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Side Effects of Antipsychotic Medications

Side Effects of Antipsychotic Medications



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Antipsychotic medications are mainly used to treat certain mental health conditions or symptoms of psychosis, like hallucinations or delusions.

Like most other medications, antipsychotic drugs may have certain side effects. These can range from hardly noticeable to severe.

The type and severity of side effects you get may depend on the type of medication and how often you take it.

It’s natural to feel overwhelmed or concerned if you’re just starting out on this type of medication or are exploring your treatment options. The good news is that these medications are effective at managing many symptoms.

For example, if you’re experiencing hallucinations, these could go away after just a few days of taking your meds. Some other symptoms, such as delusions, may take up to 6 weeks to be managed.

Everyone responds a little differently to antipsychotic medication.

It’s highly advisable that you take these medications under a professional’s supervision and that you always let them know about side effects you may be experiencing.

It’s not unusual for someone to try different types of antipsychotic medications or dosages before they find a combination that works.

This “trial period” might feel discouraging, but it’s part of a process that may lead you to feel better in the long term.

Antipsychotic medications are mainly used to treat the symptoms of psychosis, although they can help manage symptoms of other mental health conditions.

You might also take antipsychotic medication alone or in combination with other medications if you have a mental health condition or a neurological disorder such as:

  • schizophrenia
  • bipolar disorder
  • delirium
  • post-traumatic stress disorder
  • obsessive-compulsive disorder
  • generalized anxiety disorder
  • an eating disorder
  • ADHD
  • Parkinson’s disease
  • severe depression (known as psychotic depression)
  • chronic depression without psychosis

Antipsychotic medications won’t cure a condition but rather help you manage the symptoms you’re experiencing. Oftentimes, you may be on an antipsychotic for months or years.

It’s important that you not stop taking your medication (even if you’re feeling well) without talking with your health professional first.

In most cases, these medications need to be gradually tapered down in dosage to avoid further side effects. This means they have to be gradually decreased in dosage so your body can make the adjustment.

There are two main types of antipsychotics: typical and atypical.

Older medications, or first-generation medications, are called “typical” antipsychotics or neuroleptics. They include:

  • haloperidol
  • chlorpromazine
  • fluphenazine
  • perphenazine

The newer medications, or second-generation antipsychotic medications, are known as “atypical” antipsychotics. Some examples are:

  • risperidone
  • olanzapine
  • aripiprazole
  • lurasidone
  • paliperidone

All prescription medications can have side effects, and antipsychotic drugs are no exception.

Every body is different, so not everyone experiences the same side effects or with the same intensity. You might find you don’t notice any side effects at all, depending on the medication and your unique situation.

If you experience side effects, these can decrease after a few weeks of taking the drug. If this doesn’t happen, you might want to talk with your doctor about the possibility of changing the brand or the dosage.

It’s important that you don’t suspend the medication without consulting with your healthcare team first.

Antipsychotic medications can have both physical and psychosocial effects, and some of them can be long-term.

Physical side effects

  • Dizziness or blurry vision.
  • Drowsiness. You may feel sleepy, especially when first starting the medication, so don’t drive until you know how the medication affects you.
  • Sexual challenges. These can be related to the increase in the hormone prolactin. It can cause you to have a lower sex drive. If you have a penis, you might have difficulty getting an erection or have ejaculation problems. If you menstruate, you could notice your cycle becoming irregular.
  • Weight gain. This is often a side effect of atypical antipsychotic medications.
  • Digestive issues. You might feel nauseous, have a dry mouth, or have constipation or vomiting.
  • Low blood pressure.

Psychosocial side effects

  • Restlessness. You may experience agitation or episodes of high anxiety.
  • Mental fog. You might have a hard time thinking clearly or focusing on a task. You might also have difficulty recalling information.
  • Loss of motivation. You might feel like you lack the drive to accomplish tasks or feel like you’re not interested in the things you used to do.
  • Social withdrawal. You could feel inclined to stay home more often or avoid certain social situations.

Long-term effects

  • Uncontrollable movements. A side effect of some antipsychotic drugs is a condition known as tardive dyskinesia. It causes tics and tremors, oftentimes around your mouth. You can’t control these movements, and sometimes it doesn’t go away by stopping the medication. Usually, this is a side effect of typical antipsychotics.
  • Type 2 diabetes. Your chance of developing type 2 diabetes depends on the type of antipsychotic medication you take. Since weight gain is a side effect of some antipsychotic medications, you might develop a slightly increased risk for diabetes.
  • Metabolic syndrome. This includes a cluster of symptoms and conditions such as high blood pressure, heart disease, high cholesterol, and diabetes.

