Antipsychotics

Antipsychotics are medications primarily used to treat psychotic disorders like schizophrenia and bipolar disorder. These medications help reduce symptoms such as hallucinations, delusions, and disorganised thinking, while also helping to stabilise mood and behaviour.

Table of Contents | Jump Ahead

• What Are Antipsychotics?
• Types of Antipsychotics
• What Antipsychotics Treat
• How Antipsychotics Work
• Benefits of Antipsychotics
• Common Side Effects
• Movement Side Effects
• Metabolic Side Effects
• Starting Antipsychotics
• Monitoring and Follow-Up
• Finding the Right Antipsychotic
• Long-Acting Injectable Antipsychotics
• Antipsychotics and Pregnancy
• Drug Interactions
• Managing Side Effects
• When Antipsychotics Don't Work
• Stopping Antipsychotics
• Emergency Situations
• Special Populations
• Questions to Ask Your Doctor
• Cost and Insurance
• Myths About Antipsychotics
• Support and Resources
• Related Terms
• References

What Are Antipsychotics?

Antipsychotics, also called neuroleptics, are psychiatric medications that work by affecting dopamine and other neurotransmitter systems in the brain. They help restore the balance of brain chemicals that become disrupted in psychotic disorders and severe mood disorders.

Key characteristics of antipsychotics:

Two Main Categories Typical (first-generation) and atypical (second-generation) antipsychotics with different side effect profiles.

Multiple Uses Treat psychosis, stabilise mood, and help with severe behavioural symptoms.

Individual Response Different people respond better to different antipsychotics, requiring personalised treatment.

Long-Term Treatment Many people need to take antipsychotics for extended periods to maintain stability.

Types of Antipsychotics

Atypical (Second-Generation) Antipsychotics Newer medications like risperidone (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), and aripiprazole (Abilify).

Long-Acting Injectable Forms Monthly or quarterly injections for people who have difficulty taking daily pills.

Combination Medications Some antipsychotics are combined with mood stabilisers or antidepressants.

What Antipsychotics Treat

• Schizophrenia
• Schizoaffective disorder
• Bipolar disorder (manic and mixed episodes)
• Brief psychotic disorder
• Delusional disorder

Specific Symptoms

• Hallucinations (hearing or seeing things that aren't there)
• Delusions (false beliefs)
• Disorganised thinking and speech
• Severe agitation or aggression
• Catatonia (movement disorders)

Other Uses

• Severe depression with psychotic features
• Tourette syndrome
• Severe behavioural problems in autism
• Nausea and vomiting (some medications)

How Antipsychotics Work

Multiple Neurotransmitters Atypical antipsychotics also affect serotonin, norepinephrine, and other brain chemicals.

Brain Region Specificity Different antipsychotics affect different brain regions, leading to varying effects and side effects.

Gradual Improvement Symptoms typically improve gradually over weeks to months of treatment.

Benefits of Antipsychotics

Improved Functioning Better ability to work, maintain relationships, and care for yourself.

Mood Stabilisation Help prevent manic episodes and stabilise mood in bipolar disorder.

Reduced Hospitalisation Fewer psychiatric emergencies and hospital stays.

Quality of Life Enhanced overall well-being and life satisfaction.

Common Side Effects

• Movement disorders (tremor, stiffness, restlessness)
• Tardive dyskinesia (involuntary movements)
• Sedation and drowsiness
• Weight gain
• Sexual side effects

Atypical Antipsychotics

• Weight gain and metabolic changes
• Sedation
• Dizziness
• Constipation
• Lower risk of movement disorders

Serious Side Effects

• Neuroleptic malignant syndrome (rare but life-threatening)
• Severe movement disorders
• Metabolic syndrome
• Heart rhythm problems

Movement Side Effects

Tardive Dyskinesia Involuntary movements of the face, tongue, and limbs that may be permanent.

Akathisia Feeling of inner restlessness and need to move constantly.

Dystonia Sudden muscle contractions causing abnormal postures.

Metabolic Side Effects

Diabetes Risk Increased risk of developing type 2 diabetes, particularly with certain medications.

High Cholesterol Changes in lipid levels that may increase cardiovascular risk.

Metabolic Syndrome Combination of weight gain, diabetes, and high cholesterol.

Starting Antipsychotics

Low Starting Dose Most antipsychotics are started at low doses and gradually increased.

Monitoring Period Regular follow-up appointments to track response and side effects.

Baseline Testing Blood tests, weight, and other measurements before starting treatment.

Monitoring and Follow-Up

Weight and Vital Signs Regular checks of weight, blood pressure, and heart rate.

Movement Assessment Screening for movement side effects at each visit.

Symptom Tracking Monitoring improvement in psychotic symptoms and overall functioning.

