Antipsychotics - About
What are antipsychotics?
Psychosis is a medical term. If you have psychosis, you might see or hear things (hallucinations) that are not there. Or you might have ideas or beliefs that do not match reality (delusions). Some people describe it as a break from reality. Doctors may call these ‘psychotic symptoms’, a ‘psychotic episode’ or a ‘psychotic experience’.
Psychotic symptoms can be part of conditions such as schizophrenia, schizoaffective disorder, personality disorder and bipolar disorder. But some people can have psychotic symptoms without having any of these conditions.
If you have psychosis, your doctor may offer you antipsychotic medication to help you with your symptoms. Antipsychotics can help to control symptoms of psychosis. This can help you feel more in control of your life, particularly if you are finding the psychotic symptoms distressing.
According to the Royal College of Psychiatrists, 4 out of 5 people who take antipsychotics find they are successful in treating their symptoms. It is not possible to predict which one will work best for you, so you may have to try a few before you find the right one.
Some antipsychotics are used to treat mania (which is a symptom of illnesses such as bipolar disorder) and psychotic symptoms of depression.
How do antipsychotics work?
Your brain contains chemicals which help to carry messages from one part of the brain to another. One of these chemicals is called dopamine. It is thought that high levels of dopamine may cause the brain to function differently and may cause the symptoms of psychosis. Antipsychotic medications reduce the amount of dopamine in the brain or restore the balance of dopamine with other chemicals in the brain.
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Are there different types of antipsychotics?
Some people talk about two types of antipsychotic medication. Your doctor might call them the following:
- Typical or ‘first generation’. These medications have been used since the 1950s.
- Atypical or ‘second generation’. These medications have been used since the 1990s.
The main difference between these types is in their side effects. First generation antipsychotics may have more of an effect on your movement than newer ones. Although this does not mean newer generation antipsychotics don’t have any side effects on your movement.
This distinction can make it easier to talk about the different medications. But you should think about each antipsychotic individually. This is because everyone reacts differently to medication. You can never be certain how you will be affected by side effects or whether the medication will work for you. This can mean that the first medication you try may not be the right one for you.
If you have been on an antipsychotic for a few weeks and the side effects are too difficult to cope with, you should ask your doctor about trying a different one. You can read more about side effects here.
You can find more information about ‘Medication – choice and managing problems’ here.
Antipsychotic medication can come as tablets, a syrup or as an injection. The injections are called a depot. You may find a depot useful if you struggle to remember to take your medication, or might take too much. Your doctor should take your views into account when prescribing you medication.
We have listed the main types of antipsychotics below.
First generation antipsychotics (Typical)
The first generation of antipsychotics have been prescribed since the 1950s. The following medications are typical antipsychotics. They have been listed by their generic name with the brand name in brackets.
- Benperidol (Anquil)
- Chlorpromazine (Largactil)
- Flupentixol (Depixol)
- Fluphenazine (Modecate)
- Haloperidol (Haldol)
- Levomepromazine (Nozinan)
- Perphenazine (Fentazin)
- Pimozide (Orap)
- Sulpiride (Dolmatil, Sulpor)
- Trifluoperazine (Stelazine)
- Zuclopenthixol (Clopixol)
Second generation antipsychotics (Atypical)
The second generation of antipsychotics have been used more since the 1990s. Although some of them were developed before then. They have been listed by their generic name with the brand name in brackets.
- Amisulpride (Solian)
- Aripiprazole (Abilify, Abilify Maintena)
- Clozapine (Clozaril, Denzapine, Zaponex)
- Risperidone (Risperdal & Risperdal Consta)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Paliperidone (Invega, Xeplion)
Clozapine works slightly differently to others. It is sometimes given to people who are treatment resistant. This means other medication hasn’t helped their symptoms. The National Institute for Health and Care Excellence (NICE) says that people with schizophrenia should only be offered clozapine after having tried 2 other drugs.
Clozapine can cause your white blood cell numbers to drop. But this is rare. This could mean that you get infections more easily. If you take clozapine, you will need regular blood tests to make sure your white blood cell count is healthy.
If your white blood cell numbers start dropping, you will be asked to stop taking the medication. You will have another blood test after you have stopped clozapine to make sure they are back to normal. Your doctor might decide to change your dose of clozapine or offer you another type of medication.
NICE produce guidelines for the assessment and treatment of mental illnesses, such as psychosis and schizophrenia. Doctors might use these guidelines to decide which medication to offer you. You can find these in the further reading section.
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