Schizophrenia and Bipolar Disorder: Medicines, Side Effects and Family Support

When a family member becomes withdrawn, hears voices, talks to themselves, cannot sleep for days, or swings between very high and very low moods, the first reaction in many homes is fear, shame, or a search for a spiritual cause. The person may be taken to a shrine, kept at home, or called pagal. Serious mental illnesses such as schizophrenia and bipolar disorder are medical conditions of the brain, and they respond well to treatment. With the right medicines, regular follow-up and family support, many people live stable, productive lives.

This guide explains schizophrenia and bipolar disorder in simple terms, how the main medicines work, the side effects to know about, why continuing the medicine matters, and how families can help in a crisis.

Schizophrenia

Schizophrenia usually starts in late teens to the thirties. It is not a split personality, and it is not caused by jinn, black magic, bad parenting or weak faith. Symptoms include:

• Hallucinations: hearing voices, or seeing things that others do not.
• Delusions: fixed false beliefs, such as being watched, poisoned or controlled.
• Disorganised speech and behaviour.
• Negative symptoms: loss of motivation, flat emotions, withdrawal, neglecting hygiene.
• Difficulty with attention and memory.

Bipolar disorder

Bipolar disorder involves episodes of mania or hypomania (very high, energetic, irritable mood, little need for sleep, racing thoughts, overspending, risky behaviour, big plans) and episodes of depression. Between episodes, many people are well. Untreated, the episodes can wreck relationships, jobs and finances, and carry a serious risk of self-harm during depression.

How medicines help

Antipsychotics

These reduce hallucinations, delusions and agitation, and prevent relapse. Several are used in both schizophrenia and bipolar disorder.

• Risperidone, for example Raze, Recept and Mozart.
• Quetiapine, for example Quto XR, Qusel XR and Seroquel.
• Olanzapine and aripiprazole.
• Haloperidol (Serenace), an older medicine, with more movement side effects.
• Clozapine, the most effective for treatment-resistant schizophrenia, but it needs regular blood tests for the white cell count.
• Long-acting injections such as fluphenazine (Gencate) are given every few weeks, which helps people who forget or refuse tablets.

Mood stabilisers

• Lithium carbonate is the gold standard for bipolar disorder. It prevents mania and depression and reduces suicide risk. It has a narrow safety range, so blood lithium levels, kidney and thyroid tests are needed regularly. Dehydration, heavy sweating, vomiting, diarrhoea, a low-salt diet and painkillers such as ibuprofen can raise levels and cause poisoning (tremor, vomiting, confusion, unsteady walking). Seek urgent help if these signs appear. See our guides to painkillers explained and thyroid disorders.
• Sodium valproate and carbamazepine (Tegral) are also used as mood stabilisers. Valproate must be avoided in women who can become pregnant, because of a high risk of birth defects. See our guide to epilepsy medicines.
• Lamotrigine helps prevent the depressive episodes of bipolar disorder.

See the psychiatric care category. These are prescription medicines. If you have a prescription, upload it here.

Side effects to know about

• Weight gain, higher sugar and cholesterol, especially with olanzapine, clozapine and quetiapine. Weigh regularly, and check sugar and lipids at least yearly. See our guides to diabetes medicines and high cholesterol.
• Drowsiness and sedation, often easier by taking the dose at bedtime.
• Stiffness, tremor and restlessness (extrapyramidal effects), especially with haloperidol and higher risperidone doses. These can be treated. Tell the doctor.
• Raised prolactin (risperidone), causing breast changes, milk discharge and menstrual changes, and sexual side effects.
• Dizziness on standing, a dry mouth, constipation and blurred vision.
• Tardive dyskinesia: involuntary movements of the mouth or limbs after long use. Report early.
• Rare, serious reactions: high fever with severe stiffness and confusion (neuroleptic malignant syndrome), and very low white blood cells with clozapine (sore throat, fever). These are emergencies.

Never stop a medicine because of a side effect without speaking to the doctor. There are usually ways to manage it, or other medicines to choose.

Why you must not stop the medicine

• Feeling well is a sign that the medicine is working, not that it is no longer needed.
• Stopping suddenly is the most common reason for relapse, and each relapse can make the illness harder to treat.
• Many people stop because of side effects, lack of insight (not feeling ill), cost, stigma, or because they feel better. Open talk with the doctor, a long-acting injection, simplifying the regimen, or a different medicine can help.
• A relapse often follows missed doses, lack of sleep, alcohol or drugs, and stress.

What helps besides medicine

• Regular follow-up with a psychiatrist, and a clear plan.
• Talking therapy and family education. Understanding the illness lowers conflict and relapse.
• A steady routine: regular sleep, meals, light activity and meaningful tasks. See our guide to insomnia and sleeping tablets.
• Avoiding alcohol, cannabis, hashish and other drugs, which trigger relapse.
• Healthy habits: exercise and a balanced diet, to limit weight gain.
• Work and community: support to study or work, and to keep friendships.

Early warning signs of relapse

• Sleeping much less, or much more.
• Becoming suspicious, withdrawn or more irritable.
• Talking to oneself, or hearing voices again.
• Racing thoughts, big plans, excessive spending (in bipolar).
• Stopping the medicine, or missing doses.

Call the doctor early. A small change in the plan can prevent a full relapse.

In a crisis

• Stay calm, speak softly, and do not argue with delusions or voices. Do not shout, laugh at or threaten the person.
• Remove anything dangerous, and stay with them.
• If there is a risk of harm to themselves or others, call for emergency help, or take them to the nearest hospital or a psychiatric emergency service. Do not tie or lock them up, or beat them.
• If they have talked about ending their life, take it seriously. Do not leave them alone, and get urgent professional help.

Supporting a family member

Caring for someone with a serious mental illness is hard. Learn about the condition, share responsibilities, protect your own health and sleep, and look for family support groups. Blame and shame help nobody. See our guide to depression and anxiety medicines for common mood problems.

Pregnancy and breastfeeding

Do not stop medicines on your own if you become pregnant. Some, especially valproate and lithium, carry risks, and others can be used with monitoring. Plan pregnancy with your psychiatrist and gynaecologist.

When to see a doctor

• Any change in behaviour that lasts more than a week, or voices or strange beliefs.
• Not sleeping for several nights, with high energy.
• Thoughts of self-harm or harming others. This is an emergency.
• Side effects that trouble you, or signs of lithium poisoning.
• You have missed several days of medicine.

Frequently asked questions

Can schizophrenia be cured?

It is a long-term illness, but with treatment many people recover well, and some have long periods without symptoms.

Are these medicines addictive?

No. Antipsychotics and mood stabilisers do not cause craving. They are not sleeping pills.

Will my child inherit it?

There is a family risk, but most children of a person with schizophrenia or bipolar disorder do not develop it.

Can a person with bipolar disorder work and marry?

Yes. With treatment and support many do both.

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This article is for general information and is not a substitute for advice from your psychiatrist or doctor. It does not include doses; your doctor decides the medicine and amount. If someone is in danger, call for emergency help or go to the nearest hospital.