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Antipsychotic Drugs: Types, Uses, and More

Psychosis occurs when a person’s mental health causes them to lose touch with reality. Doctors prescribe antipsychotic drugs to treat this.

Statistics from the National Institute of Mental Health suggest that 3 out of 100 people in the United States suffer from psychosis at some point. Psychosis can cause hallucinations, delusions, inappropriate behavior, etc.

Schizophrenia and bipolar disorder are two of the mental health conditions that can cause psychosis.

Read on to learn more about the best drugs for psychosis, along with short- and long-term treatments, risks, and side effects.

People with psychosis perceive or experience situations differently than others around them.

This can lead to :

  • Hallucination: experiences of seeing, hearing and potentially smelling, smelling or tasting things that are not there – for example, a person may hear voices
  • Delusions: experiences of firmly believing that something is true despite evidence to the contrary – for example, a person may think that someone wants to hurt them

When a person experiences these hallucinations and delusions, it is called a psychotic episode. This can be very distressing for the person and lead to a change in behavior.

Other potential signs of psychosis include:

  • confusing speech
  • inappropriate behavior
  • the Depression
  • anxiety
  • sleeping troubles
  • social withdrawal
  • lack of motivation
  • general difficulty in functioning

It is important to note that psychosis is a symptom rather than a condition itself. In some people, a mental health problem such as schizophrenia or bipolar disorder may cause psychosis.

In others, psychosis may be the result of:

  • sleep deprivation
  • a medical condition
  • a prescription drug
  • drug or alcohol abuse

People with schizophrenia or bipolar disorder may benefit from taking antipsychotics. These medications can also help people with hard-to-treat depression or anxiety.

Antipsychotics can help reduce:

  • auditory hallucinations (like hearing voices)
  • delusions
  • disordered or confused thinking
  • mood changes associated with bipolar disorder

Antipsychotic drugs fall into two main subclasses: first generation (older types) and second generation (newer types).

The type prescribed by a doctor will depend on a person’s biological makeup and mental health status.

First-generation antipsychotics, also called “typical” or “conventional,” include:

  • Chlorpromazine (Thorazine): Doctors prescribe it to treat schizophrenia and other psychotic disorders, as well as mania in bipolar disorder, severe behavioral problems in children, nausea and vomiting, hiccups lasting at least a month, preoperative nerves , acute intermittent porphyria and tetanus.
  • Fluphenazine (Prolixin): This medication treats schizophrenia and psychotic symptoms such as hallucinations, delusions, and hostility.
  • Haloperidol (Haldol): Doctors prescribe this drug to treat psychotic disorders, tics associated with Tourette’s syndrome, and severe behavioral problems in children.
  • Perphenazine (Trilafon): This treats schizophrenia or severe nausea and vomiting in adults.
  • Thioridazine (Mellaril): Doctors may prescribe it to treat schizophrenia in people who have already tried two or more other medications without success.

Second-generation or “atypical” antipsychotics include:

  • Aripiprazole (Abilify): Doctors prescribe it to treat schizophrenia in people at least 13 years old, mania and the combination of mania and depression in people with bipolar disorder at least 10 years old, treatment-resistant depression, irritable behavior in autistic children and Tourette’s syndrome in children.
  • Asenapine (Saphris): This treats the symptoms of schizophrenia. Doctors may also prescribe it alone or with other medications to treat or prevent mania and combination mania and depression in adults and children with bipolar disorder.
  • Brexpiprazole (Rexulti): Doctors prescribe it to treat the symptoms of schizophrenia. They may also use it with antidepressants when antidepressants alone are not helping to manage a person’s symptoms of depression.
  • Cariprazine (Vraylar): This treats schizophrenia and depression in people with bipolar I disorder.

Learn more about antipsychotic medications.

Antipsychotics help people manage the symptoms of mental health problems, which can often be serious.

However, these drugs have side effects, so it is important for doctors to determine the risk/benefit ratio of prescribing antipsychotics for each individual. This assessment should also take into account how long the person needs to take the medication.

A 2018 review published in Global Psychiatry concluded that the available scientific evidence supports the long-term use of antipsychotics. The authors looked at the long-term effects of the drugs, including their impacts on the brain, metabolic health, and life expectancy.

However, the authors acknowledged that a minority of people with schizophrenia do not appear to relapse even if they do not take long-term antipsychotics. They said more research was needed to explore this phenomenon.

Since the publication of this review, a clinical test began.

It will assess the effects of continuing antipsychotic medication versus reducing or stopping medication once the first episode of psychosis has ceased to affect:

  • personal and social functioning
  • the severity of psychotic symptoms
  • health-related quality of life

The exact list of possible side effects of antipsychotics varies from drug to drug. Some people experience no side effects, while others experience them to varying degrees.

Another 2018 review published in Global Psychiatry provides a list of the most common side effects of antipsychotic medications. They understand:

  • dystonias (uncontrolled muscle movements)
  • Parkinsonism (tremor, rigidity, slowness of movement)
  • akathisia (inability to stay still)
  • tardive dyskinesia (unusual, involuntary movements)
  • sialorrhea (overproduction of saliva)
  • sedation
  • high prolactin (the hormone needed for lactation)
  • sexual side effects
  • orthostatic hypotension (dizziness/lightheadedness when standing, due to low blood pressure)
  • QT prolongation (when the heart takes longer to contract and relax than usual)
  • neuroleptic malignant syndrome (fever, rigidity, altered mental status and nervous system dysfunction)
  • neutropenia/agranulocytosis (low white blood cell count)
  • impulse control disorders and behavioral addictions
  • myocarditis (heart inflammation)
  • weight gain and imbalance of blood lipids, including cholesterol
  • anticholinergic effects (dry mouth, blurred vision, abnormally fast heart rate, constipation)

The authors report that the groups of side effects do not apply perfectly to first- and second-generation antipsychotics. On the contrary, each drug has its own list of potential side effects.

Additionally, the Food and Drug Administration (FDA) considers older adults with dementia to be at a higher risk negative effects of antipsychotics. The FDA requires all antipsychotic drug labels to warn people of the increased risk of stroke and death in this population group.

Also, doctors usually do not prescribe risperidone or paliperidone as first-line treatment during pregnancy because these drugs may have a slight increase risk of fetal developmental abnormalities.

It is important for anyone considering taking antipsychotic medication to discuss their individual risks and benefits with their doctor.

Psychosis is a symptom rather than a condition. People with psychosis experience hallucinations and delusions and essentially lose touch with reality.

Each antipsychotic drug has its own list of benefits and side effects. The best medication for psychosis always depends on the individual and their particular condition.