Antipsychotics

Antipsychotic medicines affect the action of chemicals in the brain (neurotransmitters). These are chemicals your brain cells need to talk to each other.

Antipsychotics do not cure psychosis but they can help to reduce and control many psychotic symptoms, including: 

• delusions and hallucinations, such as paranoia and hearing voices 
• anxiety and serious agitation, for example from feeling threatened
• incoherent speech and muddled thinking 
  confusion
• violent or disruptive behaviour
• mania. 

Talking minds has detailed information on how antipsychotics work

How medication works - Talking Mindsexternal link

There are 2 main types of antipsychotics – first generation (typical) and second generation (atypical). 

First generation antipsychotics include chlopromazine and haloperidol. They are no longer commonly used .

The most common side effects from first generation antipsychotics are movement disorders include stiffness and shakiness, restlessness and feeling sluggish and slow in your thinking. 

Second generation antipsychotics include clozapine, olanzipine, quetiapine and riseridone

They are less likely to cause side effects though can cause constipation, weight gain and raised sugar and cholesterol in your blood.

Compare specific antipsychotics and their side effects

Benefits and side effects - Talking Mindsexternal link

The antipsychotic medicine you are prescribed will depend on: 

• the severity and nature of your illness
• other medical conditions you may have
• other medicines you're currently taking
• your response to your medicine
• past experiences of taking antipsychotic medicines (what has and has not worked for you)
• other considerations, for example, whether you need your medicine in a different form such as an injection instead of tablets, capsules or liquids.

Before taking antipsychotic medicines talk to your healthcare provider if any of these apply as you may need special care. 

• You have epilepsy, diabetes, Parkinson's disease or glaucoma.
• You suffer from heart, liver, kidney, thyroid or prostate trouble.
• You are pregnant, breastfeeding or want to get pregnant. 

Antipsychotics are not addictive so do not cause cravings or dependence. You may get withdrawal symptoms when you stop the medication, but these can be managed. 

Antipsychotics can be taken as tablets, liquids and long-acting injections. 

They do not work straight away. It may take several days or even weeks for some of your symptoms to improve. 

• To begin with, you may find the medication helps you feel more relaxed and calmer. 
• After 1 or 2 weeks, other symptoms should begin to improve.
• You may need to take an antipsychotic for quite a long time, often for years.

If you are taking antipsychotics, you will need to avoid: 

• alcohol
• marijuana
• synthetic cannabis
• party pills (herbal highs). 

Taking any of these can make your psychosis worse, affect your mood or give you further side effects. 

Do not stop an antipsychotic suddenly. You and your healthcare provider should decide together when you can stop.

If you stop taking your antipsychotic, your original symptoms may return. This may happen quickly, but it can take up to 6 months after you stop taking your antipsychotic. 

Some antipsychotic medicines used to treat mental illnesses may cause weight gain. This usually happens in the first 6 weeks of treatment.

Causes of weight gain

Mental illness itself, or the side-effects of medication, may mean you have less energy and are less active than usual, making it harder to maintain your weight.

Some antipsychotic medications can make you feel hungrier, so you eat more. You might also crave sweet or fatty food.

Preventing weight gain from antipsychotics

Weight gain can make you more at risk of developing diabetes as well as many other medical conditions such as heart disease and high cholesterol. It is easier to avoid gaining weight than to try to lose it.

To help with preventing weight gain:

• monitor your weight — weigh yourself every 2 weeks and speak to your healthcare provider if you notice it increasing
• eat well — have regular meals, watch your portion sizes and cut down on foods and drinks rich in sugar and fat
• stay active.

Activity and diet

You can also speak to your healthcare provider about taking metformin. Metformin can help you lose weight if you have already put it on. It can also help you keep the weight off. You might be prescribed it if your mental health team thinks you are at a high risk of gaining weight when you start an antipsychotic.

If you start taking metformin at the same time as your antipsychotic, you may only need to take it for the first 6 to 8 weeks of treatment.

Metformin — My Medicinesexternal link