Finding the Right Antipsychotic

Symptom Profile Different antipsychotics may be better for specific symptoms or conditions.

Side Effect Tolerance Choosing medications based on which side effects you can best manage.

Previous Response Past medication responses help guide future choices.

Long-Acting Injectable Antipsychotics

Steady Blood Levels Provide more consistent medication levels than daily pills.

Reduced Relapse Lower risk of symptom return due to missed doses.

Convenience Fewer doses to remember and manage.

Antipsychotics and Pregnancy

Safer Options Some antipsychotics have better safety profiles during pregnancy.

Specialised Care Working with specialists experienced in treating pregnant women with psychotic disorders.

Planning Ahead Discussing family planning before becoming pregnant.

Drug Interactions

Smoking Tobacco use can affect the metabolism of some antipsychotics.

Alcohol Can increase sedation and other side effects.

Supplements Even vitamins and herbal supplements can interact with antipsychotics.

Managing Side Effects

Additional Medications Sometimes other medications are added to manage specific side effects.

Dose Adjustments Lowering doses may reduce side effects while maintaining effectiveness.

Switching Medications Changing to a different antipsychotic if side effects are intolerable.

When Antipsychotics Don't Work

Medication Switching Trying different antipsychotics if the first one isn't effective.

Combination Therapy Adding other medications like mood stabilisers or antidepressants.

Clozapine Consideration For treatment-resistant schizophrenia, clozapine may be considered despite requiring special monitoring.

Stopping Antipsychotics

Gradual Tapering Slowly reducing doses over weeks or months to prevent rebound symptoms.

High Relapse Risk Most people with psychotic disorders will have symptom return if they stop medication.

Careful Monitoring Close observation during and after medication discontinuation.

Emergency Situations

Severe Movement Disorders Sudden onset of severe muscle contractions or movements.

Metabolic Crisis Severe changes in blood sugar or other metabolic problems.

Psychotic Relapse Return of severe symptoms may require hospitalisation.

Special Populations

Children and Adolescents Careful monitoring for growth and development effects.

People with Dementia Increased risk of death; use only when absolutely necessary.

Medical Conditions Heart, liver, or kidney problems may affect medication choice and dosing.

Questions to Ask Your Doctor

• How long will it take to work?
• What side effects should I expect?
• How will we monitor for problems?
• What should I do if I miss a dose?

About Treatment

• How long will I need to take this medication?
• What are the signs that it's working?
• When should I contact you?
• Are there alternatives if this doesn't work?

Cost and Insurance

Insurance Coverage Most insurance plans cover antipsychotics, though some newer ones may require prior authorisation.

Patient Assistance Programs Help is available for people who can't afford their medications.

Long-Acting Injections May be more expensive initially but can reduce overall healthcare costs.

Myths About Antipsychotics

"They Turn You Into a Zombie" Proper dosing should reduce symptoms while maintaining normal functioning.

"Natural Alternatives Are Just as Good" While lifestyle changes help, psychotic disorders typically require medication for effective treatment.

"You Should Be Able to Manage Without Them" Psychotic disorders are serious medical conditions that usually require medication.

Support and Resources

Family Education Help family members understand psychotic disorders and treatment.

Support Groups Connect with others who have similar conditions and understand the challenges.

Crisis Planning Develop plans for managing symptom relapses and emergencies.

Related Terms

• Schizophrenia - Primary condition treated with antipsychotics
• Bipolar Disorder - Another condition where antipsychotics are used
• Psychiatric Medications - Broader category including antipsychotics

References

U.S. Food and Drug Administration. (2016). Atypical Antipsychotic Drugs Information. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/atypical-antipsychotic-drugs-information

U.S. Food and Drug Administration. (2024). FDA Approves Drug with New Mechanism of Action for Treatment of Schizophrenia. https://www.fda.gov/news-events/press-announcements/fda-approves-drug-new-mechanism-action-treatment-schizophrenia

StatPearls/NCBI. (2023). Antipsychotic Medications. https://www.ncbi.nlm.nih.gov/books/NBK519503/

NCBI. (2024). Tables of FDA-Approved Indications for First- and Second-Generation Antipsychotics. https://www.ncbi.nlm.nih.gov/books/NBK84656/

World Health Organisation. (2023). Antipsychotic medicines for psychotic disorders. https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme/evidence-centre/psychosis-and-bipolar-disorders/antipsychotic-medicines-for-psychotic-disorders

NHS. (2024). Treatment - Schizophrenia. https://www.nhs.uk/mental-health/conditions/schizophrenia/treatment/

This information is for educational purposes only and is not a substitute for professional medical advice. Always consult with a qualified healthcare provider before starting, stopping, or changing any medication regimen.