Antipsychotics: Types, Side Effects, & Uses

What Are Antipsychotics?

If you have psychosis, your doctor may recommend an antipsychotic medication. Antipsychotics are psychiatric medications used to treat symptoms of psychosis. These medications can also be prescribed to treat other mental health conditions, such as severe depression and bipolar disorder. These medications work by reducing the action of dopamine.

Antipsychotic drugs can be used alone to treat symptoms of psychosis which include delusions and hallucinations. However, when used to manage symptoms of mania, they are often taken with a mood-stabilizing drug. Taking antipsychotics like haloperidol with tricyclic antidepressants can increase the risk of serious side effects.¹

Antipsychotic drugs don’t cure psychosis but help to reduce and control psychotic symptoms. These drugs are not addictive and your doctor may consider this drug as a treatment based on its effectiveness and treatment duration.

Antipsychotics are FDA-approved to treat the following conditions:²

• Bipolar disorder (bipolar psychosis)
• Severe depression (major depressive disorder and treatment-resistant depression)
• Schizophrenia
• Personality disorders
• Delusional disorder

Some off-label uses of antipsychotic drugs include treating the following conditions:³

• Anxiety
• Attention deficit hyperactivity disorder (ADHD)
• Eating disorders
• Posttraumatic stress disorder (PTSD)
• Obsessive-compulsive disorder (OCD)
• Psychotic features of dementia
• Physical problems such as balance problems and hiccups

How Are Antipsychotic Medications Prescribed?

Antipsychotic medications are only available by prescription through a licensed health practitioner. Severe side effects may be associated with the medications, including blurred vision, hallucination, and drowsiness which can be life-threatening. While you can get administered the drugs in hospitals, you can also take them home after consulting your doctor.

Antipsychotics can be lethal if taken in excessive doses. The maximum dosage of the medication varies depending on a particular antipsychotic drug, your medical history, and your health condition. Therefore, taking the medication as prescribed by your doctor to prevent severe health risks is critical.

Medical professionals who can prescribe antipsychotics include:

• Psychiatrists
• Licensed nurse practitioners
• Licensed physician assistants
• Primary care providers
• Licensed pharmacists

Antipsychotics have multiple delivery methods, such as:

• Oral tablets: This is the most common delivery method for antipsychotics. Usually, the drug is swallowed and absorbed in the body. The medication is usually taken once daily and can be taken at home or in the office. However, it’s important to note that the timing of antipsychotic tablets can vary based on medication and a patient’s needs, as some may cause drowsiness while others may cause insomnia.
• Liquid solutions: This is another delivery method for antipsychotics. Liquid solutions can be administered once per day. The frequency can also vary depending on a patient’s needs and medication. Since antipsychotics can cause drowsiness or insomnia, administration time is an important factor your doctor will consider. However, it is usually administered in the morning and can be at home or the office.
• Depot injections: This type of long-acting injectable drug can provide a sustained release for some time. Depot injections can be administered either after two or four weeks depending on the condition being treated, the medication, and a patient’s needs.⁴

How Do Antipsychotics Work?

Generally, antipsychotics affect brain chemistry by regulating certain neurotransmitters, such as dopamine which regulates mood, behavior, and thought processes. These medications block or reduce dopamine action in the brain, which helps relieve the symptoms of hallucinations and delusions in psychotic disorders like schizophrenia. Also, some antipsychotics may induce Parkinsonism or other movement side effects in some people by inhibiting the effects of dopamine in the brain, which is involved in movement control.^5,6

Antipsychotic medications do not cure the causes of psychosis. Instead, they help alleviate the intensity of the symptoms. Therefore, before starting your medication, consult your doctor to understand the benefits and risks of the medication.⁵

Antipsychotics may reduce negative symptoms such as:

1. Incoherent speech or rapid speech: Antipsychotics positively impact mood, impulsive behavior, and reduce excessive energy because they reduce delusions.
2. Delusions of persecutory delusions: These drugs regulate dopamine and other neurotransmitters in the brain, which help improve mood, behavior, and delusions.
3. Mania: This is a symptom of bipolar disorder. Antipsychotic drugs help reduce symptoms of mania by blocking the actions of dopamine, which helps influence mood and behavior.

Common Antipsychotic Drugs

Two types of antipsychotic drugs are categorized into two generations: 1st generation antipsychotics and 2nd generation antipsychotics. The first generation was developed in the 1950s, while the second generation was developed in the 1980s. The primary difference between the two generations of antipsychotic drugs is that the 1st generation is dopamine receptor antagonists (DRA, also known as typical antipsychotics). In contrast, the 2nd generation is serotonin-dopamine antagonists (atypical antipsychotics).

*All medications have a risk of side effects, some of which can be severe. Before starting any medication, you should discuss the potential benefits and risks with your doctor. It would be best to tell them about any medications, herbs, or supplements you take regularly and share your health history to ensure you take safe medication.

