Antipsychotics

Explains what antipsychotics are used for, how the medication works, possible side effects and information about withdrawal.

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What are antipsychotics?

Antipsychotics are psychiatric drugs which are available on prescription, and are licensed to treat types of mental health problems whose symptoms include psychotic experiences. These include:

Some antipsychotics may also be used to treat:

severe anxiety (but only in very low doses)
physical problems, such as persistent hiccups, problems with balance and nausea (feeling sick)
agitation and psychotic experiences in dementia (although they're not usually recommended in this case)

Antipsychotics can be prescribed to be taken in various different ways. Most commonly this will be orally in tablet or liquid form, but some of them can also be prescribed as depot injections.

Other terms for antipsychotics

Antipsychotic drugs can also be called neuroleptics. Some people prefer this term because it means 'seizing hold of the nerves', which describes their action more accurately. You might also hear antipsychotics referred to as major tranquillisers, which is an old-fashioned term for the same drugs.

What's it like taking them?

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

How do they work?

Antipsychotic drugs don't cure psychosis but they are often effective in reducing and controlling many 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

Rather than getting rid of these symptoms completely, the drugs may just stop you feeling so bothered by them – so you feel more stable and can get on with leading your life the way you want to.

"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 can be effective in controlling and reducing psychotic symptoms:

Blocking the action of dopamine. Researchers 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 messages, which may be too frequent in psychotic states.
Affecting other brain chemicals. Most antipsychotics are known to affect other brain chemicals too, such as the neurotransmitters serotonin and noradrenaline, which are both thought to be involved in regulating mood.
Parkinsonism. Some academics have suggested that antipsychotics may actually work by causing Parkinsonism (a movement disorder) – not just the physical symptoms, which are well known neuromuscular side effects of these drugs, but also the psychological symptoms, such as not feeling emotions and losing interest in activities.

What different types of antipsychotics are there?

Antipsychotic drugs tend to fall into one of two categories: first generation (older) antipsychotics and second generation (newer) antipsychotics. Both types can potentially work well, but they differ in the kind of side effects they can cause and how severe these may be.

First generation (older) antipsychotics

Key facts:

mostly developed and first licensed in the 1950s
sometimes referred to as 'typicals'
these 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
however, they're 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:

mostly developed and first licensed in the 1990s
sometimes referred to as 'atypicals'
in general these cause less severe neuromuscular side effects than first generation antipsychotics
some also cause fewer sexual side effects compared to first generation antipsychotics
however, second generation antipsychotics are more likely to cause serious metabolic side effects, including rapid weight gain

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