New Schizophrenia Medications Receive FDA Approval – But There’s a Catch
The FDA has recently approved the use of two new treatments to alleviate symptoms of schizophrenia, but these medications only address the “positive” symptoms of the condition.
New Schizophrenia Medications
Scientists and researchers have been working to treat schizophrenia effectively for years, and while several medications on the market lessen symptoms, two new treatments have gained traction in the mental health community. Lumateperone, also known as Caplyta, is an antipsychotic produced by the biopharmaceutical company Intra-Cellular Therapies, and it’s the most recent oral medication proven to reduce positive symptoms of schizophrenia.
The company first began clinical trials in 2019 and received FDA approval to treat patients using Caplyta in December 2019. Many researchers are excited about the medication because, while traditional schizophrenia medications inhibit dopamine D2 and serotonin 2A receptors to regulate the neurotransmission of dopamine and serotonin, this new medication also targets dopamine D1, glutamate, and serotonin reuptake. This is a new combination that has so far been successful. In part because of this study, scientists are now investigating other neurotransmitters in the brain and how they affect positive symptoms. Caplyta became available for use in early 2020, and the evidence continues to show that it is effective in the treatment of schizophrenia.
Even more exciting, in September 2021 the FDA approved Invega Hafyera, also known as paliperidone palmitate, which is the first and only twice-yearly treatment for adults with schizophrenia. It offers the least doses per year of any injectable used to treat the disorder, meaning fewer issues for patients who struggle with medication adherence or receiving injections.
Not only is the injection schedule easier to abide by, but the treatment itself is extremely effective. A 12-month randomized double-blind trial that had 702 adult participants found that 95% of participants treated with the 3-month regimen and 92.5% of participants treated with the 6-month regimen experienced no relapse of symptoms at the end of 12 months. The only drawback is that patients must take Invega Sustenna once a month for at least 4 months or Invega Trinza three times a month for at least one 3-month injection cycle before transitioning to Invega Hafyera. This may be difficult for some patients, but once they get past the first injection cycle of the other treatments, they are likely to find that Invega Hayfera’s injection cycle is less demanding and the treatment itself more efficacious in the long term.
While these advancements in medicine are astounding and provide a brighter future for people with positive symptoms of schizophrenia, there is one subgroup that was ignored in these studies. Neither Invega nor Caplyta alleviates the negative symptoms of schizophrenia, and there is a huge gap in the current research on medications for negative symptoms. This begs the question: why are negative symptoms so often ignored?
What is Schizophrenia?
Schizophrenia is a chronic mental disorder that affects roughly 1% of the world’s population. It’s characterized by three major categories of symptoms: positive, negative, and disorganized. Positive symptoms are what most people think of when they picture schizophrenia, perhaps due to their coverage in the media and their externalized manifestations. Some examples include visual, auditory, or even olfactory hallucinations of people, voices, and things that aren’t a part of reality. Delusions, often paranoid or persecutory, are irrational thoughts or false beliefs held despite the clear lack of evidence of their veracity. These symptoms, along with distorted perceptions, repetitive, jerky movements, and trouble concentrating comprise the positive symptoms of schizophrenia.
Positive symptoms add “abnormal,” or atypical, behaviors to people with schizophrenia, whereas negative symptoms take away behaviors that are present in neurotypical individuals. A person with negative symptoms of schizophrenia may appear “lazy” or lethargic to the untrained eye, but in reality, they may be struggling with a myriad of draining and debilitating symptoms. The inability to feel pleasure or enjoyment; poverty of speech; flat affect; absence of movement for hours at a time; and lack of interest in work, school, hobbies, or social activities, are all ways that negative symptoms can manifest: these symptoms may sound similar to those of depression, but depression also involves low mood and suicidal ideation, whereas negative schizophrenia is more characterized by flat tone, lack of facial expression, and poverty of speech.
It’s important to identify negative symptoms because they often occur before the onset of a major psychotic break, during which positive symptoms will take over. Catching the symptoms early on may help reduce the chance of developing positive symptoms. In addition, negative symptoms in and of themselves are debilitating and deserving of treatment. Although they may not be as conspicuous as the positives, they are still a major part of schizophrenia and deserve recognition.
Why Negative Symptoms Don’t Receive Public Attention
Positive symptoms are not subtle. People who have them may behave abnormally, talk to themselves, cover their ears, shout at random, or act as if they are being watched. Perhaps the extremity of positive symptoms and the easily observable behaviors explain why negative symptoms are often pushed to the side.
Negative symptoms can be quite conspicuous and unsettling as well, but the public is ill-informed about how they present and therefore doesn’t know what to look for. Even those experiencing negative symptoms may not understand what they’re going through. They may chalk it up to other mental illnesses, such as depression or anxiety. If they don’t recognize their negative symptoms for what they are, and others don’t either, they may go untreated until their first psychotic break. This is why it’s so important to recognize and treat these symptoms right as they present.
It’s not easy to identify schizophrenia when there are no positive behaviors. People with negative symptoms can be mistaken as socially awkward, introverted, “boring,” or tired. When people talk in a monotone, as do those with negative symptoms in some cases, others tend to tune them out. Think of the teacher’s voice in the movie Ferris Bueller’s Day Off – half the class doesn’t respond at first because they can’t pay attention to his flat, uninteresting tone. The lack of spontaneous or continued conversation may offend or put off people as well: they may think someone is being rude, unfriendly, or secretive. In reality, that person is experiencing poverty of thought and lack of interest, which leaves them at a loss for what to say.
Traditional media coverage is another barrier to achieving awareness of negative symptoms. While most media outlets have no issue reporting on and selling movies about the positive symptoms of schizophrenia, they typically pay no attention to the other side of schizophrenia. The media doesn’t always get stories about people with mental illness right – like in the movie Split, for example – but improved coverage could bring about more awareness of the negative symptoms of schizophrenia. This, in turn, could lead to increased funding for research on the treatment of negative symptoms.
Invega and Caplyta prove that wonderful advancement in medicine can still happen, but it looks as though society and research have a long way to go before all of the symptoms of schizophrenia are appropriately addressed and neutralized. Negative symptoms deserve the same attention positive symptoms receive because they have just as much of a negative impact on people’s lives. Because of people’s lack of awareness, though, people with negative symptoms may unjustly suffer in silence for years. That is unacceptable.
People have a responsibility to check in on the people in their lives, and if they observe abnormal behavior in an individual, they must try to help. Armed with more knowledge about the full spectrum of symptoms in schizophrenia, people will feel more empowered to speak up and help people with schizophrenia before their symptoms worsen and before their lives are negatively impacted.