If you or someone you love has been diagnosed with schizophrenia, you probably know how difficult it can be to find a treatment that truly works—and one that doesn’t cause frustrating or even painful side effects. It’s a constant balancing act. For many, it feels like being stuck between a rock and a hard place: medications might reduce symptoms like paranoia or hallucinations, but they can also leave people feeling emotionally flat, physically tired, or disconnected from life.
What’s even more frustrating? For nearly 70 years, the medications used to treat schizophrenia have worked in basically the same way. Since the 1950s, medications for schizophrenia have focused on blocking dopamine, a brain chemical involved in movement, pleasure, and motivation. While this approach can help reduce psychosis, it’s not very precise. These medications often affect parts of the brain we don’t want to disturb—leading to side effects like weight gain, hormonal imbalances, sexual dysfunction, sedation, and movement disorders such as tremors or tardive dyskinesia (TD), a potentially irreversible condition.
In fact, a major study found that three out of four people stopped their antipsychotic medication within 18 months, often due to side effects or because the medication wasn’t working well enough. When that happens, the risk of relapse, hospitalization, and long-term disability increases—making it harder to stay on the road to recovery.
But now, there’s reason to feel hopeful.
In 2024, the FDA approved a new kind of treatment called Cobenfy (xanomeline–trospium chloride). Unlike traditional antipsychotics, it doesn’t work by blocking dopamine receptors. Instead, it acts on the muscarinic system, which plays a key role in how the brain communicates. Specifically, xanomeline activates M1 and M4 muscarinic receptors in the brain. These receptors are thought to help regulate dopamine activity. By stimulating these receptors, this medication may reduce the excessive dopamine signaling associated with schizophrenia—but without directly blocking dopamine itself.
Trospium chloride is included to help reduce side effects. While xanomeline works in the brain, trospium blocks muscarinic receptors in the body, which helps prevent issues like nausea, sweating, and gastrointestinal discomfort. It’s a balancing act that allows the medication to target the brain where it’s needed, while protecting the rest of the body from unwanted side effects.
Think of it this way: Traditional treatments are like trying to block the flow of water by clamping your hand over the end of a hose. This treatment is more like turning down the faucet at its source—less pressure, more control.
In a key clinical trial, people treated with Cobenfy had a greater reduction in schizophrenia symptoms compared to those who took a placebo. After five weeks, scores on a standard symptom scale (called PANSS) dropped by about 20 points in the treatment group, versus around 12 points in the placebo group. Cobenfy led to roughly twice the reduction in positive symptoms (like hallucinations and delusions), negative symptoms (such as lack of motivation or emotional expression), and general psychiatric symptoms compared to placebo.
Here’s what makes this even more exciting: Cobenfy is not classified as an antipsychotic. It also comes without a black box warning and has no known risks for weight gain, prolactin elevation, or tardive dyskinesia. While it still has side effects—most commonly dry mouth, constipation, nausea, and drowsiness—many symptoms, including nausea and vomiting, were mild to moderate and short-term.
For those who’ve had to choose between mental stability and tolerable side effects, this treatment represents a long-overdue shift. It opens up the possibility of managing symptoms without feeling like you’ve lost a part of yourself in the process.
And perhaps most promising of all? This is likely just the beginning. Researchers are developing new treatments that work through different brain systems beyond dopamine. While antipsychotic medications have played a central role in managing schizophrenia for decades, this new direction may expand the tools available to address symptoms more precisely—and potentially with fewer side effects.
If you’ve ever felt discouraged by side effects or felt stuck in your treatment journey, know this: Better options are on the horizon, and they are rooted in science, compassion, and hope.