Antipsychotics

Antipsychotics are a group of prescription medications used to treat psychosis and other serious mental health conditions. They play an important role in managing psychotic disorders such as schizophrenia and schizoaffective disorder, as well as mood disorders like bipolar disorder. Antipsychotic drugs help reduce distressing psychotic symptoms, improve daily functioning, and support long-term quality of life when used as part of a complete treatment plan.

These medications are sometimes called antipsychotic medications or neuroleptics. Over time, newer options have been developed to improve effectiveness and reduce the incidence and severity of side effects.

Antipsychotics are medications designed to treat symptoms of psychosis, which can include hallucinations, delusions, disorganized thinking, and changes in behavior or emotions. These symptoms are common in schizophrenia, but they can also occur in bipolar disorder, severe depression, and other psychotic disorders. In some cases, they are used alongside antidepressants or benzodiazepines to help manage complex mental health needs.

Antipsychotics work by changing how certain neurotransmitters send signals in the brain. Neurotransmitters are chemical messengers that affect mood, thinking, and behavior. Dopamine and serotonin are two key neurotransmitters involved in psychotic symptoms.

Most antipsychotics work by blocking or adjusting dopamine receptors. Too much dopamine activity is linked to hallucinations and delusions. By reducing this activity, antipsychotics help calm psychotic symptoms. Many newer medications also affect serotonin, which may help improve mood, anxiety, and negative symptoms such as low motivation or social withdrawal.

However, changes in neurotransmitters can also explain some side effects of antipsychotic medications, including sedation or movement-related effects.

First-generation Antipsychotics (typical antipsychotics)

These older medications mainly block dopamine receptors and are effective for positive symptoms of schizophrenia, such as hallucinations and delusions.

• Haloperidol (Haldol)
• Chlorpromazine (Thorazine)
• Fluphenazine (Prolixin)
• Perphenazine (Trilafon)
• Thiothixene (Navane)
• Trifluoperazine (Stelazine)
• Loxapine (Loxitane)
• Pimozide (Orap)
• Prochlorperazine (Compazine)

Second-generation Antipsychotics (atypical antipsychotics)

These newer medications affect both dopamine and serotonin and are often better tolerated.

• Clozapine (Clozaril)
• Risperidone (Risperdal)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Aripiprazole (Abilify)
• Ziprasidone (Geodon)
• Paliperidone (Invega)
• Lurasidone (Latuda)
• Asenapine (Saphris)
• Iloperidone (Fanapt)

Clozapine is often reserved for treatment-resistant schizophrenia when other antipsychotics have not worked.

The main use of antipsychotics is to treat schizophrenia and other psychotic disorders. They help control symptoms of schizophrenia such as hallucinations, delusions, and disorganized thinking.

Other common uses of antipsychotics include:

• Bipolar disorder, especially for manic or mixed episodes
• Schizoaffective disorder
• Severe depression when added to antidepressants
• Mood disorders with psychotic features
• Autism-related irritability and aggression
• Personality Disorder
• Tourette syndrome
• Obsessive-compulsive disorder in select cases

The use of antipsychotics depends on individual symptoms, response to treatment, and overall mental health goals. Proper prescribing and monitoring are essential.

Side effects of antipsychotics vary by medication and person. Some side effects are mild, while others may require medical attention. Common side effects include:

• Sedation or sleepiness
• Weight gain
• Dry mouth
• Constipation
• Dizziness
• Blurred vision
• Movement-related side effects such as tremors, stiffness, or restlessness
• Risk of tardive dyskinesia, which causes involuntary movements

Serious but rare side effects include:

• Neuroleptic malignant syndrome, a life-threatening reaction with fever, muscle rigidity, and confusion
• Risk of metabolic syndrome, including high blood sugar and cholesterol changes (common with atypical antipsychotics)
• Blood cell count changes with Clozapine

These are not all of the possible side effects of Antipsychotics. You should always seek medical advice from your healthcare provider for any questions or concerns about your medical condition or treatment. Read all patient information, medication guides, or drug information sheets that come with this medication. You can also report adverse effects to the Food and Drug Administration at www.fda.gov/medwatch or 1-800-FDA-1088.

Although these medications are generally well-tolerated and safe, there are certain warnings, precautions, and drug interactions you should be aware of.

Warnings

Before starting Antipsychotics, it is crucial to discuss any existing health conditions with your healthcare provider. You should be sure that your healthcare provider is aware of all your medical conditions, including if you have:

• Heart disease or irregular heart rhythms
• Diabetes or risk factors for metabolic syndrome
• A history of movement disorders
• Seizures
• Low white blood cell or other blood cell problems
• Liver disease

Some antipsychotics may increase the risk of falls, especially in older adults, due to sedation or low blood pressure.

Boxed Warning

Many antipsychotics carry a boxed warning about increased risk of death in older adults with dementia-related psychosis. These medications are not approved for this use unless specifically directed by a healthcare provider.

Contraindications

Antipsychotics may not be appropriate for people with certain medical conditions or allergies. For example, clozapine should not be used in patients with uncontrolled blood disorders. Always follow your provider’s guidance.

Drug Interactions

When Antipsychotics are taken with other prescription drugs, over-the-counter medications, vitamins, and supplements, it may change how they work or increase the frequency or severity of side effects. Make sure that you tell your healthcare professional about anything that you are taking to avoid any negative drug interactions, including:

• Benzodiazepines, which can increase sedation
• Other medications affecting serotonin or dopamine
• Certain heart medications that affect heart rhythm
• Alcohol, which can worsen side effects