Not everyone experiences these side effects, and if you do, these can often go away after a while or after changing dosage or the type of drug.

There are some things you can do to manage some of the side effects you may experience. Talking with your healthcare team is highly advisable and can help you reduce unwanted effects.

  • Taking other medications. Some drugs can counteract some of the possible side effects. For instance, if you have weight gain as a result of your antipsychotic medication, you may be given a drug such as metformin to manage your weight gain or risk for diabetes.
  • Developing or reinforcing healthy habits. A few lifestyle habits can help you reduce the effects of medication. For example, getting 8 hours of sleep every day, eating fresh vegetables and fruits, and exercising a few times per week.
  • Seeking support. Talking with a psychotherapist or joining a support group may help you manage the psychosocial side effects of antipsychotic medications.

When someone abruptly stops taking their antipsychotic medication, they could experience a few unwanted effects.

Some people might also experience a relapse in symptoms if their medication is stopped. In some cases, these symptoms can be worse than before taking the drug.

Stopping your medications all of a sudden can cause what’s called “rebound psychosis,” which means your psychosis symptoms may come back as soon as you stop your drug.

Even if you go off your medications under the supervision of your healthcare team, you might see your symptoms coming back within 3 to 6 months.

It’s advisable that you discuss these instances with a health professional and make a treatment plan that covers all your bases.

Since antipsychotic medications come in a variety of forms, a healthcare professional can guide you towards the options that may work better for you.

Some questions you might consider are:

  • What forms does my medication come in? Does it come in pills, capsules, liquids, injections, patches, or tablets dissolved under the tongue?
  • What are the most common side effects, and how long do they last?
  • Will I have to take additional medications if I experience side effects?
  • What happens if I miss a dose?
  • What happens if I stop taking the medication?
  • Will I be taking this medication forever?
  • Are there any foods, drinks, supplements, or drugs I should be careful with when taking this drug?

Some antipsychotic medications may cause you to experience side effects. These can often go away after a few weeks, or they may be long term.

Because antipsychotic drugs can help you manage symptoms of psychosis, and may make you feel better overall, it’s advisable that you weigh the challenges versus the benefits. Discussing this with a healthcare professional can help you make the right decisions for your situation.


Medications for Schizophrenia

Heather M. Jones is a freelance writer with a strong focus on health, parenting, disability,and feminism.

Mary Choy, PharmD, is board-certified in geriatric pharmacotherapy and is an active leader in professional pharmacy associations.

The first line of pharmacological treatment for schizophrenia is antipsychotic medication.  

These medications come in three forms:

  • Second-generation antipsychotics
  • First-generation antipsychotics
  • Long-acting injectable antipsychotics

With the exception of long-acting injectables, antipsychotic medication is usually taken in pill form, but some are available in dissolving tablets, suppository, or liquid form.

Dean Mitchell / Getty Images


Types of Psychotropic Medications

There are five main types of psychotropic medications: antidepressants, anti-anxiety medications, stimulants, antipsychotics, and mood stabilizers.

Antidepressants are used to treat depression. There are many different types of antidepressants. Some types are less frequently used than others but may work for you in consultation with your doctor. The most common antidepressants are:

  • Selective serotonin reuptake inhibitors (SSRIs), which steadily increase the amount of serotonin in your brain. Serotonin is a powerful neurotransmitter that regulates your mood, bowel movements, sleep, blood clotting, and more.
  • Selective norepinephrine reuptake inhibitors (SNRIs), which gradually increase the amount of norepinephrine in your brain. Norepinephrine makes you feel awake and alert.
  • Bupropion, which promotes important brain activity and can be used to treat seasonal affective disorder (SAD) or to help people quit smoking.

Side effects of antidepressants include:

  • Drowsiness
  • Insomnia
  • Constipation
  • Weight gain
  • Sexual problems
  • Tremors
  • Dry mouth

Anti-anxiety medications treat an array of anxiety disorders. These medications can be used to treat panic attacks, phobias, generalized anxiety, and various anxiety-related symptoms.

Anti-anxiety medications include beta-blockers that help treat the physical symptoms of anxiety, including increased heartbeat, nausea, sweating, and trembling.

Because they typically cause drowsiness, some tranquilizers and sleep medications are also used to treat anxiety and insomnia. These tend to be prescribed for only a short time to prevent dependency.

Potential side effects of anti-anxiety medications include:

  • Nausea
  • Blurry vision
  • Headaches
  • Confusion
  • Fatigue
  • Nightmares

Stimulants help manage unorganized behavior. They accomplish this by improving concentration and having a calming effect. Stimulants are often prescribed for people with attention deficit hyperactivity disorder (ADHD).

