Loss of Beliefs, Values, and Personality After Invega Sustenna
Direct Answer
The subjective experience you describe—feeling that you've lost your beliefs, values, and personality after multiple Invega Sustenna injections—represents a recognized phenomenon associated with antipsychotic medications, though it is not typically framed as a direct pharmacological effect in clinical literature. This experience may reflect several overlapping mechanisms including negative symptoms, cognitive blunting, emotional flattening, or what some patients describe as a loss of their "sense of self."
Understanding What May Be Happening
Potential Mechanisms
Antipsychotic medications, including paliperidone palmitate (Invega Sustenna), can affect subjective experience and sense of self through several pathways:
Dopamine blockade in mesocortical and mesolimbic pathways can contribute to what clinicians term "negative symptoms"—reduced motivation, emotional blunting, and decreased goal-directed behavior—which patients may experience as loss of personality or values 1
Cognitive effects have been documented with antipsychotics, though the relationship is complex, as the underlying illness itself significantly impacts cognitive functioning 2
Emotional flattening or affective blunting is a recognized adverse effect that can make patients feel disconnected from their previous emotional life and value systems 1
The Nature of the Illness Itself
A critical consideration is that schizophrenia and related psychotic disorders themselves can profoundly impact cognitive functioning, insight, personality expression, and social/vocational functioning 2. Distinguishing between medication effects and illness progression is clinically challenging but essential.
What the Evidence Shows About Invega Sustenna
Efficacy and Tolerability Profile
Paliperidone palmitate (Invega Sustenna) demonstrated efficacy in acute and maintenance treatment of schizophrenia, with reasonable tolerability in clinical trials 1, 3
The most common adverse events were extrapyramidal symptoms, tachycardia, and somnolence, with dose-related increases in Parkinsonism and akathisia 1
Paliperidone ER (the oral formulation) showed efficacy in adolescents aged 12-17 years with schizophrenia, though treatment-emergent adverse events were dose-related 4
Long-Term Considerations
Long-term exposure to antipsychotic medications carries inherent risks 2:
Concerns include tardive dyskinesia development and metabolic/endocrine adverse effects 2
The benefit-to-risk ratio of long-term treatments must be continuously reassessed 2
Guidelines emphasize that long-term medication exposure is "generally not without risk" 2
Critical Clinical Considerations
The Medication Non-Adherence Dilemma
Your experience highlights a fundamental tension in schizophrenia treatment:
Non-adherence to antipsychotic medication is associated with a five times higher relapse rate compared to continued treatment 2
However, the subjective tolerability of medications—including effects on sense of self, personality, and quality of life—is a legitimate and important outcome that should guide treatment decisions 2
Long-acting injections like Invega Sustenna were developed specifically to address non-adherence, but they also remove patient autonomy in stopping medication if side effects become intolerable 2
Quality of Life as a Priority Outcome
While preventing relapse is important, quality of life and subjective well-being are equally valid treatment goals:
The experience of losing one's beliefs, values, and personality represents a profound quality-of-life concern that warrants serious clinical attention
Some patients may prefer accepting higher relapse risk in exchange for better subjective experience and sense of self
The "potential heterogeneity of outcome in schizophrenia" means not all patients require the same intensity or duration of treatment 2
What You Should Do
Immediate Steps
Schedule an urgent appointment with your prescribing psychiatrist to discuss:
Your specific subjective experiences—describe in detail what aspects of your beliefs, values, and personality feel lost or changed
Timing of symptom onset—when did you first notice these changes relative to starting Invega Sustenna?
Dose and duration—what dose are you receiving and for how long?
Alternative treatment options, including:
- Switching to a different antipsychotic with potentially less impact on subjective experience
- Dose reduction if clinically appropriate
- Transitioning from long-acting injection to oral medication to allow more flexibility
- Considering whether continued antipsychotic treatment is necessary at current intensity
Treatment Modification Considerations
If your psychiatrist determines medication adjustment is appropriate:
Switching antipsychotics may help, as different agents have varying effects on subjective experience, though all antipsychotics carry some risk of these effects 2
Dose reduction might preserve some therapeutic benefit while reducing subjective adverse effects, though this must be balanced against relapse risk 2
Gradual discontinuation with close monitoring is an option if you and your psychiatrist determine the subjective costs outweigh benefits, recognizing this carries significant relapse risk 2
The Importance of Shared Decision-Making
Your subjective experience and quality of life should be central to treatment decisions:
Guidelines emphasize "patient preference" in treatment planning 2
The goal of treatment is not merely symptom suppression but restoration of meaningful life and functioning
You have the right to weigh the risks of relapse against the subjective costs of medication
Common Pitfalls to Avoid
Don't abruptly stop Invega Sustenna without medical supervision—the medication remains in your system for months after the last injection, and abrupt changes in psychiatric medication can be dangerous 5
Don't assume these effects are permanent—many medication-related subjective effects improve after switching medications or dose adjustment
Don't accept dismissal of your concerns—if your psychiatrist minimizes your experience of personality change, seek a second opinion
Don't delay seeking help—the longer you remain on a medication that profoundly affects your quality of life, the more difficult the situation becomes
The Bottom Line
Your experience of losing beliefs, values, and personality after Invega Sustenna injections represents a serious quality-of-life concern that warrants immediate clinical attention and potential treatment modification. While antipsychotic medications are effective at preventing relapse, their impact on subjective experience and sense of self is a legitimate reason to reconsider the current treatment approach. Work with your psychiatrist to find a treatment strategy that balances relapse prevention with preservation of your identity and quality of life.