Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Treating schizophrenia with long-acting injectables

Greg Smith, MD
Meds
July 12, 2019
Share
Tweet
Share

It happens all too often.

You have not been taking good care of yourself. You don’t eat, you sleep poorly, and you neglect your medical health. Over months or sometimes years, you begin to isolate yourself from your friends and family. You can’t seem to hold a job. You lose interest in once pleasurable activities. Your thinking becomes odd, your thoughts distorted and fragmented and strange. No one knows about that just yet, because the voices you begin to hear tell you not to mention it, to keep it to yourself. The voices become threatening over time. Sometimes, they tell you to hurt others, or to kill yourself. It becomes harder and harder to tell reality from fantasy. You get depressed, agitated, and finally can’t stand it anymore. Someone gets you to a doctor.

You or someone you know are diagnosed with a major psychiatric illness such as schizophrenia.

The trauma of hearing that kind of diagnosis is bad enough, but then comes the part that most of my patients do not like at all — the part when I talk to them about medications. Now, right off the bat, let me tell you that good treatment of mental illness is not simply taking meds. It might involve counseling, education, learning new job skills, going to group therapy, talking to your counselor with your family, couples counseling, or getting peer support. That being said, this column will deal with medications, and a specific form of medication, which we will get to shortly. I’m quite sure we will come back to other treatments in this column in the future.

So, you have been told you have schizophrenia. Among those many treatment options, your doctor might suggest that you take a medication to treat your psychotic symptoms, one that usually comes in pill form, pills that you must take at least one time per day or maybe more. You discuss how to take them, the possible side effects, how long you might have to take them, and how they should help you recover. You get the prescription filled, begin the course of treatment, and get better! So much better that you decide you don’t need these medications any longer, and you stop them. Can you guess what happens then, within a few weeks to a few months? Many patients will relapse, meaning that the same symptoms that got them to come to the doctor in the first place come back, sometimes worse than before.

You get so sick during this relapse that you end up in the emergency department, and you’re admitted to a psychiatric hospital. You are put back on the same medications you tell the staff you were taking before, since they did work once, and in fairly short order you are discharged home. You see your doctor, you are feeling so much better, things are great, and you are sent home with a new prescription. You may decide, just within the first month home, that you feel so much better, again, that you won’t even get the prescription refilled. Then, those gnawing depressive feelings come back, you can’t sleep at night, and you begin to hear voices that tell you that it’s not worth living anymore. Your family starts discussing taking you back to the emergency department, and you know that they are trying to harm you by doing so. You can feel them scheming and plotting against you. The voices agree with you and tell you to “hurt them before they hurt you.”

Do you see the pattern here?

There is one treatment modality we have which may help you to avoid some of this heartache and misery. If you have a diagnosis such as schizophrenia, and you have trouble taking oral medications or keeping up with your plan of care, including taking medications, then long-acting injectables or LAIs, may be right for you.

What are LAIs? They are medications that are formulated to be given by injection with a needle into the muscle, from which they are slowly absorbed over weeks or months to treat your psychotic symptoms. They include such medications as Haldol decanoate, Prolixin decanoate, Invega Sustenna, Risperdal Consta, aripiprazole monohydrate, Aristada, and Invega Trinza.

Why use them? If you have trouble taking oral medications every day, if you have a substance abuse problem, if you tend to take too many pills at one time, or if you are very sensitive to drug side effects with frequent dosing of pills, then LAIs may be for you. Obvious advantages include not having to remember to take pills every day, not having to come to the drugstore to pick up refills as often, more smooth levels of the medication in your bloodstream leading to fewer side effects, and reduced risk of under or overdosing with your medications.

Are there downsides to these medications? Of course. It might take a while to get to the very best dose for you, as you are like no other patient. Dosing guidelines help, but every patient is different. It is not as easy to adjust the ongoing dose of your medication as it might be with pills. You might have some transient pain in the injection site (though a very skillful nurse can inject these medications with little trauma to you!) And of course, there is the always present stigma of having to “go get my shot” every month.

Do I think that the advantages outweigh the problems with these medications? If you meet the criteria for receiving this kind of medication therapy, absolutely. If you have the opportunity, speak with your doctor, or make sure your loved one does, to discuss this recovery enhancing opportunity.

Greg Smith is a psychiatrist who blogs at gregsmithmd.

Image credit: Shutterstock.com

Prev

The line between family member and personal doctor

July 12, 2019 Kevin 0
…
Next

These are the best investments physicians can make

July 12, 2019 Kevin 0
…

ADVERTISEMENT

Tagged as: Psychiatry

Post navigation

< Previous Post
The line between family member and personal doctor
Next Post >
These are the best investments physicians can make

ADVERTISEMENT

More by Greg Smith, MD

  • Finding peace after years of abuse: a journey through grief

    Greg Smith, MD
  • What would you save if your house was on fire?

    Greg Smith, MD
  • Lessons learned in psychiatry: How experience shapes your career

    Greg Smith, MD

Related Posts

  • Treating the patient’s body is not synonymous with treating the patient

    Steven Zhang, MD
  • Why aren’t you treating opioid addiction?

    Kathleen A. Hallinan, MD
  • Treating depression with ketamine: We need incremental treatment for depression

    Shaili Jain, MD
  • Bias when treating supporters of President Trump

    Anonymous
  • Stop treating doctors like school children

    Rebekah Bernard, MD
  • Treating mental illness will not stop mass shootings

    M. Bennet Broner, PhD

More in Meds

  • FDA delays could end vital treatment for rare disease patients

    GJ van Londen, MD
  • Pharmacists are key to expanding Medicaid access to digital therapeutics

    Amanda Matter
  • How medicine repurposing enables value-based pain management and insomnia therapy

    Olumuyiwa Bamgbade, MD
  • Forced voicemail and diagnosis codes are endangering patient access to medications

    Arthur Lazarus, MD, MBA
  • From stigma to science: Rethinking the U.S. drug scheduling system

    Artin Asadipooya
  • How drugmakers manipulate your health from diagnosis to prescription

    Martha Rosenberg
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why clinical research is a powerful path for unmatched IMGs

      Dr. Khutaija Noor | Education

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • Why specialist pain clinics and addiction treatment services require strong primary care

      Olumuyiwa Bamgbade, MD | Conditions
    • Who gets to be well in America: Immigrant health is on the line

      Joshua Vasquez, MD | Policy
    • When a medical office sublease turns into a legal nightmare

      Ralph Messo, DO | Physician
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • FDA delays could end vital treatment for rare disease patients

      GJ van Londen, MD | Meds
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
  • Recent Posts

    • Inside the heart of internal medicine: Why we stay

      Ryan Nadelson, MD | Physician
    • The quiet grief behind hospital walls

      Aaron Grubner, MD | Physician
    • Why peer support can save lives in high-pressure medical careers

      Maire Daugharty, MD | Conditions
    • Bundled payments in Medicare: Will fixed pricing reshape surgery costs?

      AMA Committee on Economics and Quality in Medicine, Medical Student Section | Policy
    • How Project ECHO is fighting physician isolation and transforming medical education [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why clinical research is a powerful path for unmatched IMGs

      Dr. Khutaija Noor | Education

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...