What are antidepressants?
Antidepressants are substances used to treat symptoms of depression. In the context of a schizophrenic disorder, this makes sense because many patients develop depression as a concomitant disease. Antidepressants unfold their effect by increasing the concentration of messenger substances in the brain, which are important for mood and drive.
These are mainly serotonin and noradrenalin. The drugs inhibit the breakdown of these messenger substances (neurotransmitters) at the synapses, i.e. the contact points between the nerve cells, so that they work longer and more strongly. The selection of antidepressants is very large and each substance has an individual effect profile.
Some of these drugs have a calming (sedative) effect in addition to improving mood, others have a stimulating effect. There are also side effects of antidepressants. Treatment with these drugs therefore requires an experienced doctor and some patience to find the right substance.
What are tranquilizers?
Tranquilizers are all those substances that have a calming, anxiety-relieving and sedative, i.e. tiring effect. The most effective sedatives are the so-called benzodiazepines, such as diazepam (Valium ®), which are used in highly agitated patients, for example in schizophrenic delusion. Although they are very effective, they also have a high dependence potential. If possible, other drugs are therefore used, such as sedative antidepressants, to avoid habituation. Herbal medicines such as valerian are also used in less pronounced cases.
What side effects are to be expected?
The symptoms of schizophrenia are stronger than those of most other mental illnesses.Accordingly, the drugs that are supposed to be effective for such symptoms must be correspondingly effective. Unfortunately, this strong effect often leads to side effects. The extent of these side effects varies from individual to individual and is therefore difficult to predict.
In very severe schizophrenia, these side effects must be accepted, as the symptoms must be contained for one’s own protection and that of others. Once the most severe symptoms are under control, the search for the right medication in the right dose can begin. This is because after the schizophrenic relapse has been contained, the drugs usually have to be taken for a long period of time and any side effects tolerated.
Exactly which side effects are involved varies from one drug to another. By far the most restrictive side effects are caused by the typical antipsychotics, such as Haloperidol, namely the so-called extrapyramidal motor disorders (EPS). These are problems in executing movements similar to those known from Parkinson’s disease.
Patients suffer from involuntary cramps and convulsions, their hands shake and it is difficult for them to take their first steps when walking. These EPS are difficult to treat and do not always regress completely even after stopping medication. Nevertheless, the typical antipsychotics remain the most effective weapon against the symptoms of schizophrenia and are used at least initially, but are replaced in the course of time if possible by other substances such as atypical neuroleptics like risperidone or clozapine.
Other side effects that can occur with both typical and atypical antipsychotics are sedation, impaired metabolism, dry mouth, constipation, cardiac rhythm disturbances, circulatory problems and sexual function disorders. Although these are also by no means pleasant, they can be treated well. Another possible, albeit rare, side effect is the so-called malignant neuroleptic syndrome (MNS), in which a potentially life-threatening dopamine deficiency occurs. This manifests itself in fever, palpitations, clouding of consciousness, confusion, tremors and changes in some laboratory parameters, such as an increase in liver values. The MNS is an absolute emergency, but fortunately it occurs very rarely.
