Schizophrenia and Attention-deficit/hyperactivity disorder are psychiatric conditions. ADHD is a common disorder affecting the normal development of the brain. It is associated with inattention, hyperactivity, and impulsivity.

Schizophrenia, like ADHD, is also a neurodevelopmental disorder. Schizophrenia is a mental health disorder in which a person has lost contact with reality. Individuals with schizophrenia experience both negative, i.e. social withdrawal, and positive symptoms such as delusions and hallucinations.  

Both ADHD and Schizophrenia can be managed with appropriate medications. This article is about the treatment of ADHD and schizophrenia with the help of medications. 

Schizophrenia medication

Schizophrenia is incurable, therefore, medications are prescribed to reduce the effects of psychosis and other related symptoms of schizophrenia. Antipsychotics are the first-line medication regimen for schizophrenia. Subsequent medications for schizophrenia involve the use of antidepressants, mood stabilizers, and anti-anxiety medications for treating co-occurring conditions, like depression and mood disorders. 

Antipsychotics

Antipsychotics are the medications that are commonly prescribed for conditions and symptoms related to psychosis. Psychosis is one of the symptoms of schizophrenia and is characterized by hallucinations and delusions. Anti-psychotics primarily reduce hallucinations and delusions. Antipsychotics work by blocking the neurotransmitter dopamine, which is increased during psychosis. 

Sometimes, antipsychotics are recommended with other drugs to overcome the potential side effects of antipsychotics. 

Types of Antipsychotic Medications for Schizophrenia

There are two types of antipsychotics, typical and atypical antipsychotics. They are differentiated based on their side effects. 

Types of Antipsychotic Medications for Schizophrenia

Typical antipsychotics

Typical antipsychotics are the first generation of antipsychotics used to treat schizophrenia. Typical antipsychotics work to decrease the release of dopamine in the brain. By decreasing dopamine in the brain, typical antipsychotics reduce the positive symptoms of schizophrenia, such as hallucinations, delusions, and disoriented thinking patterns. These symptoms occur because of the increased activity of dopamine in the brain. 

Because typical antipsychotics work on just one neurotransmitter, dopamine, they have no activity on any other neurotransmitter; therefore, they worsen the negative symptoms of schizophrenia, which are social withdrawal and a lack of emotions. 

Thus, typical antipsychotics are only used when other antipsychotics are not giving the desired result. The noteworthy side effects of typical antipsychotics are related to movement, such as 

  • Muscle stiffness 
  • Dystonia
  • Tardive dyskinesia

Commonly recommended typical antipsychotics are: 

  • Chlorpromazine (Thorazine)
  • Fluphenazine (Prolixin)
  • Haloperidol (Haldol)
  • Loxapine (Loxitane)
  • Perphenazine (Trilafon)

Atypical antipsychotics 

Atypical antipsychotics are the newer or second-generation antipsychotics

These antipsychotics target two neurotransmitters, dopamine and serotonin, and decrease their level in the brain. Therefore, they tend to reduce both the positive and negative symptoms of schizophrenia. However, they do have side effects other than the ones caused by the typical antipsychotics.

The possible side effects of the second-generation antipsychotics are, 

  • Blurred vision
  • Dry mouth
  • Dizziness
  • Drowsiness
  • Muscle stiffness or tremors
  • Decreased sex drive or function
  • Weight gain. 

 A few examples of atypical antipsychotics include: 

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Brexpiprazole (Rexulti)
  • Cariprazine (Vraylar)
  • Clozapine (Clozaril)
  • Iloperidone (Fanapt)

Advantages of atypical over typical antipsychotics

The biggest advantage of the second-generation antipsychotics over the first-generation antipsychotics is that the newer medications do not cause any extrapyramidal symptoms (EPS)- symptoms related to movements, like the typical ones. 

Besides managing the positive symptoms, atypical antipsychotics reduce the negative symptoms of schizophrenia and other psychotic disorders. Thus, improving the overall mood and enhancing motivation. 

Complementary medications for comorbid conditions

 

Mood Stabilizers

Mood stabilizers are sometimes recommended when a comorbid bipolar disorder occurs in schizophrenia. A combination of mood stabilizers like lithium, carbamazepine, and valproic acid, plus an antipsychotic, is effective in managing co-occurring depression, anxiety, and psychosis. 

Antidepressants

Individuals with schizophrenia often experience depression. Antidepressants are effective in dealing with the negative symptoms of schizophrenia. Negative symptoms can include a lack of emotion or motivation.

