Q. How much of medications should I take for schizophrenia without it affecting my professional life?

Answered by
Dr. Parth N. Nagda
and medically reviewed by Dr. Sneha Kannan
This is a premium question & answer published on Apr 29, 2020 and last reviewed on: Apr 10, 2021

I have schizophrenia and am on medication. My query relates to how much of medication to have that it has least impact on my professional life. My earlier symptoms related to auditory hallucinations and these were handled through medication and a visit to the rehab for 4 months, last year. I am currently consulting a doc, but he is unavailable during these times and I would like to change my doctor too. I am six feet tall and 87kg in weight.

I was first diagnosed as a schizophrenic some 4 years ago. The medication I am taking are Asprito 40mg, Olimelt 10 mg and Divaa OD 750 mg.

# Hello sir.
Thanks for your detailed query.

I would like to know first that do you have any symptoms still? Or are you doing completely well with the medicines..i guess you've mentioned for the past year you've been doing fine. So im assuming you don't have any symptoms now.
Also you've mentioned asprito 40mg. That's a fairly high dose sir and I don't really advise my patients to take beyond 20 or max 30mg.

Currently, if you're doing fine, I would advise you to reduce the dose of asprito to 30mg for 4 weeks.

After that to take 20mg for another 4 weeks and see how you're doing and let me know for further dose reduction.

Also the least amount of medicines for minimal impact on your life would be the following doses
Olanzapine between 5 to 7.5mg
Divaa about 500mg
And asprito around 7. 5 to 10mg
This is for still some residual symptoms.

For no symptoms I would eventually want to maintain you at
Olanzapine 5mg
Asprito 5mg
Divaa 500mg

Also just a reminder sir that normally for 1st episode of schizophrenia, treatment is to be given for 1 or 2 yrs. For the 2nd episode, between 3 to 4 yrs, and for the 3rd episode, treatment of atleast a small dose is advised lifelong.
I seem to have no symptoms apart from a bout of occasional aggression.
# Then I would suggest you start tapering down the dose of asprito a little sir.
Take 30 mg instead of 40mg and please let me know after 4 weeks.
If you're still feeling the same, then we can consider further reduction of the dose.
There is no doubt you know what you are talking about
# Hello
As long as you're taking the medicines regularly and following up regularly, you don't need supervision.

Yes, since you have taken them in afternoon, you will be drowsy in the evening.
It's to be taken at night sir.
Take all medicines at night only.

Only tests for blood sugar for risk of diabetes is needed every 3 or 4 months.
Nothing else needed sir.
Thanks parth !
# Welcome. So what's the dose that you're taking currently sir?
Hi Dr Parth ! I am taking 30 mg asprito and diva OD 750 mg, I still feel sleepy. Otherwise disposition is absolutely perfect. I feel disappointed sometimes and work gets affected.
# Ok Sir.
Now I want you to reduce divaa to 500mg sir and I want you to take it about 2 hrs before your sleeping time

Since medicines take about 2 hrs to start taking effect

And last for 8 hrs or so

So if you take at around 8 or 8.30 pm, you should be able to sleep by 10 and wake up by 6 or 7.

Taking night medicines later isn't advised

Medicines can be taking on empty stomach also

Not necessary to take after dinner.

Could you tell me dose of asprito and olanzapine please that you're currently taking?
The dose of asprito is 40mg and olanzapine is 10mg

My sleeping time is irregular, since it is work from home. I do take medicine at 9pm
# Ok Sir. I would suggest you reduce the dose of asprito to 30mg from 40mg.
And add 20mg of fluoxetine in the morning. It should help with making you more alert in the day, help with the occasional disappointment also.

So to sum it up, it would be
T. Divaa 500mg at night
T. Asprito 30mg at night
T. Olanzapine 10mg at night
C. Fluoxetine 20mg in the morning

Next month I would like to reduce dose of olanzapine to 7.5mg

Yes sir. If possible, try take 2hr before sleep. No matter the time.

Like if u know u are going to sleep early today then take early. If u know u have to work late a little then take later
Thank you. If there is anything that troubles me in the next 100 hours I will buzz you.
# And that's 1 more reason I want to reduce olanzapine since it is the main reason for your sleepiness /drowsiness

Please dont hesitate to ping me.
Olanzapine really isn't my type of medicine. It was recommended long ago and my current off line doctor persisted with it
# I first want to get you off asprito a little quicker since it's a fairly high dose of 40mg that's why i want to taper it first.
# Yes not an issue. Eventually as i said, my goal is to get you to 5mg of olanzapine and 10mg of asprito
Thank you

I consult Dr Manish Sarkar currently
# See, taking higher doses of antipsychotics when not needed, also can lead to lowered mood and depressive symptoms. That's why you seem to be feeling a little low. And its a sign that these medicines need tapering down.
I always tell my doc I don't need a counsellor and he goes, "You do You do". Its funny because doctors love recommending counsellors
# And that's why I've chosen fluoxetine 20mg. For 2 reasons. 1 to help with your mood.
And 2nd, it's available as a combination tablet of olanzapine 5mg and fluoxetine 20mg (oleanz plus or fostera).
So when ever we get to 5mg, i can combine it with this and your number of tablets will reduce

I'm also thinking long term sir.