Some side effects of stimulants include:

Antipsychotics help manage psychosis. Psychosis describes multiple conditions that affect the mind. They are often indicated by the person becoming separated from their reality and experiencing delusions or hallucinations.

Antipsychotics can help people with psychosis think more clearly, feel calmer, sleep better, and communicate more effectively.

Antipsychotics can be used to treat:

Some side effects of antipsychotics include:

Mood stabilizers help regulate extreme emotions. This doesn’t mean they don’t let you feel all the good that life has to offer. They simply help you manage your range of emotions. Mood stabilizers are primarily used to treat bipolar disorder and extreme mood swings.

Some side effects of mood stabilizers include:

  • Upset stomach
  • Drowsiness
  • Weight gain
  • Dizziness
  • Tremors
  • Blurry vision
  • Confusion

Extrapyramidal Side Effects of Antipsychotic Medications

Extrapyramidal side effects refer to reactions that patients may experience when taking antipsychotic or dopamine-blocking medications. The disorders include akathisia, dystonia, pseudoparkinsonism and tardive dyskinesia. Symptoms of the disorders range from mild discomfort to permanent involuntary muscle movements. Reactions may begin after a single dose of a medication or they may develop and progress over time as treatment continues.

The term refers to one of the most common extrapyramidal side effects. The disorder may have subjective or objective symptoms. Patients typically complain of feeling restless, having sleep pattern disruptions or having difficulty concentrating. Obvious signs of restlessness include continual foot-tapping, marching, pacing or shuffling. Patients might also rock back and forth while sitting or standing. Other symptoms include continually shifting body weight from one leg to another.

Dystonic side effects are seen as involuntary muscle contractions involving the head, neck, torso or the extremities. Muscles of the head and neck most often affected include the face, eyes, jaw, throat and tongue. Symptoms involving the face and eyes may appear as a facial tic, obsessive blinking or rolling of the eyes. An oculogyric crisis occurs when the eyes roll upward and lock in that position. Symptoms involving the tongue and throat may affect the vocal cords, which causes vocal hoarseness, a stiffened or thick tongue. Individuals may have difficulty speaking, have pharyngeal spasms or a possible obstruction, which entails an emergency situation. Neck and torso symptoms include involuntary tilting of the head, spinal twisting or severe back arching.

The disorder causes physical symptoms that are often associated with Parkinson's disease. Individuals may exhibit pill-rolling with their fingers, have a mask-like facial expression or have a weakened speaking voice. Their arms remain still when walking and they might appear stooped forward. Patients might walk with a shuffle or have a rachet-like movement when extending their arms. Additional facial symptoms may include what is known as rabbit syndrome, which involves continuous movement of the lips and chewing motions. Cognitive symptoms are referred to as bradyphrenia and involve impaired think ability.

The symptoms involve quick, repetitive and involuntary movements of the face, torso, extremities and breathing muscles. Facial movements include a continual protruding or rolling of the tongue, lip smacking, puckering or sucking motions. Patients may also habitually frown, grimace, or exhibit other facial distortions. The arms or legs exhibit abnormal, quick and purposeless movements or slow movements that resemble a serpent. The torso may rock back and forth, jerk, thrust forward or twist.

Symptoms usually subside once the patient stops taking the medication. Sometimes lowering the dose remedies the effects. Akathisia symptoms respond when the antipsychotic medication is discontinued and the patient receives a prescription for an anti-anxiety medication. Dystonia responds to anticholinergic or antiparkinson pharmaceuticals. Patients susceptible to tardive dykinesia should be monitored closely.


Antipsychotic drugs: atypical advantages and typical disadvantages

Atypical antipsychotic drugs are recommended for the first line treatment of all patients with schizophrenia. This is because it has been demonstrated that atypical antipsychotic drugs are more effective across a broader range of symptoms of schizophrenia than typical antipsychotic drugs and because they are dramatically less likely to cause the extrapyramidal and endocrine side effects that greatly impair quality of life for patients and reduce their willingness to adhere to maintenance treatment. Atypical antipsychotic drugs are not perfect but they are the most effective and the safest treatment for schizophrenia presently available.

The atypical antipsychotic drugs currently marketed in Ireland for the first line treatment of schizophrenia include amisulpride, olanzapine, quetiapine, risperidone and ziprasidone. These agents differ somewhat in chemical class, indications, daily dose range, need for titration, daily dosing regimen and available formulations (see Table 1). Clozapine is marketed for patients unresponsive to, or intolerant of, other antipsychotic drugs and must thus be regarded as a second line treatment for schizophrenia. Zotepine is not yet available in Ireland while the marketing of sertindole has been suspended following reports of arrhythmias and sudden cardiac deaths.


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