

Most antipsychotics are taken as tablets. But some come as long-lasting injections. Injections might be helpful if you find it hard to remember to take medicines.

There are two main groups of antipsychotic:

• Typical antipsychotics: You might have heard these called first-generation antipsychotics. These older medicines are good at reducing hallucinations and delusions. But they have a higher risk of movement-related side effects.

• Atypical antipsychotics: You might have heard these called second-generation antipsychotics. They might be better than typical antipsychotics at preventing relapse and can help with a broader range of schizophrenia symptoms. However, they may cause weight gain and other side effects.

Both types of antipsychotics work well. If you have recently been diagnosed with schizophrenia, you will probably be offered an atypical antipsychotic first.

There are many types of atypical and typical antipsychotics. Your doctor will talk to you about the benefits and side effects to help choose the best one for you.

It may take more than 4 weeks before you notice any improvement in your symptoms. Some people’s symptoms fully improve with antipsychotics. If they only partially improve, your doctor might prescribe another antipsychotic to take at the same time. They might also try switching to a different antipsychotic.

What are the side effects of antipsychotics?

The main side effect of typical antipsychotics is that they can affect how your brain controls your muscles. You might find that your muscles feel stiff or shaky, or that you twitch. You might also feel restless, and have trouble keeping still.

Doctors call these problems movement disorders. If antipsychotic medicines affect you in this way, your doctor might be able to prescribe other medicines to help control these side effects. They might also try switching you to a different antipsychotic.

The main side effect of atypical antipsychotics is weight gain, but some are more likely to cause weight gain than others. Other side effects include:

• problems with blood sugar or cholesterol, which can increase the risk of heart disease

• movement problems, like shaking or stiffness, although these are less common than with typical antipsychotics

• feeling sleepy or tired during the day

• restlessness, which makes it hard to sit still

• dizziness when standing up, due to low blood pressure

• serious infections or muscle problems, but this is rare.

General side effects of both typical and atypical antipsychotics also include:

• drowsiness

• restlessness

• constipation

• a dry mouth

• low sex drive.

If you are having trouble with side effects, talk to your doctor. You might be able to switch to a different antipsychotic or try a lower dose.

The side effects of antipsychotics sometimes stop after you have been taking the medicine for a while.

Whatever medicines you take, your doctor should review your treatment regularly to make sure that you are getting the treatment that helps you most, while causing the fewest problems from side effects.

Other medicines

Some people with schizophrenia might have additional symptoms like depression, anxiety, or mood swings. Your doctor might recommend different medicines to treat these symptoms. You’ll take these at the same time as antipsychotics.

Valproate and pregnancy

Valproate is a medicine sometimes used to treat mood swings in people with schizophrenia. If you are a female at an age when you could become pregnant, your doctor should not prescribe valproate unless there is no other suitable treatment. This is because valproate causes severe birth defects.

If you do need to take valproate, your doctor should make sure you follow a pregnancy prevention programme. This means that you should:

• have a pregnancy test before taking valproate

• be given counselling about the dangers of valproate and the need to use effective contraception while taking it

• have regular reviews with your doctor and a specialist.

If you have any questions about valproate, don't hesitate to ask your doctor.

Psychosocial support

Once your symptoms are under control, you will be offered psychosocial support to help you manage your schizophrenia. Psychosocial support includes different types of help to improve your wellbeing and prevent a relapse. It includes talking treatments and practical support with things like housing, work, and relationships.

Talking treatments

Talking treatments involve having regular conversations with a professional specially trained to help people with schizophrenia. They can help you understand your thoughts and feelings, manage stress, and find healthy ways to cope with your symptoms.

There are different types of talking treatments, and the most common ones are explained below.

• Cognitive behavioural therapy helps you recognise and change unhelpful thoughts and behaviours. It teaches you new ways to cope with stress and feel more in control of your emotions.

• Cognitive remediation therapy helps you improve your memory, attention, and problem-solving skills. This can make daily tasks easier, and help with work or social situations.

• Psychoeducation involves learning more about schizophrenia and how to manage it. You will also learn how to spot the signs of a relapse and what to do about it.

• Family therapy involves you and your family meeting with a therapist together. It involves everyone learning more about schizophrenia, improving communication, and finding better ways to solve problems together.

• Social skills training helps you improve how you interact with others. It focuses on learning better communication and social skills to help you feel more confident in social situations. This might help if you have become isolated because of your schizophrenia.

• Supportive psychotherapy offers emotional support and helps you cope with daily challenges. It may be helpful if you’re not interested in other talking treatments, or they aren’t right for you.

The right talking treatment for you will depend on your individual needs and preferences. You can talk with your doctor to decide which option is best for you.

Practical support

You may find that your schizophrenia makes it difficult for you to find or keep a job. You may also find it hard to access the right treatment and social support. This can all make managing your schizophrenia harder. But there is a lot of support available to help you stick to your treatment and improve your quality of life. Your doctor will be able to show you how to access these services.

For instance, there are programmes called supported employment that can help you find and keep a job. Having a job can be an important part of your recovery as it might reduce your chances of hospitalisation, and improve your daily life.

Taking care of your physical health

When you have a mental health condition such as schizophrenia, you are more likely to neglect your physical health. That’s why it’s important for your doctor to check in with you regularly. They can make sure you’re tested for:

• common conditions such as diabetes

• problems that can be caused by your medicines

• infections that tend to be more common in people with mental health problems, such as hepatitis and HIV.

There are also simple things you can do to keep yourself healthy, such as:

• avoiding smoking, drinking alcohol, or taking drugs

• eating regularly and as healthily as possible

• staying active, even if it’s just going for regular walks. Being outdoors and moving around is good for both your physical and mental health.