Commonly prescribed antidepressants are the selective serotonin reuptake inhibitors (SSRIs), including 

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Prozac)
  • Paroxetine (Paxil, Pexeva)
  • Sertraline (Zoloft)

Anti-anxiety medications

Antianxiety medicines are often used with antipsychotic medication to help treat people with schizophrenia. The medicines include:

  • Alprazolam (Xanax)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Lorazepam (Ativan)

Antianxiety medications can help relieve anxiety and nervousness. They can be used to treat an episode of psychosis or agitation that comes with psychosis. 

Extrapyramidal medications

Extrapyramidal symptoms are often manifested in schizophrenia and cause disruptions in motor control and coordination. They are drug-induced movement disorders that appear as a result of antipsychotics. If these symptoms develop, your healthcare provider may prescribe medications such as:

  • Anticholinergics (benztropine, trihexyphenidyl)
  • Benzodiazepines (lorazepam, clonazepam)

Cobenfy- the new schizophrenia medication

A combination of drugs, xanomeline and trospium chloride, Cobenfy is considered a breakthrough in treating the symptoms of schizophrenia and does not cause any side effects. 

The mechanism of action of Cobenfy is different from both typical and atypical antipsychotics. While these two types work directly on dopamine/serotonin receptors in the brain, Cobenfy indirectly blocks dopamine and serotonin. It works on a different brain receptor, the muscarinic receptor, which is associated with cognition and control of behavior. By attaching to muscarinic receptors, Cobenfy decreases the level of dopamine in the brain. 

Benefits of Cobenfy 

Cobenfy has a lower risk of developing extrapyramidal symptoms (EPS) and metabolic symptoms, like weight gain. It is an add-on medication in case the first medication is not yielding promising results.  

Antipsychotic shots for Schizophrenia

Long-acting injectables (LAIs) are the injection form of antipsychotic medications. Like oral antipsychotics, LAIs are also of two types, first-generation LAIs and second-generation LAIs. Long-acting injectables and reduce the symptoms of psychosis. 

Antipsychotic injections for schizophrenia act on the neurotransmitters dopamine, serotonin, and glutamate to lessen psychotic symptoms associated with schizophrenia. It usually takes 2–12 weeks for LAIs to show a response. 

Common LAIs are: 

  • Aripiprazole (Abilify Maintena)
  • Aripiprazole lauroxil (Aristada)
  • Fluphenazine (Prolixin)
  • Haloperidol (Haldol)
  • Olanzapine pamoate (Zyprexa Relprevv)
  • Paliperidone (Invega Sustenna, Invega Trinza)
  • Risperidone (Risperdal Consta)

Second-generation LAI antipsychotics include:

  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Aripiprazole (Abilify)
  • Paliperidone (Invega)
  • Aripiprazole lauroxil (Aristada)

Benefits of Long-acting injectables 

The medication is absorbed slowly in the bloodstream, this way, allowing for a sustained release effect. The efficiency of the Long-acting injectables is similar to that of the oral antipsychotics. LAIs have a lower risk of side effects than oral antipsychotics.

ADHD Medication

They play a role in increasing the levels of the neurotransmitters dopamine and norepinephrine in the brain. Dopamine affects focus, concentration, and motivation, while norepinephrine has a function in increasing alertness, arousal, and impacts mood and memory. For ADHD, two versions of ADHD medications, i.e. stimulants and non-stimulants, are used. Antidepressants are also effective in managing a few ADHD symptoms. 

Types of ADHD medication

ADHD medications are divided into two types: Stimulants and non-stimulants. 

Stimulants

Stimulants are the primary medication for ADHD in children and adults. They act on dopamine and norepinephrine and significantly increase attention span, alleviate hyperactivity, and enhance mood.  

Stimulants accelerate the transmission of messages between the brain and the body, thus making you feel alert, euphoric, and confident. Stimulants are controlled substances and have the potential for risks and misuse. 

muscarinic receptors, muscarinic receptors, Stimulants come in two forms: 

  • Immediate-release Stimulants: 

Short-acting stimulants quickly enter the bloodstream and target the neurotransmitters. The effects of stimulants subside in 3 to 6 hours. Their immediate activity is associated with a side effect known as ‘the rebound effect’, in which you feel an intense fall in energy level, making you feel wired and exhausted. 

