Antipsychotic Medications

What are antipsychotics?

Antipsychotic medications are drugs that mainly treat psychosis-related conditions and symptoms. But taking an antipsychotic drug doesn’t always mean you have a symptom or condition related to psychosis. That’s because these drugs are very important for treating other conditions, too.

How do antipsychotics work?

Antipsychotics work by changing how certain signals in your brain — called neurotransmitters — affect how you feel and act. If these chemicals are out of balance, you may develop symptoms of psychosis like hallucinations and delusions. Scientists are still learning exactly how antipsychotics help. But by changing the balance of the chemicals in your brain, you may start to have fewer symptoms.

Are there different types of antipsychotics?

There are three main types of antipsychotic medications:

First-generation antipsychotics

These block the way your brain uses several neurotransmitters, especially dopamine. They also block acetylcholine, histamine and norepinephrine from latching onto various receptors.

Second-generation antipsychotics

These medications block receptors like serotonin and dopamine. And they activate other serotonin and dopamine receptors.

Next-generation antipsychotic

This new medication targets psychosis differently. Xanomeline and trospium chloride (Cobenfy™) don’t affect dopamine, so it has no impact on motor function and won’t make you sleepy. It attaches to specific acetylcholine receptors that are only in your brain and affect memory and cognition. In clinical trials, it reduced schizophrenia symptoms. And it had fewer unpleasant side effects than traditional antipsychotics.

First-generation (typical) antipsychotics

• Chlorpromazine: The brand name of this medication (Thorazine®) isn’t available in the U.S., but generic versions are.
• Fluphenazine: The brand names of this medication (Prolixin®, Permitil®) aren’t available in the U.S., but generic versions are.
• Haloperidol (Haldol®)
• Loxapine (Adusuve®)
• Molindone: The brand name of this medication (Moban®) isn’t available in the U.S., but generic versions are.
• Perphenazine: The brand name of this medication (Trilafon®) isn’t available in the U.S., but generic versions are.
• Pimozide (Orap®)
• Prochlorperazine (Compro®)
• Thiothixene: The brand name of this medication (Navane®) isn’t available in the U.S., but generic versions are.
• Thoridazine: The brand name of this medication (Mellaril®) isn’t available in the U.S., but generic versions are.
• Trifluoperazine: The brand name of this medication (Stelazine®) isn’t available in the U.S., but generic versions are.

Second-generation (atypical) antipsychotics

• Aripiprazole (Abilify®, Aristada®)
• Asenapine (Secuado®, Saphris®)
• Brexpiprazole (Rexulti®)
• Cariprazine (Vraylar®)
• Clozapine (Clozaril®, Versacloz®)
• Iloperidone (Fanapt®)
• Lumateperone (Caplyta®)
• Lurasidone (Latuda®)
• Olanzapine (Zyprexa®, Lybalvi®, Symbyax®)
• Quetiapine (Seroquel®)
• Paliperidone (Invega®)
• Pimavanserin (Nuplazid®)
• Risperidone (Perseris®, Risperdal®)
• Ziprasidone (Geodon®)

Next-generation antipsychotic

• Xanomeline and trospium chloride (Cobenfy™)

What conditions do antipsychotics treat?

Antipsychotics treat mood disorders, including:

• Schizophrenia (and its related spectrum of disorders, including schizoaffective disorder and schizophreniform disorder)
• Bipolar disorder
• Mania
• Major depressive disorder with some psychosis
• Delusional disorder
• Severe agitation
• Borderline personality disorder
• Dementia
• Delirium
• Substance-induced psychotic disorder

Providers may treat other conditions with antipsychotics, but those drugs aren’t their main treatment. These conditions include:

• Tourette syndrome
• Huntington’s disease
• Parkinson’s disease
• Lesch-Nyhan syndrome
• Obsessive-compulsive disorder

What are the potential benefits of antipsychotics?

Antipsychotic medications have several benefits, including:

• Treating conditions that are very difficult (if not impossible) to treat with other kinds of medications. Also, many people with these conditions would need long-term (or even lifelong) care 24/7 without these drugs.
• History of research and use. First- and second-generation antipsychotics have decades of research and study supporting them.
• There are many different antipsychotic drugs. Partner with your healthcare provider to find one that relieves your symptoms with the fewest side effects.
• Contributions to other treatment approaches. Antipsychotics can also make other types of mental health treatments — like psychotherapy — more effective.

What are the side effects of antipsychotics?

Antipsychotics are useful, but there are possible drawbacks. Antipsychotic medications can have various side effects and complications, including:

• Abnormal movements: First- and second-generation antipsychotics
• Constipation: All antipsychotics
• Dizziness and sedation: First- and second-generation antipsychotics
• Drug-induced movement disorders: First- and second-generation antipsychotics
• Dry mouth: All antipsychotics
• Heart and circulatory problems: First- and second-generation antipsychotics
• High blood sugar: First- and second-generation antipsychotics
• High cholesterol: First- and second-generation antipsychotics
• High prolactin levels: First- and second-generation antipsychotics
• Immune disruption: Some antipsychotics
• Drug interactions: Any antipsychotic medication
• Jaundice: All antipsychotics
• Tardive dyskinesia: First- and second-generation antipsychotics
• Type 2 diabetes: First- and second-generation antipsychotics
• Urinary retention: All antipsychotics
• Weight gain: First- and second-generation antipsychotics

How long can I stay on antipsychotics?

Some antipsychotic medications are for short-term use only. Others, you can take for years. It depends on what medication you take, why you take it and much more. Your healthcare provider is the best person to tell you how long to take one of these medications.

When should I call my healthcare provider?

Call your healthcare provider as soon as possible if you develop any of the following:

• High fever
• Confusion
• Rigid or stiff muscles
• Uncontrolled facial movements
• Yellowing of your skin or whites of your eyes

If you feel like you or someone you know is in danger of self-harm or suicide, dial 988 for the National Suicide and Crisis Lifeline. Outside the United States, call your local emergency services number.

What is the most commonly prescribed antipsychotic drug?

The most commonly prescribed first-generation antipsychotic drugs are:

• Haloperidol
• Perphenazine

The most commonly prescribed second-generation antipsychotics are:

• Aripiprazole
• Olanzapine
• Quetiapine
• Risperidone