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.
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