Common antipsychotics include:

Typical “1st Generation” Antipsychotics

First-generation antipsychotics (typical antipsychotics) are a class of antipsychotic medications commonly prescribed to treat symptoms of schizophrenia and other mental conditions. Typical antipsychotics work by inhibiting the actions of dopamine, which helps to regulate mood and behavior. Common 1st generation of antipsychotics includes fluphenazine and haloperidol. These drugs were developed in the 1950s when chlorpromazine was first discovered and prescribed by doctors for use as antipsychotic medication.¹²

These antipsychotic drugs have a higher risk of side effects, including movement disorder side effects, than the second generation of antipsychotics. Some commonly reported side effects associated with the medications include movement disorders such as parkinsonism and tremors.

Common, typical antipsychotics prescribed include:²

• Phenothiazines (perphenazine, acetophenazine)
• Butyrophenones (haloperidol)
• Thioxanthenes (thiothixene, chlorprothixene)
• Dibenzoxazepines (loxapine)
• Diphenylbutylpiperidine (pimozide)

Atypical “2nd Generation” Antipsychotics

Second-generation antipsychotics (atypical antipsychotics) are antipsychotics used to treat symptoms of schizophrenia and other mental conditions such as bipolar disorder. Compared to typical antipsychotics, 2nd generation antipsychotics mainly target dopamine receptors and neurotransmitters such as serotonin and norepinephrine.² This helps to improve mood and reduce anxiety and agitation symptoms. These medications were developed in the 1990s and approved in the United States. Since then, it has become a first-line choice among doctors and patients due to its effectiveness and improved side effects than typical antipsychotics.

Compared to 1st generation, atypical antipsychotics have a lower risk of severe movement disorders. However, they are associated with other side effects, such as weight gain. Therefore, these side effects associated with the medications are significant factors doctors usually consider before prescribing the drugs.²

Common atypical antipsychotics prescribed include:²

• Lurasidone (Latuda)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Amisulpride (Solian)
• Aripiprazole (Abilify)
• Aripiprazole (Aristada injection)
• Paliperidone (Invega)

Clozapine

Clozapine works slightly differently from other antipsychotics. The drugs are usually prescribed to people who are treatment-resistant. Generally, it’s a medication for patients who have failed multiple antipsychotic therapy trials.² This medication is associated with severe side effects, including agranulocytosis (this results in a drop in red blood cell count in the body), seizures, and suicidal thoughts. Clozapine is sometimes effective at treating symptoms of tardive dyskinesia. The FDA has approved clozapine for treating:²

• Resistant mania
• Severe psychotic features
• Obsessive-compulsive disorder
• Pervasive developmental disorders
• Childhood autism
• Parkinson disease

Side Effects of Antipsychotic Medications

Antipsychotic medications belong to the same drug class. This means they carry similar risks of side effects across them all. Some of these medications may cause severe side effects that usually vary from person to person, depending on the psychotic dose and a person’s characteristics. Commonly reported side effects associated with antipsychotic medication include drowsiness and blurred vision.

Common side effects of 1st generation antipsychotics include:²

• Uncontrolled movement
• Sexual problems
• Weight gain
• Hyperprolactinaemia
• Sedation
• Drowsiness
• Confusion

Are Antipsychotics Right for Me?

Your doctor will assess your health condition and determine if antipsychotic medications are right for you. However, several factors will have to be considered. This includes your health condition, the nature of the condition being treated, and the effectiveness and treatment duration of the medication. To prevent risks of withdrawal effects, ensure your doctor helps you taper your dosage or prescribe another medication.

Questions to Ask your Health Team About Antipsychotics

Talk with your doctor before starting any medication. This will help address safety concerns and ensure you are safe on the medication. You can ask your doctor about the risks associated with the medication or if it’s possible to take them with other medications. Also, if you are struggling with your condition or have overdosed on antipsychotic drugs, call the 9-1-1 hotline number for immediate medical assistance.

Questions to ask your care team before taking antipsychotics include:

1. Is this the right medication for my condition?
2. What are the side effects associated with antipsychotic medications?
3. What are the benefits and risks of taking antipsychotic drugs?
4. What should I do if the medications do not work for me?
5. How long will I take this medication to benefit fully from it?
6. Can I use other medications apart from antipsychotics for my condition?
7. What is the benefit of tapering my dosage instead of quitting immediately?
8. Why would this medication be recommended over others?
9. How much will my medications cost, and are there ways to save money, such as coupons for Vraylar?

Final Thoughts

Antipsychotics can be extremely helpful in reducing symptoms of psychosis, but it’s essential to discuss with your care team whether it’s the right medication for you. This will ensure you are safe on the medication and address possible health risks before starting your prescription.