After 3 weeks we will still reduce asprito to 20mg if you're feeling fine.
Can we get rid of olanzapine completely I wonder ?
# Not at all. I never usually recommend them. It's fine if you use in combination with medicines sometimes.

I'll give u a small example sir. For fever, you normally take crocin (paracetamol) and also try cold water sponging. Crocin is a must. Sponging will help the effect of crocin, but can't replace crocin. The same way in psychiatry, medicines are the crocin and counselling is the sponging.

Counselling will help sometimes the action of medicines, but it can't be a substitute for proper medicines

You are speaking with me perfectly, coherently, able to reason perfectly well. That's not the dose given for someone with schizophrenia what you're taking currently sir.

That's why it needs a reduction.

Eventually, we could, and maybe just try either asprito or amisulpride if needed

Or I was actually thinking more on long term basis of just giving u 250mg of Divalproex and the combination of olanzapine and fluoxetine

Just 2 tablets for maintenance
I am never stable unless I have my work with me and these days with work going full swing, I am very comfortable. Thats why I don't recommend me sitting idle at all
# Thats good to hear. Work itself is a good sort of medicine
Forget it
# Do let me know after 3 weeks or 4 weeks and we'll consider another reduction in the dose of asprito.
This is going no where

Could there be a reason I feel fine when I am working
# Normally when you're working your mind is diverted and you don't pay attention to other things which bother you.

That's also another reason why sitting idle usually leads to more anxiety and depression.
If this is my only reason to eat medicine, then I should continue working and stop medicines. I think perhaps the diagnosis of schizophrenia was wrong.
# Schizophrenia happens due to an imbalance of certain neurotransmitters such as dopamine and it leads to the symptoms that you've been having.
Medicines help correct this chemical imbalance and help with your problem.

Once you're fine with medicines, working helps prevent a relapse.

You are feeling fine because you're in medicines and working.

If you stop either one, especially medicines, symptoms will return. I wouldn't advise it sir

If you're only taking medicine and not working, you are back to normal but with nothing to do, it leads to boredom, excessive thoughts and anxiety and depressive symptoms.
That's why both are essential.
I think you are right and I will continue medicine. The other thing is about social discrimination because of the disease, your thoughts ?
# Yes, most common people don't realise that there are so many different types of psychiatric illness. Most people have the stereotyped idea of mental illness what's see in movies.
It's still reducing nowadays, the stigma of having a psychiatric illness due to better awareness. But it still needs to be reduced.

Best way to deal with social discrimination is to give people information and make them understand. Also you can explain in your own words using other examples which they understand, like how headache can't be seen but a person suffers from it. Same way this can't be seen, but you're suffering from this.

For you, the best way is to ignore what other people say and just try clear their doubts if possible. If not, just keep on doing your work and take medicines regularly.

even before I apply for a job, I tell them this is my condition, the disease and then balance the negative, if I may say so, with the positive of my skills at work. I am an HR professional

# That's good. Telling things openly actually helps establish trust early on. That itself is seen as a positive thing by many companies.
Dr Pervez was my previous doctor and Dr Manish Sarkar my present one.
It was written like that so that I could get to the full history of what they thought was wrong with me. My last question about me perhaps not being a schizophrenic was addressed to Dr Sarkar.
# No idea why that happened. I guess either the wrong chat box must have popped up or your query got redirected here.
Just have a word with customer care and see if there's been some issue with consults /queries not being addressed to the appropriate doctor properly.
The query box seemed to go somewhere and I couldn't get back to it. I tried calling him them and spoke to him on the second try for 3 minutes. It seems too expensive a consultation
# True. You can try asking for a refund.
Hi Dr Parth,

How are you doing today ?

