What are Antipsychotics, Know its Types, Effectiveness, Side Effects & When is it Prescribed

What are Antipsychotics?

Antipsychotics are referred to the category of medicines, which are used to treat mental health conditions, such as psychosis, mania, schizophrenia, bipolar disorder etc. Antipsychotic medications can also be used for the treatment of severe anxiety and depression. Antipsychotics are also known as major tranquilizers. Antipsychotic Medications can be taken in the form of capsules, tablets, depot injections and liquids and are available in different brand names.

What are the Types of Antipsychotic Medications?

Antipsychotic Medications are of 2 main types:

Typical Antipsychotics (Older Antipsychotics): Typical Antipsychotics are known as first-generation antipsychotics and consist of medications such as: flupentixol, chlorpromazine, haloperidol, pericyazine, levomepromazine, sulpiride, zuclopenthixol and perphenazine. Typical Antipsychotics have been in use since the 1950s and doctors prescribe them to their patients even now.

Atypical Antipsychotics (Newer Antipsychotics): Atypical Antipsychotics are also known as second-generation antipsychotics and consist of medications such as: aripiprazole, amisulpride, clozapine, quetiapine, olanzapine and risperidone. Newer antipsychotics or Atypical Antipsychotics were developed in the 1970s and were initially thought that these medicines carry lesser side-effects than the typical antipsychotics; however, it has now become clear that the newer antipsychotics also cause side-effects.

The Action of Antipsychotic Medications

Antipsychotic Medications work by changing the effect of certain chemicals in the brain, such as serotonin, dopamine, acetylcholine and noradrenaline. All these brain chemicals affect a person’s emotions, mood, behavior; and changes in these chemical also change these characteristics of the patient. Dopamine is the primary chemical which the Antipsychotic Medications have an effect on.

Antipsychotic Medications change the effects of these chemicals in the brain so they suppress or prevent the patient from experiencing symptoms such as: delusions, hallucinations, thought disorder and extreme mood swings.

When are Antipsychotic Medications Prescribed?

Antipsychotic Medications are prescribed to relieve the symptoms of mental health issues such as schizophrenia, psychosis, bipolar disorder, severe anxiety and depression. Antipsychotic medications are prescribed by a psychiatrist who is a doctor specializing in mental health conditions.

Antipsychotic Medications were also previously used to soothe elderly patients suffering from dementia; however, Antipsychotic Medications are no longer used for this purpose, as they are thought to slightly increase the risk of early death and stroke. The only antipsychotic medication, which is recommended for such a purpose is risperidone; however, it is only recommended to be used for a short duration and that too for severe symptoms.

Which is the Commonly Prescribed Antipsychotic Medication?

There is no particular or commonly prescribed antipsychotic medication. The choice of antipsychotic medication used depends on the mental health condition which the patient is suffering from, the severity of the symptoms and patient’s other health problems. Each antipsychotic medication is different from another. Some antipsychotic medicines cause more sedation than others. So, a particular Antipsychotic Medication, which works for one individual may not work the same for another. A psychiatrist is the best person to decide, which antipsychotic medication is to be used. It is difficult to assess which antipsychotic medicine is going to work for a particular patient. If one antipsychotic medicine is not effective then another is given to see if it works.

Clozapine is one antipsychotic medicine, which is thought to work better than others. However, clozapine has many potentially serious side-effects, one of which is changes in the level of white blood cells. For this reason, the patients taking clozapine need to be monitored on a weekly basis to see if their blood tests remain stable.

Some patients may need only an injection of a depot injection (long-acting antipsychotic medicine) after the symptoms has eased. The medicine is released slowly into the body and is given every 2 to 4 weeks. The aim of depot injection is preventing relapses or recurrence of psychotic symptoms. The advantage of depot injections is that the patient doesn’t have to remember to take antipsychotic medication daily.

How Effective are Antipsychotic Medications?

How Effective are Antipsychotic Medications?

About 8 in 10 patients taking Antipsychotic Medications experience an improvement or relief in their symptoms. However, antipsychotic medications cannot keep the symptoms at bay forever, neither do they resolve all the symptoms; however, they are effective most of the times and in most of the patients. Most of the patients need to take Antipsychotic Medications for a long period of time, even after they are feeling well and this is done to prevent recurrence of symptoms or a relapse. Even if the patient has taken antipsychotic medications on a long term basis, there is still a chance of recurrence of symptoms.

It make take about 2 weeks to a month for the symptoms to improve after starting Antipsychotic Medications and it may take further some more weeks for complete improvement. The doctor will increase the dose of the antipsychotic medicine gradually in order to prevent side-effects.

How Long Do The Antipsychotic Medications Need To Be Taken?

