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Updated January 05, 2015.

I have schizophrenia. Which antipsychotic should I take?

It depends. The choice of an antipsyhchotic is based on past responses to antipsychotics, the balance between benefits and side effects, and personal preferences. Some medications can be taken by month in pill or liquid form, some as injections. Some injections can be given every other week or even once a month. How would you like to take your medication?


If you have diabetes you’d want to stay away from medications they can make your diabetes worse (e.g. olanzapine or quietiapine); if you are very young or very old you are at risk for neurological side effects and will want to stay away from typical antipsychotics (e.g. haloperidol), known for increasing the risk for these type of adverse effects.

I already take an antipsychotic for schizophrenia. What’s a good dose?

You should take at least the lowest effective dose. All antipsychotics have a therapeutic range, meaning that the medications can be taken at different doses – as long as the doses are part of the established range. For example, olanzapine’s range for an adult person is between 10 to 30 mg daily, meaning that any dose between 10 and 30 mg is on the therapeutic range. For any medication, you’d want to be at least at the low end of the range, as sub-therapeutic dosing (under the recommended dose) is not effective. Once at a good dose – wait. A full response might take 2-4 weeks before settling in – so it’s usually a good idea to give a good dose a good try before moving on to a higher dose.

A poor response while taking the medication, as prescribed and at a therapeutic dose, is reason to move up to the next therapeutic dose, as long as you stay within the therapeutic range.

A poor response to the highest therapeutic dose is a reason to switch to a different antipsychotic.

I already take an antipsychotic for schizophrenia. Can I stop it? If not, for how long should I take it?

First, do not ever discontinue antipsychotics on your own. You are doing well and you are thinking about stopping your medication or changing your dose? Talk it over with your doctor. Anything else puts you at risk for your symptoms coming back. The main reason for people with schizophrenia getting worse nowadays is stopping medications on their own.

Yes, there is a minority of people with schizophrenia who stop medications and remain well. But for the vast majority of people with schizophrenia after stopping the medications the symptoms get worse. Unfortunately, we don’t have a clear way of differentiating between the two groups. For this reason stopping medications need to be done under very careful monitoring to make sure appropriate measures can be taken right away if the symptoms come back.

You should not stop your medications if you had multiple episodes of schizophrenia. However if you had only one episode and you had no symptoms for longer than one year it is reasonable to discuss with your doctor the prospect of stopping your medications in the future.

Further reading:

Antipsychotic Medicines for Treating Schizophrenia and Bipolar Disorder: A Review of the Research for Adults and Caregivers

Typical and Atypical Antipsychotics: What differentiates atypical from typical antipsychotics?

Selection of an Antipsychotic Medication: Difficult choices