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HomeAnswersPsychiatryschizophreniaFor schizophrenia, what medications should be taken without it affecting the professional life?

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

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Parth Nagda

Medically reviewed by

Dr. Sneha Kannan

Published At April 29, 2020
Reviewed AtDecember 1, 2021

Patient's Query

Hi doctor,

I have schizophrenia, and I am on medication. My query relates to how much medication I should take to have the least impact on my professional life. My earlier symptoms were related to auditory hallucinations, and these were handled through medication and a visit to the rehabilitation center for four months last year. I am currently consulting a doctor, but he is unavailable, and I would like to change my doctor.

I was first diagnosed as a schizophrenic four years ago. I am taking Asprito 40 mg, Olimelt 10 mg, and Divaa OD 750 mg.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Could you let me know if you still have any symptoms, or are you doing completely well with the medicines? I think you have mentioned for the past year you are doing fine. So I am assuming you do not have any symptoms now.

The tablet Asprito 40 mg, which you are taking, is a fairly high dose, and I do not suggest my patients take beyond 20 mg or a maximum of 30 mg. Currently, if you are doing fine, I would suggest you reduce the dose of tablet Asprito to 30 mg for four weeks. After that to reduce to 20 mg for another four weeks. In order to have minimal impact on your life, I suggest reducing the dosage of other medicines as mentioned below; a) Tablet Olanzapine between 5 to 7.5 mg. b) Tablet Divaa OD (Divalproex) about 500 mg. c) Tablet Asprito around 7.5 to 10 mg. This is for some residual symptoms. If there are no symptoms, I would suggest taking a) Tablet Olanzapine 5 mg, b) Asprito 5 mg, and c) Tablet Divaa OD 500 mg.

Normally for the first episode of schizophrenia, treatment is to be given for one or two years. For the second episode, between three to four years, and for the third episode, treatment is advised lifelong.

Patient's Query

Hi doctor,

I seem to have no symptoms apart from a bout of occasional aggression.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

I would suggest tapering down the dose of tablet Asprito a little. I suggest taking 30 mg instead of 40 mg, and please let me know after four weeks.

If you are still feeling the same, then we can consider further reduction of the dose.

Patient's Query

Hi doctor,

Are you sure that I can change the dosage?

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

As long as you take the medicines regularly and follow up regularly, you do not need supervision. Take all the medication at night. I recommend you check your blood sugar level every three to four months.

Patient's Query

Hi doctor.

Thank you.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

So what is the dose that you are taking currently?

Patient's Query

Hi doctor,

I am taking Asprito 30 mg and Divaa OD 750 mg and I still feel sleepy. Otherwise disposition is absolutely perfect. I feel disappointed at times and work gets affected.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

I suggest reducing the dosage of tablet Divaa to 500 mg and taking it about two hours before your sleeping time as the medication takes about two hours to act, and its action lasts for eight hours. If you take at around 8 PM or 8.30 PM, you will be sleeping by 10 PM and wake up by 6 AM or 7 AM. Taking night medicines later is not advised. Medicines can be taken on an empty stomach also. It is not necessary to take it after dinner. Could you tell me the dose of tablet Asprito and tablet Olanzapine you are currently taking?

Patient's Query

Hi doctor,

The dose of Asprito is 40 mg and Olanzapine is 10 mg My sleeping time is irregular, since it is work from home. I do take medicine at 9 PM.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

I would suggest you reduce the dose of tablet Asprito to 30 mg from 40 mg and take 20 mg of Fluoxetine in the morning. It should help you to be more alert in the day, help with the occasional disappointment also. So my suggestion taking tablet Divaa OD 500 mg at night, tablet Asprito 30 mg at night, tablet Olanzapine 10 mg at night, and tablet Fluoxetine 20 mg in the morning. I also suggest reducing the dosage of tablet Olanzapine to 7.5 mg next month. If possible, try taking the medication two hours before sleep.

Patient's Query

Hi doctor,

If there is anything that troubles me in the next 100 hours I will let you know.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

There is one more reason why I want to reduce the dosage of tablet Olanzapine, as it is the main reason for your sleepiness or drowsiness.

Patient's Query

Hi doctor,

Olanzapine is not my type of medicine. It was recommended long ago, and my current doctor persisted with it.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

I suggest tapering the dosage of tablet Asprito first, as 40 mg is a fairly high dose.

