Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of other psychotic disorders.
Antipsychotic medications are used as a short or long-term treatments for bipolar disorder to control psychotic symptoms such as hallucinations, delusions, or mania symptoms. These symptoms may occur during acute mania or severe depression. Some also treat bipolar depression, and several have demonstrated long-term value in preventing future episodes of mania or depression.
In people with bipolar disorder, antipsychotics are also used “off label” as sedatives, for insomnia, anxiety, and/or agitation. Often, they are taken with a mood-stabilizing drug and can decrease symptoms of mania until mood stabilizers take full effect. Some antipsychotics seem to help stabilize moods on their own. As a result, they may be used alone as long-term treatment for people who don’t tolerate or respond to lithium (Eskalith, Lithobid) and anticonvulsants.
How do antipsychotic drugs work?
Antipsychotic drugs help regulate the functioning of brain circuits that control thinking, mood, and perception. It is not clear exactly how these drugs work, but they usually improve manic episodes quickly. 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).
The newer antipsychotics usually act quickly and can help you avoid the reckless and impulsive behaviors associated with mania. More normal thinking often is restored within a few weeks.
What different types of antipsychotic are there?
Antipsychotic drugs tend to fall into one of two categories:
First generation (older), or ‘typical’ antipsychotics: Typical antipsychotics were first developed in the 1950s to treat psychosis. The usage of the drugs has since been expanded to include acute mania, agitation, and other serious mood disorders. Depending on your symptoms, the doctor may choose to use a low-potency, medium-potency, or high-potency typical antipsychotic.
Commonly prescribed typical antipsychotics include:
- Haldol (haloperidol)
- Loxitane (loxapine)
- Mellaril (thioridazine)
- Moban (molindone)
- Navane (thiothixene)
- Prolixin (fluphenazine)
- Serentil (mesoridazine)
- Stelazine (trifluoperazine)
Second generation (newer), or ‘atypical’ antipsychotics: The atypical antipsychotics, also known as second generation antipsychotics and serotonin–dopamine antagonists, are a group of antipsychotic drugs largely introduced after the 1970s and used to treat psychiatric condition.
Commonly prescribed atypical antipsychotics include:
Both types can potentially work for different people. They also have different side effects.
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.
The adverse effects of antipsychotic medications range from relatively minor tolerability issues (e.g., mild sedation or dry mouth) to very unpleasant (e.g., constipation, akathisia, sexual dysfunction) to painful (e.g., acute dystonias) to disfiguring (e.g., weight gain, tardive dyskinesia) to life threatening (e.g., myocarditis, agranulocytosis). Some adverse effects have little short‐term clinical implications (e.g., increased prolactin or serum lipid levels), but may involve long‐term risk of medical complications.
Each antipsychotic medication has a unique side effect profile, which affects individuals differently. Because the incidence of the side effects varies considerably across the large number of antipsychotic medications.
Antipsychotic Safety and Warnings
Long-term use of typical (older) antipsychotic drugs may cause a serious and sometimes incurable movement condition called tardive dyskinesia (TD). About 5 percent of people who take antipsychotics get TD each year, according to the National Institute of Mental Health.
Antipsychotics aren’t recommended for older adults with dementia, as these drugs may put them at increased risk for stroke and death. The antipsychotic clozapine is highly effective, but it can cause a serious decrease in the number of white blood cells, which help your body fight off infections. Talk to your doctor about this risk. Antipsychotics may also raise your risk of developing high cholesterol and diabetes.
Tell your doctor about all medical conditions you have before taking an antipsychotic. Also, let your doctor know about all prescription, non-prescription, illegal, recreational, herbal, nutritional, or dietary drugs you’re taking.
Don’t drive or perform activities that require alertness until you know how the antipsychotic you’re taking affects you. Follow the instructions on your prescription or package label carefully. Don’t take more or less of the drug than is recommended.