Antipsychotics

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What are antipsychotics?

Antipsychotics are a type of psychiatric medication which are available on prescription to treat psychosis. They are licensed to treat certain types of mental health problem whose symptoms include psychotic experiences. This includes:

• schizophrenia
• schizoaffective disorder
• some forms of bipolar disorder
• severe depression
• the psychotic symptoms of a personality disorder.

Some antipsychotics are also licensed to treat other health problems, including:

• physical problems, such as persistent hiccups, problems with balance and nausea (feeling sick)
• agitation and psychotic experiences in dementia. This is only recommended if you pose a risk to yourself or others, or if you are severely distressed.

Antipsychotics can be prescribed to be taken in various different ways. Most commonly you will take them by swallowing them, in tablet or liquid form. But some of them can also be prescribed as a depot injection. This is a slow-release, slow-acting form of the medication, given as an injection every few weeks. 

If you are given antipsychotics in hospital, doctors may use a type of antipsychotic that you can inhale, called loxapine adasuve. But this is not available for general prescription.

Who can prescribe antipsychotics?

The healthcare professionals who can prescribe you antipsychotics include:

• a psychiatrist
• your doctor (GP)
• a specialist nurse prescriber
• a specialist pharmacist.

When you are first prescribed antipsychotics, this is usually done by a psychiatrist. Your GP can also sometimes give your first prescription. But they more likely to give you ongoing prescriptions, once you are already taking the medication.

These information pages usually refer to 'your doctor or psychiatrist' prescribing this medication. They are the most likely people to prescribe you these drugs.

Talking about antipsychotics

Watch Steve, Joe, Laura and Ziaul talk about their experiences of taking antipsychotics in this video:

How do antipsychotics work?

Antipsychotic drugs don't cure psychosis but they can help to reduce and control many psychotic symptoms, including:

• delusions and hallucinations, such as paranoia and hearing voices
• anxiety and serious agitation, for example from feeling threatened
• incoherent speech and muddled thinking
• confusion
• violent or disruptive behaviour
• mania.

Antipsychotics might not get rid of these symptoms completely. They may just stop you feeling so bothered by them. This is to help you feel more stable, so you can lead your life the way you want to. Taking antipsychotics can also reduce the risk of these symptoms returning in future (relapse).

You may find that some types of antipsychotic work better than others for your symptoms. Or you may find that antipsychotics aren’t right for you. See our page on how antipsychotics can help to find out more.

They make me feel calm, help me sleep, stop racing thoughts and help blunt hallucinations. Meds don't make life perfect – they just help me cope with the imperfections and struggles I face.

What's the science behind antipsychotics?

There are several possible explanations why antipsychotic drugs may help to reduce psychotic symptoms:

• Blocking the action of dopamine. Some scientists believe that some psychotic experiences are caused by your brain producing too much of a chemical called dopamine. Dopamine is a neurotransmitter, which means that it passes messages around your brain. Most antipsychotic drugs are known to block some of the dopamine receptors in the brain. This reduces the flow of these messages, which can help to reduce your psychotic symptoms.
• Affecting other brain chemicals. Most antipsychotics are known to affect other brain chemicals too. This may include the neurotransmitters serotonin, noradrenaline, and glutamate. These chemicals are thought to be involved in regulating your mood.
• Parkinsonism. Some scientists believe that certain antipsychotics work by causing Parkinsonism, which is a movement disorder. This means that they may cause some of the physical symptoms of Parkinsonism as side effects. But they may also cause the psychological symptoms of Parkinsonism, such as not feeling emotions and losing interest in activities. These effects are more common with first-generation, or 'typical' antipsychotics.

Antipsychotics may help to relieve psychotic symptoms by causing changes to your brain chemistry. But the causes of psychosis can be very complex, and may be affected by your life experiences and your environment as much as the chemicals in your brain.

This is why you are likely to be offered talking therapy as a treatment for your psychosis, alongside medication. This is to help you with the causes of your psychosis, while the medication helps you deal with the symptoms.

What different types of antipsychotic are there?

Antipsychotic drugs tend to fall into one of two categories:

• first generation (older), or 'typical' antipsychotics
• second generation (newer), or 'atypical' antipsychotics.

Both types can potentially work for different people. They also have different side effects.

First generation (older) antipsychotics

Key facts:

• These are sometimes referred to as 'typicals'.
• They divide into various chemical groups which all act in a very similar way and can cause very similar side effects, including severe neuromuscular side effects.
• But they are not all the same. For example, some may cause more severe movement disorders than others, or be more likely to make you more drowsy.

Second generation (newer) antipsychotics

Key facts:

• These are sometimes referred to as 'atypicals'.
• In general, they cause less severe neuromuscular side effects than first generation antipsychotics.
• Some are also less likely to cause sexual side effects compared to first generation antipsychotics.
• But second generation antipsychotics may be more likely to cause serious metabolic side effects. This may include rapid weight gain and changes to blood sugar levels.

The side effects that you may experience from drugs in either group will vary, depending on your dose and how you respond to the drug that you are prescribed.

For a full list of all antipsychotic drugs compared by category, form and half-life, see our page on comparing antipsychotics. For more details about specific antipsychotics, you can also look up each individual drug in our A–Z of antipsychotics.

I still take antipsychotic medication today and I don't have a problem with it. I feel so much better than when I was first prescribed an antipsychotic. I know that they work for me and help.

This information was published in September 2020. We will revise it in 2023.

References and bibliography available on request.

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