Antipsychotics are used for much more than psychosis, from bipolar disorder to severe agitation. They can be life-changing, but they also affect physical health, which is why regular checks matter.
Imagine your brother being started on an antipsychotic after a frightening episode of psychosis. Within weeks he is calmer and sleeping again. Months later, he has gained weight and feels slowed down. Knowing what to watch for helps him and his care team find the right balance.
What antipsychotics are used for
- Schizophrenia and other psychotic disorders
- Bipolar disorder, including mania
- Severe depression with psychotic features, or as an add-on treatment
- Severe agitation in some situations
- Some are used in Tourette’s syndrome or other conditions under specialist care
How they work
Antipsychotics mainly work by affecting dopamine and serotonin signalling in the brain. They can reduce hallucinations, delusions and disordered thinking, and help stabilise mood.,There are two broad groups. First-generation (typical) antipsychotics, such as haloperidol, were developed earlier. Second-generation (atypical) antipsychotics, such as olanzapine, quetiapine, risperidone and aripiprazole, are more commonly used today. Clozapine is used for schizophrenia that has not responded to other treatments, with special blood monitoring.
How they are taken
Antipsychotics come as tablets, liquids and long-acting injections given every few weeks or months. Injections can be helpful for people who find it hard to take tablets every day. The right medicine and dose differ from person to person, and finding them can take time.
Common side effects
- Drowsiness and feeling slowed down
- Weight gain and increased appetite, especially with olanzapine, quetiapine and clozapine
- Raised blood sugar, cholesterol and triglycerides
- Dizziness when standing
- Dry mouth or excess saliva
- Sexual problems and changes in periods, sometimes linked to raised prolactin
- Constipation, which can be serious with clozapine
Movement side effects
- Restlessness, feeling unable to sit still (akathisia)
- Stiffness, slowness and tremor similar to Parkinson’s disease
- Sudden muscle spasms, often in the neck or eyes
- Long-term involuntary movements of the mouth, face or limbs (tardive dyskinesia)
- These are more common with first-generation antipsychotics; tell the care team early, as treatments and dose changes can help
Serious side effects needing urgent help
- High fever, very stiff muscles, confusion and sweating, which may be neuroleptic malignant syndrome
- Signs of infection such as fever or sore throat in people taking clozapine, as it can lower white blood cells
- Fainting, palpitations or chest pain
- Severe constipation or abdominal pain with clozapine
Physical health checks
People with severe mental illness have a much higher risk of heart disease and diabetes, and some antipsychotics add to that risk. Guidelines recommend regular checks of weight, waist size, blood pressure, blood sugar (HbA1c) and cholesterol, usually before starting, after a few months and then at least yearly. An ECG may be needed for some medicines.,Healthy eating support, physical activity and help to stop smoking are an important part of care, not optional extras.
Antipsychotics in older adults with dementia
Antipsychotics are sometimes used for severe distress or aggression in dementia, but they increase the risk of stroke and death in this group. Guidelines recommend trying other approaches first and using antipsychotics only when the person is at risk of harm or in severe distress, at the lowest dose for the shortest time, with regular review.
Do not stop suddenly
Stopping antipsychotics suddenly can cause withdrawal symptoms and increases the risk of relapse. If side effects are difficult, talk to the prescriber or care team about adjusting the dose or switching medicine. Any reduction should be planned and gradual.
Frequently asked questions
Will I have to take them forever?
Not always. It depends on the condition, how many episodes you have had and your own wishes. Decisions should be shared.
Can I drink alcohol?
Alcohol can increase drowsiness and worsen mental health. It is best avoided or kept minimal.
Do antipsychotics change your personality?
They should not. If you feel emotionally flat or not yourself, tell your care team.
But I feel better now. Do I still need it?
Feeling better often means the medicine is working. Stopping too soon can lead to relapse. Talk to your care team about a plan.
Your next step: If you or someone you care for takes an antipsychotic, check when the last physical health check was done.
Related: Finding a counsellor or therapist
Sources: National Institute for Health and Care Excellence (CG178, CG185), Royal College of Psychiatrists, World Health Organization, British National Formulary (BNF).
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