The duration of treatment with Antipsychotic Medications depends on many things. Some patients may only need to take antipsychotics for some weeks and other patients may need to take them for longer duration, especially in case of more serious mental disorders, such as schizophrenia. Even after the symptoms subside, it is recommended to continue taking antipsychotic medications long-term, especially in case of schizophrenia and also to prevent and limit a relapse. The duration of treatment with Antipsychotic Medications is best decided by the psychiatrist and depends on the patient’s illness and the severity of the symptoms.

Stopping Antipsychotic Medications

Antipsychotic Medications should never be stopped abruptly or on your own. They should be stopped under the guidance of your doctor. So, if you desire to stop taking Antipsychotic Medications, then you need to consult your doctor first, as the doctor is the best person to decide if stopping them is advisable and the manner in which they should be stopped. Antipsychotic Medications need to be stopped gradually over a period of number of weeks. If the Antipsychotic Medication is stopped suddenly, then patient can become severely ill and suffer from withdrawal symptoms or can suffer an acute relapse of the disease. For this reason, it is important to stop antipsychotic medications under your doctor’s advice and they should be tapered off slowly so the body gradually adjusts to small number of doses of Antipsychotic Medication.

What are the Side-Effects of Antipsychotic Medications?

Antipsychotic Medications tend to have quite a number of troublesome side effects. The doctor needs to weigh all the pros and cons between easing the symptoms of the patient and the side-effects of Antipsychotic Medications before deciding on the best course. Different antipsychotic medicines have different types of side-effects. It is not necessary that one antipsychotic medicine, which has caused side-effects in a patient to produce the same side effect in others. Therefore, most of the times two or more antipsychotic medications are tried to see which one has the least side effect and which medicine suits the patient most.

Some of the common side-effects of Antipsychotic Medications are:

Drowsiness is a common side effect of Antipsychotic Medications, but it may also indicate that the dose of the antipsychotics is high. So, a low dose can be tried out.

Blurred vision, dry mouth, constipation and flushing, which can ease off after the patient has become used to the antipsychotic medicine.

Weight gain is another common side effect of Antipsychotic Medications and this increases the risk of the patient developing heart problems and diabetes in the longer term. Weight gain is one of the important side effects of atypical antipsychotics, especially olanzapine and clozapine.

Movement disorders can also develop as a side effect of Antipsychotic Medications and these include:

  • Akathisia, which is felt as restlessness of the legs.
  • Parkinsonism, which produces symptoms, such as tremor and muscle stiffness that are similar to Parkinson’s disease.
  • Dystonia where the patient experiences abnormal movements of the face and body.
  • Tardive dyskinesia (TD) is experienced if the patient has been taking antipsychotic medication for prolonged period of time. Patient experiences rhythmical and involuntary movements, such as tongue-rotating and lip-smacking movements. Tardive dyskinesia can affect the arms and legs also.

Typical antipsychotic medicines are thought to cause more movement disorder side-effects than atypical antipsychotic medicines. This is the reason why atypical antipsychotic medications are preferred over typical antipsychotic medicines. However, the atypical antipsychotic medications do carry other risks, especially weight gain. Other medicines are usually prescribed to counteract the movement disorder side-effect of Antipsychotic Medications.

Are There Any Tests Required Before Starting On Antipsychotic Medications?

The patient needs to be monitored carefully while on Antipsychotic Medications for their side-effects. The tests which need to be done and the frequency of the tests depend on the type of antipsychotic, which the patient is taking.

A blood sample is taken usually before starting Antipsychotic Medications to look at:

  • The number of the blood cells the patient has.
  • The function of the patient’s liver and kidneys.
  • Patient’s cholesterol level.
  • To check if the patient has diabetes.

When you take clozapine, patient’s white blood cells and differential blood count need to be normal before starting clozapine. After this particular antipsychotic is started, patient’s full blood count should be tested every week for at least 18 weeks and after that every two weeks. If the patient continues to take clozapine and if the patient’s blood count remains stable after one year, then monitoring needs to be done every four weeks and for about four weeks after completing the treatment.

Patient’s blood pressure and weight are checked before starting Antipsychotic Medications and are continued to monitor every few weeks for the initial few months after starting Antipsychotic Medications.

The level of prolactin hormone in the blood is also measured before starting Antipsychotic Medications and is tested again after six months, after which it is checked every year. The level of the prolactin hormone is tested because in some patients, the antipsychotic medications causes increase in the production of this hormone. Excess of prolactin hormone causes the breasts to grow bigger and production of breast milk.

Who Cannot Take Antipsychotic Medications?

Antipsychotic Medications are commonly contraindicated or not prescribed in patients who are in a coma or who have a depressed central nervous system, or patients with pheochromocytoma, that is tumor on the adrenal gland.

Are Antipsychotic Medications Available Over-The-Counter?

A doctor’s prescription is required for buying antipsychotic medications and they cannot be bought over the counter.

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:June 10, 2019

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