What is the first line of treatment for severe schizophrenia?

Clozapine is considered the first line of treatment for severe schizophrenia, particularly in cases that are resistant to other treatments. It is an atypical antipsychotic that has shown efficacy in improving symptoms and is often used when patients have not responded adequately to at least two other antipsychotic medications. Clozapine is recognized for its unique ability to reduce the risk of suicide in patients with schizophrenia, making it a key option for those with severe illness.

While other medications may be used for schizophrenia, they do not have the same level of effectiveness in treatment-resistant cases as clozapine. Atypical antipsychotics, like risperidone, are often considered first-line treatments, but clozapine is reserved for scenarios where patients do not show improvement with other options. Escitalopram and bupropion are primarily used to treat mood disorders and are not indicated for the primary management of schizophrenia, which further establishes clozapine's role as the most suitable choice in severe cases.