Patient's Query

Hi doctor,

Okay. I got it.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

It is not an issue. Eventually, as I said, my goal is to suggest you to 5 mg of Olanzapine and 10 mg of Asprito.

Patient's Query

Hi doctor,

Thank you.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Taking higher doses of antipsychotics when not needed can lead to low mood and depressive symptoms. That is why you seem to be feeling a little low. And it is a sign that these medicines need to be tapered down.

Patient's Query

Hi doctor,

I always tell my doctor I do not need a counselor, but he always recommends counseling.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

I suggested tablet Fluoxetine 20 mg for two reasons, to help with your mood and it is available as a combination tablet of Olanzapine 5 mg and Fluoxetine 20 mg (Oleanz plus or Fostera). So when the dose is reduced to 5 mg, I suggest to combine it with this and your number of tablets will reduce. If you are feeling fine I suggest to reduce Asprito to 20 mg after three weeks.

Patient's Query

Hi doctor,

Can I get rid of Olanzapine completely?

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Not at all. I usually do not recommend them. It is fine if you use in combination with other medicines sometimes. I will give you a small example. For fever, you normally take tablet Crocin (Paracetamol) and also try cold water sponging. Crocin is a must. Sponging will help the effect of crocin, but cannot replace Crocin. The same way in psychiatry, medicines are the Crocin and counselling is the sponging. Counselling will help with the action of medicines sometimes, but it cannot be a substitute for proper medicines.You are speaking with me perfectly, coherently, and able to reason perfectly well. That is why I suggested a reduction in dosage. Eventually, we could, and maybe just try either tablet Asprito or tablet Amisulpride if needed. On long term basis I may suggest 250 mg of Divalproex and the combination of Olanzapine and Fluoxetine, two tablets for maintenance.

Patient's Query

Hi doctor,

I am never stable unless I have work, and these days with work going full swing, I am very comfortable. Thats why I do not want to sit idle.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

That is good to hear. Work itself is a sort of medicine.

Patient's Query

Hi doctor,

Kindly forget it.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Do let me know after three or four weeks and we will consider another reduction in the dose of tablet Asprito.

Patient's Query

Hi doctor,

This is going nowhere. Could there be a reason I am feeling fine when I am working?

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Normally when you are working your mind is diverted and you do not pay attention to other things which bother you. That is another reason why sitting idle usually leads to more anxiety and depression.

Patient's Query

Hi doctor,

If this is my only reason to eat medicine, then I should continue working and stop medicines. I think perhaps the diagnosis of schizophrenia is wrong.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Schizophrenia happens due to an imbalance of certain neurotransmitters such as dopamine and it leads to the symptoms that you are having. Medicines help correct this chemical imbalance and help with your problem. Once you are doing good with medicines, working helps prevent relapse. You are feeling fine because you are taking medicines and working. If you stop either one, especially medicines, symptoms will return. I will advise it.If you are only taking medicine and not working, you are back to normal, but with nothing to do it leads to boredom, excessive thoughts, anxiety, and depressive symptoms. That is why both are essential.

Patient's Query

Hi doctor,

I think you are right and I will continue medicine. What are your thoughts about the social discrimination because of the disease?

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Yes, most common people do not realize that there are so many different types of psychiatric illness. Most people have the stereotyped idea of mental illness is what they see in movies. It is 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 cannot be seen but a person suffers from it. Same way this cannot be seen, but you are suffering from this. For you, the best way is to ignore what other people say and just try to clear their doubts if possible. If not, just keep on doing your work and take medicines regularly.

Patient's Query

Hi doctor,

Even before I apply for a job, I tell them about my condition. I am an HR professional.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

That is good. Telling things openly actually helps establish trust. That is seen as a positive thing by many companies.

Patient's Query

Hi doctor,

It was written like that so that I could get to the full history of what was wrong with me. My last question about me perhaps not being a schizophrenic was addressed to my current doctor.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

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 the customer care and see if there is been some issue with queries not being addressed to the appropriate doctor properly.

Patient's Query

Hi doctor,

The query box seemed to go somewhere and I could not get back to it. I tried calling them and spoke to him.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Okay.

Patient's Query

Hi doctor,

I need to know what is the reason for my aggressive nature and any other abnormalities in my behaviour that you might have noticed?

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

You can have a word with customer care and explain your problem once.

Patient's Query

Hi doctor,

Okay will do.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Sure I will explain.

