By Dr Minal Mistry, Psychiatrist
Schizophrenia is a serious and enduring mental illness that affects 1% of the population worldwide. It usually starts in late teens or early 20’s and so it is prudent to identify symptoms at this early age. Symptoms include hallucinations, delusions and disorganized thinking which can be very distressing. Whilst there is no cure, the condition is treatable with antipsychotic medication that can reduce the severity of symptoms, improve quality of life, and reduce burden on family.
People with Schizophrenia may have poor insight and not understand why they have to commence medication. Even if medication is started, symptoms may improve to the point where the person feels so well that they choose to stop their medication. If people start and then stop medication, this can lead to a relapse of symptoms of the underlying illness and/or “rapid onset psychosis” after withdrawal of medication. Therefore, the challenge is ensuring medication is commenced early and then continued.
How can we ensure medication is commenced early?
This has been partly achieved by the introduction of Early Psychosis Teams who play an important role to identify the illness in adolescence and commence treatment. Young people may be reluctant to take medication. In these cases, depot (injection) medication may be a preferable option for a young person who would then rely on the care team to administer medication which has the additional advantage of ensuring they are seen regularly and monitored.
How can we ensure medication is continued?
If medication is commenced, taking an injection can be the answer to the risks of a person stopping their medication. It is understandable that a young person who is feeling well may not see the continuing need for tablets. However, it may not in their best interest to stop the tablets without careful assessment. Even if medication can be reduced in dose, they may decide to stop it on their own. In any event, a depot injection will help to ensure medication is administered.
What is the evidence to support the use of depot early?
A recent University of California, Los Angeles (UCLA) study, by Kenneth Subotnik et al (2015) found that the early introduction of depot medication in newly diagnosed people can have multiple benefits including better symptom control, and improved cognition and “intracortical myelination” (ICM). Our knowledge about ICM is an interesting development in Schizophrenia. An earlier UCLA study, by George Bartzokis et al (2012) suggested that early treatment with antipsychotic injections can change the trajectory of ICM decline leading to reduced problems with the person’s function and less “treatment resistance”.
We have seen many cases of young people and their families’ lives being disrupted by poor control of symptoms at an early stage leading to recurrent hospitalization and continuing distress. We also know that people with Schizophrenia can suffer later on in their illness. Something can be done to reduce these problems, and the answer is to “nip it in the bud”.
Latest mental health research is showing that early identification of the condition needs to be coupled with early and reliable medication administration. Therefore, psychiatrists ought to consider early use of depot medication which may increase the chances of better outcomes hence changing the future of those who suffer from this worldwide debilitating condition.
Cite this article as:
Minal Mistry (2016) Schizophrenia: starting depot medication early may help. The Beautiful Space-A Journal of Mind, Art and Poetry. July 2016. TBSB101
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