Starting antipsychotics as a teenager

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I am 19 years old now, a sophomore at a community college outside Phoenix. I started taking antipsychotic medication when I was sixteen, three months after my first hospitalization. I want to write about what those first months were actually like, because most of what I read at the time was either written for parents or written by adults who had been on medication for decades. There was almost nothing for someone like me — a kid who had not finished growing yet, who was being asked to make a long-term decision about my brain in the middle of the worst year of my life.

The lead-up

My symptoms started in tenth grade. I began to feel that the patterns of cars passing my school were sending me messages. I thought my chemistry teacher could read my thoughts. I stopped sleeping more than a few hours a night. My grades, which had been good, fell off a cliff. My parents thought I was using drugs. I was not. I was confused and frightened in a way I did not have words for.

The hospitalization happened after I called my mom from the school bathroom and told her the principal was a clone. She drove me to the children's hospital. I spent eleven days on the adolescent psychiatric unit. The discharge diagnosis was schizophreniform disorder, which the team explained could become schizophrenia if symptoms continued past six months. They prescribed risperidone — the antipsychotic the FDA has approved for adolescents with schizophrenia — at a low starting dose.

What I was not prepared for

The hospital prepared me for the diagnosis but not really for the experience of taking the medication. The pamphlet they gave me was three pages and listed every possible side effect with no sense of how common any of them were. I read it in the car on the way home and decided I was going to die.

Some things I wish someone had said to me directly in those first weeks:

• The first two weeks are usually the worst part for side effects, and many of them get better.
• You will be tired. Like, deeply tired. Like, "I cannot stay awake in fourth period" tired. This is normal at the start.
• Your appetite may change a lot. Mine doubled in three weeks.
• Your face may stop showing emotion as much. Other people will notice. You may not.
• The voices and the messages going quiet may feel weirder than you expect. The silence is not just silence; it is the absence of something that had become part of you.
• Nothing about taking medication makes you weaker, less of a person, or less yourself. It is treating an illness in your brain the same way insulin treats diabetes.

The first three months

Weeks 1–2

I slept twelve hours a night and was still tired during the day. I gained four pounds. I was nauseous in the mornings. The "messages" from passing cars stopped, which was disorienting because I had been sure they were real. I cried in my mom's car after my first follow-up appointment because the psychiatrist asked me how I was and I did not know how to answer.

Weeks 3–6

The sedation started to lift. My mind felt slower in a way that was sometimes frustrating — the racing thinking that had felt so urgent was just gone — and sometimes a relief. I went back to school for half-days. My grades were terrible, but I was there. I started to be able to read a book again.

Weeks 7–12

The dose was adjusted slightly upward because I had a few breakthrough episodes of suspicion. My weight kept creeping up. I started a relationship with a school counselor who specialized in early-psychosis programs through our county's coordinated specialty care team. The NIMH RAISE program describes the model of care I got: psychiatry, therapy, family support, and education support all coordinated together. Without that team I do not think the medication alone would have been enough.

The hardest part: feeling different from my friends

The medication itself was not the hardest part. The hardest part was being a sixteen-year-old who had to take a pill every night while my friends were sneaking sips of vodka at parties and posting on Instagram about how good they felt. I felt like I had been pulled out of the normal teenage experience and dropped into something else.

Three things eventually helped:

• Telling one friend. I told my best friend a year in. She was kinder than I had imagined. We are still friends. She knows what to look for if I get sick again.
• Finding the early-psychosis support group. The CSC program ran a weekly group for teens and young adults. Everyone there was within five years of their first episode. For the first time I was in a room of people who did not have to have schizophrenia explained to them.
• Asking my psychiatrist real questions. I learned, slowly, that I was allowed to ask things like "Will I be on this forever?" and "Could a different medication have fewer side effects?" My psychiatrist took those questions seriously. She said it was a question we would revisit at every appointment, which made it feel less like a sentence and more like a plan.

What changed in year two

By the time I was 17, the dose had stabilized. The weight gain plateaued after I started lifting weights and walking with my dog every evening. I switched eventually to a different antipsychotic with a slightly better metabolic profile after a long conversation with my psychiatrist about my goals — see when to switch antipsychotics. I finished high school on a modified schedule. My voices have been quiet for two years. I have had two short wobbles, both during finals week, both manageable.

What I would tell another teenager starting medication

• The first month is the worst of it for most people. If you can get through the first month, things usually get better.
• Track your side effects in a notebook or app. Bring the notes to every appointment. Vague descriptions are hard for prescribers to act on.
• Ask your psychiatrist about the specific side effects you are most worried about. There are usually options.
• Get involved with an early-psychosis program if your area has one. The combination of medication, therapy, and peer connection is what made the difference for me.
• You are still you. The medication does not change who you are. It quiets the noise that was making it hard to be yourself.

I am not in remission. I am in treatment. There is a difference, and I have made my peace with it. I am also in college, in a relationship, and writing this on a Tuesday afternoon between classes. None of that would have been possible without the medication that I was so afraid of at sixteen.

For more on early treatment, see teens and antipsychotics, coordinated specialty care, and early intervention services.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.