Common short-acting stimulants are: 

  • Ritalin: 3-4 hours
  • Focalin: 4-6 hours
  • Extended-release Stimulants: 

The efficacy of intermediate-acting or long-acting typically wears off in 8 to 16 hours, depending on the ongoing metabolic activity of the person. Long-acting stimulants are beneficial in lessening the risk of the rebound effect. 

Some important long-acting stimulants and their lasting duration are: 

  • Adderall XR:  8-12 hours
  • Dexedrine: 6-8 hours
  • Vyvanse: 10-12 hours

Non-stimulants

Non-stimulants are a class of ADHD medications that are considered when stimulants are not suitable enough to improve the symptoms of ADHD. Non-stimulants, like the stimulants, work to make various cognitive functions better, like attention, impulsivity, mood, emotions, and working memory. 

Non-stimulants are not controlled therefore, the risk of misuse is low.  

Selective Norepinephrine Reuptake Inhibitors (SNRIs) and alpha agonists are the two types of non-stimulant ADHD medications approved by the FDA. 

Norepinephrine modulators

SNRIs increase the neurotransmitter norepinephrine in the brain. Norepinephrine is important in reducing the deficit in executive functioning, like regulating emotions, and boosting attention. Two important FDA-approved SNRIs for ADHD are: 

  • Strattera (Atomoxetine)
  • Qelbree (Viloxazine)

Strattera is considered the second-line treatment for treating Attention-deficit/hyperactivity disorder in children, adolescents, and adults. It helps with hyperactivity, impulsivity, attention, memory, and planning. The side effects of stretta include: 

  • Constipation
  • Dry mouth
  • Nausea
  • Decreased appetite
  • Sexual side effects, such as erectile dysfunction

Suicidal ideation, heart problems, and liver damage can also occur as serious side effects of Stretta. 

Like Strattera, Qelbree also increases norepinephrine in the brain and reduces the symptoms of ADHD, along with executive functioning deficits. 

Common side effects of Qelbree are: 

  • Headache
  • Sleepiness
  • Nausea
  • Lower appetite
  • Dry mouth 
  • Constipation

Children may experience irritability as a side effect of Qelbree. Serious side effects may include suicidal thoughts and mania. 

When are non-stimulants recommended? 

When the effects of stimulants are not appearing, or a person experiences severe side effects, a psychiatrist may recommend switching to non-stimulants. 

Sometimes, both stimulant and non-stimulant medications could be coupled to reinforce the effects of each other. If you have a history of substance abuse, it’s risky to use stimulants. 

Anti-depressants

The FDA does not approve antidepressants for ADHD, so they are used as off-label medications. Because of the shared symptoms of depression and ADHD, healthcare providers recommend antidepressants for ADHD. ADHD can sometimes cause depression, leading to low mood and distorted self-image. 

The class of antidepressants commonly used for treating the symptoms of ADHD is the norepinephrine-dopamine reuptake inhibitors. Wellbutrin is widely prescribed to manage the symptoms of ADHD, especially when stimulant side effects are intolerable. 

Concluding points

Schizophrenia is a serious mental health condition. The prevalence rate of schizophrenia is 1 in 100 people. Similarly, ADHD affects 11% of the children and 6% of the adults in the U.S. The symptoms of both schizophrenia and ADHD can make it difficult for a person to continue living and functioning in a normal way, affecting occupational and social life. Therefore, medications for both conditions are usually prescribed to manage the symptoms. It is important to consult your healthcare provider in case medications are not bringing the desired results or overwhelming side effects appear. 

Explore Expert Mental Health Solutions At Advance Health Preference Group

Schizophrenia and Attention-deficit/hyperactivity disorder can be debilitating. It is important to find the right medication to live a well-balanced life. Advance Health Preference Group treats Schizophrenia and ADHD, using evidence-based treatment, including therapy and medication to help people find pathways to embrace emotional, psychological balance and enrich their lives in recovery. Book a consultation at Advance Health Preference Group and get better quality mental healthcare.

FAQs

  • Q: Can people with schizophrenia live without medication?
    A: Medications are essential to treat the symptoms of schizophrenia. Sometimes, symptoms of schizophrenia relapse when medications are not taken.
  • Q: Which Antipsychotic Medication Is Right for Me?
    A: It depends on the individual’s conditions and specific needs. Clozapine is considered the best medication for schizophrenia.
  • Q: How long does it take to stablize on ADHD medication?
    A: It usually takes two to six weeks to adjust to the ADHD medication.
  • Q: Are ADHD medications habit-forming?
    A: People with a history of substance abuse can become dependent on ADHD medication.