Patient's Query

Hi doctor,

Do you notice any abnormal behaviour in me apart from aggression?

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

In most of the 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 is why the medicines are given, which help in increasing the threshold and make you less irritable.

Patient's Query

Hi doctor,

If they are more than minor, what can I do then?

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

No sir, I have not. That is why I told you yesterday, that you are answering my questions properly and coherently and I suggested to reduce the medicines dose. You do not need such a high dose. Sometimes some irritation is justified in some situations. Also some aggressiveness is also a part of an indivudual's personality.

Patient's Query

Hi doctor,

This is the point I need more information about. Do the medicines prepare me to balance out this aggression and turn me to docile?

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Sure. Firstly irritability is something that cannot be assessed by oneself. That is why we always ask the informant or a family member for the 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 are in a similar situation, you can try to respond a little less aggressively. Also the old story of counting to ten before responding also works. It gives you a few seconds to process on how you want to react to a particular thing. Yes, that is the reason I suggesting to reduce the dose. Because there should be some normal aggressiveness too. You cannot be docile all the time.

Patient's Query

Hi doctor,

Thank you for the counselling.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

You are welcome.

Patient's Query

Hi doctor,

I have a query.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Kindly let me know your query.

Patient's Query

Hi doctor,

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 job and involves a bit of fast track learning, even though I am IT aware. My concern is whether this search for money is taking me away from my eventual goal, which is about "evolving people." Kindly help.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

If you have another option lined up, then you can consider between these two. If not, it is always better to take up the offer. Since being idle, might again worsen your symptoms. Working will keep you busy as well as ensure you have a regular flow of money. If you do not know somethings you can always try to figure it out. Also if you do not like it after a while, you can always quit. But if you say no, you will not have the opportunity again. So better not to pass any opportunity.

Patient's Query

Hi doctor,

The opportunity with IT infrastructure, I have already said yes. 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.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

It is good to see that you have multiple opportunities.

Patient's Query

Hi doctor,

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 is mind blowing that what you can become if you set your mind to it.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

That is 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 is not 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 will have a nice set of activities to keep you entertained and to focus on and improve.

Patient's Query

Hi doctor,

Primary is no longer available. I am pretty relaxed though.

Answered by Dr. Parth Nagda

Hi,

Welcome to icliniq.com.

That is fine. Good to hear that you are keeping busy and are relaxed.

Patient's Query

Hi doctor,

Tablet Olimelt seems to be giving me a strange constriction in the throat. It is there for a while now, I never noticed, today I decided to have Olimelt alone and got this sensation. What could be the reason?

Answered by Dr. Parth Nagda

Hi,

Welcome to icliniq.com.

I think you are allergic to a particular compound in that particular brand. It happens sometimes. I suggest you trying another brand like tablet Oleanz (Olanzapine) and see if you still have that sensation.

Patient's Query

Hi doctor,

What is the dosage of Oleanz?

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

You are taking 10 mg currently,so I suggest to continue with the same. After four weeks, I suggest to reduce it to 7.5 mg.

Patient's Query

Hi doctor,

Oleanz will be bought today, I want you to reduce it in two weeks. I have been talking to you for two weeks now.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Medicine is reduced every three or four weeks. Now I suggest reducing dosage of tablet Aripiprazole which is being reduced from 40 mg to 30 mg. In another two weeks I suggest reducing dosage of tablet Oleanz to 7.5 mg and Aripiprazole to 20 mg.

Patient's Query

Hi doctor,

Can Aripiprazole be reduced to 20 mg?

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Yes of course. It is not normally needed above that dose. But going straight from 40 mg to 20 mg is not advisable, so I suggest taking 30 mg for two more weeks and then we will decide.

Patient's Query

Hi doctor,

I think the best doctors are in my place.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Yes, your place does have good quality doctors.

Patient's Query

Hi doctor,

Tablet Oleanz works well.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

Kindly follow all the changes I suggested for about one or two weeks to show good effect.

Patient's Query

Hi doctor,

I hate certain people. I think that is the reason I was diagnosed with schizophrenia.

Answered by Dr. Parth Nagda

Hi,

Welcome back to icliniq.com.

That is a personal belief and most people will have such beliefs anyway. I do not think it will be a reason for your diagnosis of schizophrenia.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Parth Nagda
Dr. Parth Nagda

Psychiatry

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