Antipsychotics

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

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Could antipsychotics help me?

"I decided to try antipsychotics because my hallucinations and lack of sleep were putting my safety at risk. Before I was on my medication, I was exhausted."

Which antipsychotic might be right for me?

Your doctor's decision to offer you antipsychotic medication is likely to depend on:

Your exact diagnosis and the symptoms you experience.
For example:
- for schizophrenia – all antipsychotics may help control the 'positive' symptoms of schizophrenia (i.e. additions to your thoughts and behaviour, such as seeing or hearing things that other people don't). However, in general only second generation drugs can help with the 'negative' symptoms (i.e. losses in your thoughts and behaviour, such as lacking enthusiasm for life, neglecting your appearance and hygiene, and being unable to concentrate). First generation drugs usually have no effect on the negative symptoms, and some of their side effects may even make them worse. If neither an older nor a newer antipsychotic has controlled your symptoms after trying them for six to eight weeks, your doctor is likely to suggest you try clozapine.
- for bipolar disorder or severe depression – your doctor is more likely to suggest a second generation antipsychotic.
- for anxiety – any kind of antipsychotic might work for you, but it would only be prescribed at a very low dose.
Your past experiences of taking medication, including what's worked for you and what hasn't. For example, if you've tried one kind of antipsychotic and had lots of problems with it, your doctor should offer you a different type instead.
Your medical circumstances. See our page on taking antipsychotics safely for details of situations where you might need to be particularly cautious about taking antipsychotics, or avoid certain drugs altogether.
What you want. The choice of which medication you take should always be made on the basis of a discussion between you and your psychiatrist, taking your preferences into account. You could ask a trusted friend, family member or carer to be included in the discussion if you wish. (For guidance on what you might want to discuss with your doctor, see our pages on what to know before you take any drug and finding the right drug for you. For guidance on talking to your doctor, having your say in decisions and making yourself heard, see our pages on seeking help for a mental health problem).

"I'm always trying new medications but none have worked well for me."

How quickly will they work?

This partly depends on how you take them:

By mouth. If you take them by mouth, in tablet or in syrup form, the sedative effect usually takes a few hours; the liquid form may act more quickly than the tablets.
Depot injection. Some antipsychotics are available by deep injection into a muscle, known as a ‘depot’. This is a slow-release version, which acts slowly and steadily over the course of two to six weeks, depending on the drug. See our page on depot injections for more information.
Emergency injection. In an emergency you may be given an injection into a muscle. In this case the sedative effect is rapid and reaches a peak within one hour.

Other factors that can also affect how quickly any medication works for you personally include your metabolism, your liver enzymes and how physically active you are.

However you take the drugs, they may calm you down quite quickly but your psychotic symptoms may take days or weeks to suppress.

When could I be given an emergency injection?

An emergency situation would be if you are behaving in a way that is:

putting yourself at immediate risk
putting other people at immediate risk

In a situation like this, doctors may decide that you need something to calm you down as quickly as possible (this is called rapid tranquillisation). They can do this without your consent if you are being detained under the Mental Health Act 1983, often called being 'sectioned'. See our pages on sectioning for information about when it may be legal to section you and what your rights are in this situation.

Emergency medication should ideally be given to you by mouth, but if that's not possible you may need to be given drugs by injection (this would be a fast-acting injectable formulation for emergency use, not a depot injection). The drugs which may be given by emergency injection are: olanzapine, aripiprazole, lorazapam (a minor tranquilliser) or promethazine (an antihistamine). Zuclopenthixol (Clopixol acuphase) and haloperidol may also be used.

Understandably, experiencing rapid tranquillisation like this can be traumatic. Due to this, NICE best practice guidelines state that afterwards you should be given the opportunity to:

discuss the experience with the health professionals responsible for your care
write down your own record of what happened, to be kept in your hospital notes

Remember: if you are not happy with how you've been treated, you can complain. See our pages on making a complaint about health and social care.

Might I need to take other medication as well?

Depending on your diagnosis, the problems you experience, and the kind of side effects your main antipsychotic can cause, your doctor might suggest that a combination of an antipsychotic and another drug might be the best way to manage your symptoms. In this case, they might decide to offer you other kinds of medication as part of your treatment, such as:

antidepressants, if you are severely depressed
mood stabilisers, if you have a diagnosis of bipolar disorder or schizoaffective disorder
sleeping pills and minor tranquilisers, if you are extremely agitated or finding it impossible to sleep
anti-Parkinson's drugs – these aren't psychiatric medication, but they are sometimes prescribed alongside antipsychotics to help reduce their neuromuscular side effects. See our page on anti-Parkinson's drugs for more information about this kind of medication.

Remember: you should always check with your doctor or pharmacist before taking any drugs together, or closely following one another, in case they could interact with each other badly. See our page on taking antipsychotics safely for more information. For details about a specific drug, you can look it up in our antipsychotics A-Z.

"It's difficult to say [how antipsychotics are working for me] as I was prescribed strong antidepressants and sleeping pills at the same time."

Might I need to take two antipsychotics at once?

Prescribing more than one antipsychotic drug at the same time is called polypharmacy. In most cases doctors should avoid doing this – except in specific short-term situations, such as while you are switching from one drug to another.

However, in some circumstances your doctor may decide to prescribe more than one antipsychotic on a longer-term basis. This may happen if:

your regular medication doesn’t seem to be working well enough
you and your doctor have found that a careful combination of two drugs is what controls your symptoms best

You may find that if you are detained in hospital (sectioned) under the Mental Health Act 1983, your doctor is more likely to prescribe you more than one antipsychotic at once, or a higher dose, than someone who is a voluntary patient.

Could taking antipsychotics make me feel worse?

It's important to remember that all drugs can affect different people differently.

Not everybody finds antipsychotics helpful, and they all have the potential to cause unwanted side effects, which affect a lot of people who take them to some extent. Although many people find that the benefits of taking an antipsychotic outweigh any negatives, not everybody does – and your experience will be personal to you. You may need to try a few different drugs before you find the one that suits you best, and work with your doctor to find the right dosage for you.

It's also important to be aware that antipsychotics can be hard to come off, and may cause withdrawal effects if you come off them too quickly. See our page on coming off antipsychotics for more information.

To learn about the possible side effects and withdrawal effects associated with a particular antipsychotic, you can look it up in our antipsychotics A-Z. For ideas on managing your mental health without drugs, see our page on alternatives to medication.