Schizophrenia has a profound impact not only for the person living with schizophrenia, but also for their loved ones. It changes how people feel, think, and behave, often to extremes. While support from health professionals is essential, schizophrenia is almost always treated with antipsychotics. Current treatments with medications have proven to be helpful, but with limits. Despite this, the drug treatments for schizophrenia have barely changed in the past 70 years.

The current antipsychotics available to patients all work with the same mechanism of the brain, by blocking a specific group of receptors and altering dopamine pathway signalling. Blocking dopamine has been shown to be very effective in decreasing psychotic symptoms. However, while there are decreases in delusions and hallucinations, these medications have no effect on other symptoms associated with schizophrenia, such as social withdrawal, lack of motivation, and loss of pleasure. They can also have substantial side effects, including significant weight gain, changes in hormone levels, and increases in sugar levels in the bloodstream. These factors can make patients reluctant to continue taking medications, which increases risk of relapse.

As a result, psychiatrists and patients have been hoping for years for a new treatment with more benefits and fewer side effects. But the complexity of the brain and the fact that we do not know everything about the causes of mental illness has made progress difficult. It does not help that most major pharmaceutical companies have become more focused on other more lucrative areas of medicine, which unfortunately does not include medication for mental illness.

This is why a new antipsychotic medication that has recently become available is such an encouraging development. This new medication works differently than the medications we have had for the last few decades.

Cobenfy does not target the dopamine system directly but instead works by helping brain cells communicate in a different way. It boosts acetylcholine signals, which regulates dopamine naturally. Once a patient’s dopamine level is more balanced, symptoms such as delusions and hallucinations decrease. As well, researchers report a decrease in other negative symptoms such as social withdrawal.

Excitingly, studies have shown patients on this medication did not experience many of the usual side effects from antipsychotics. Some patients in trials reported feelings of nausea, but said it was tolerable and decreased over time. Other reported side effects include indigestion and elevated blood pressure, but they often resolved within days or weeks.

Cobenfy became available in the United States in 2024 but has not yet been approved by Health Canada. While early results seem very encouraging, further research is needed. It is yet to be seen how effective this medication is in the long term, and whether there are other, not yet identified, side effects.

The fact that research is moving forward is very promising. It is possible that this medication could be effective to treat other mental health conditions, such as bipolar disorder. Although there is still work to be done, these recent developments are encouraging and offer hope for the future.

An important note: while medication is often the first line of treatment, therapy, supportive services, diet, and exercise play important roles. Visit amiquebec.org/schizophrenia for help for yourself or someone you care about.

According to Mad in America, another new drug has recently been approved, but it is basically the same as an old medication and did not go through any clinical trials. Iloperidone (also known as Fanapt) was resubmitted to the FDA as a new drug, Bysanti. Vanda Pharmaceuticals argued that studies for the previous drug should count for this new version, even though they were submitting it as something new. Some studies they were citing were decades old, including trials conducted 25 years ago. There seems to be very little difference between the two drugs, so it’s unclear why Bysanti was released. Mad in America suspects it may have been to extend a patent that was about to expire, or to attempt to increase the company’s value by releasing something new. It could also be to complicate the upcoming release of a generic version, making it more difficult for patients to have access to a less expensive option.

–Emily Verrall
From Share&Care Fall 2026
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