I could if then

I mean I could then ask for a refund

I need to know what is possibly the reason for my aggressive nature and any other abnormalities in behaviour you might have noticed
# Hi, I'm doing good. Hope you're doing well today.. Yes. You can have a word with customer care and explain your problem once. 3 minute consult does seem too expensive :)
# Sure I'll explain
Do you notice any abnormal behaviour in me apart from aggression
# See what happens is, in most mood disorders, it leads to a reduced threshold for anger. You tend to get annoyed easily at things which are minor and can be ignored. This leads to an aggressive outburst of anger.
That's why the medicines given, help increase this threshold and make you less irritable
Sometimes they are more than minor

What do we do then
# No sir, I haven't. That's why i told you yesterday also, that you are answering my questions properly and coherently. That's why I told you that I need to reduce the medicines dose. You don't need such a high dose

See sometimes some irritation is justified in some situations. Example :a person scratches your car, you are in your right to get annoyed. You shouldn't be expected to remain calm in such situations.

Also some aggressiveness is also a part of a person's personality.
Thats the point I need information on. That is a fine balance and how to handle that

Do the medicine prepare me to balance out this aggression and not turn me too docile
# Sure. Firstly irritability is something that can't be assessed by oneself. That's why we always ask the informant or family member for degree of irritability.
So if something is difficult to assess by yourself then you should take the help of family members and friends. Ask them if your response was appropriate to a particular situation or not. Repeated feedback from them, will make you realise that the next time you're in a similar situation, you can try respond a little less aggressively

Also the old story of counting to 10 before responding also works. It gives you a few seconds to process how you want to react to a particular thing

Yes, exactly.. That's the reason I was also reducing the dose. Because there should be some normal aggressiveness also. You can't be docile all the time.
Thanks for the counselling. You're a good doc
# Welcome sir.
Hi dr parth
# Hi, what's up?
Trying to get to a resolution in my head. See, the company I was working for is shutting down. Now the owner of the company wants to retain me as an IT infrastructure head for his entire estate. This is a different ball game and involves a bit of fast track learning, even though I am IT aware. My concerns are about whether this search for money is taking me away from my eventual goal, which is about "evolving people". Tough choices all these ?
# If you have another option lined up, then you cna consider between these two. If not, it's always better to take up on the offer.

Since being idle, might again cause your symptoms to worsen.
Working will keep you busy as well as ensure you a regular flow of money.
If you don't know somethings you can always try figure it out.

Also if you don't like it after a while, you can always quit or leave later too. But if you say no, you won't have the opportunity again. So better not to pass up any opportunity.
I am programming a doctors portal, similar to the one you are on. I have the flowcharts and diagrams worked out and am working on the algorithm. Once this is up, I intend to host it and sell it. The opportunity with IT infrastructure, I have already said yes to.
# That's very nice.
Glad to hear it.
It's good to see you have multiple opportunities.
Good luck with the programming =M
What do you think of this thought of evolving people? I have worked hard at it and have a proven track record on it. It just is mind blowing what you can become if you set your mind to it.

I play the guitar, code, HR and also wood work. I could be any field
# That's very nice.
Obviously evolving to be a better you, is surely the goal of humanity in general.
Striving to be a better person as compared to the one you were previously is always an admirable pursuit. It gives a deeper satisfaction which isn't available anywhere else.

So do continue your other activities also, in addition to your primary occupation. After your working years are done and whenever you choose to retire, you'll have a nice set of activities to keep you entertained and to focus on and improve.
Primary is no longer available.
I am pretty relaxed though
# That's fine. Good to hear you're keeping busy and are relaxed.
Dr parth, Olimelt seems to be giving me this strange constriction in the throat. Its been happening for a while, I never noticed, today I decided to have olimelt alone and got this sensation. What could be causing it ?
# Maybe you're allergic to a particular compound in that particular brand. It happens sometimes. It's better to try another brand like oleanz maybe and see if you still have that sensation.
How much dosage of oleanz ?
# You're taking 10mg currently so i would like you to continue the same. After 4 weeks, i am planning to reduce it to 7.5mg
The file was a Low level diagram for the coding I intend to do for the doctors portal.

Oleanz will be bought today, I want you to reduce it in 2 weeks. I have been talking to you for 2 weeks now.
# Sure. 1 medicine is reduced every 3 or 4 weeks.
Right now its aripiprazole which is being reduced from 40 to 30. Another 2 weeks later we will reduce oleanz to 7.5 and aripiprazole to 20
Can arpiprazole be reduced to 20mg ?
# Yes of course. It's not normally needed anyway above that dose. But going straight from 40 to 20 isn't advisable, so just take 30mg for 2 more weeks and then we'll decide

I think the best doctors are in my place


Thanks :) Yes, your place does have good quality doctors.

Dr Parth, It worked, Oleanz works well
# Glad to hear it.. Give all the changes about 1 or 2 weeks to show good effect and we taper on the 3rd week

I hate certain people I think thats the reason I was diagnosed a schizophrenia

# Not really. That's a personal belief and most people will have such beliefs anyway.
I don't really think it will be a reason for your diagnosis of schizophrenia.

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