About Antipsychotic Drugs

Antipsychotics are a group of drugs that are used to treat serious mental health conditions such as psychosis as well as other emotional and mental conditions. In addition, they are prescribed for the treatment of intractable hiccoughs and pain that can result from restlessness during palliative care.
Psychosis is a condition in which a patient loses contact with reality. The condition often includes hallucinations or delusions. When experiencing hallucinations, the patient often hears voices that aren’t actually there, while delusions related to psychosis consist of feelings or ideas that aren’t based on reality.

Antipsychotics help to control the symptoms of psychosis as well as less serious mental health conditions such as bipolar and mood disorder that may develop into later psychosis. Antipsychotics reduce or increase the effect of neurotransmitters in the brain to regulate levels. Neurotransmitters help transfer information throughout the brain. The neurotransmitters affected include dopamine, noradrenaline, and serotonin. Dopamine is the primary neurotransmitter affected by taking antipsychotics; an overactive dopamine system may be one cause of the hallucinations and delusions commonly experienced during psychosis.

Effects of Antipsychotics

There are a variety of antipsychotic drugs in common use including:

• Amisulpride
• Aripiprazole
• Clozapine
• Olanzapine
• Paliperidone
• Quetiapine
• Risperidone

Antipsychotics are classified as major tranquilizers. They are separated into two groups with older antipsychotics developed prior to the 1970s known as typical antipsychotics and newer drugs known as atypical antipsychotics.
Antipsychotics provide an overall feeling of contentment when taken, usually without creating drowsiness. Those on the medication may experience periods of discomfort and restlessness. An increase in dosage over a short period can help to level overactive feelings out, though higher doses may also result in sleepiness.

The particular antipsychotic prescribed to a patient depends on the reaction the individual has to each drug tried. Each formulation of antipsychotic medication is intended to have the same basic effect, however, so finding the right one is a process of trial and error to determine which one works most effectively with the fewest side effects.

The older medications on the market were introduced in the mid-1950s to block dopamine.

While effective, they may induce side effects such as:

• Stiffness of joints and shaking
• Slowed thinking and a general sluggish feeling
• Restlessness
• Sexual dysfunction
• Tardive dyskinesia (continual tongue, mouth or jaw movements)

If side effects are experienced when taking antipsychotics, a lower dose will generally cause them to stop. If lower doses are ineffective in controlling the symptoms of psychosis, then the side effects can often be treated with the use of anticholinergic drugs, such as orphenadrine and procyclidine.
The newer brands of antipsychotics block less dopamine than the older brands do and also work on other neurotransmitters.

Side effects of the newer generation of drugs include:

• Sleepiness and general slowness
• Weight gain
• Sexual dysfunction
• Increased risk of diabetes
• Shaking (when taken in high doses)
• Tardive dyskinesia that can manifest in the arms and legs as well as the face

The primary advantages of the newer drugs are that they can improve symptoms that the older antipsychotics did not affect, such as lack of interest in previously enjoyed activities, lack of self-care and lowered motivation.

One antipsychotic drug that stands out from the rest is clozapine. Clozapine is generally more effective than the other drugs in handling the symptoms of psychosis along with reducing suicidal thoughts among schizophrenics. It has little effect on the movement-controlling dopamine systems, reducing the shakiness and stiffness side effects experienced with other drugs. It also does not generally result in tardive dyskinesia. It can make patients who use it drowsy, and it causes an increase in the production of saliva. Clozapine also reduces the white blood cell count in most users, increasing the chances of infection. This means that a patient taking clozapine will have to undergo regular blood tests, and the drug will need to be discontinued occasionally so that the bone marrow can produce the white blood cells that the patient’s body needs.

Length of Use

The length of time that a patient has to use antipsychotics is largely dependent on the condition that is being treated. If the patient only has a single schizophrenic episode, there is a 25 percent chance of nonreoccurrence, so continued use of drugs may be unnecessary. If taken to treat bipolar disorder, which is an ongoing condition, the drug treatment will also continue in an ongoing manner. If the medication is not taken, the symptoms of the condition it is used to treat will return. This return typically occurs within three to six months. Many users cease taking the drugs when they work because the patients believe that the drug is no longer needed. Decisions to cease antipsychotic use should be discussed with the prescribing physician before any patient stops taking medication so that the patient can gain a full understanding of the likely effects of doing so.

Use on Dementia in Elderly Patients

Antipsychotics are sometimes used to treat dementia in elderly patients. This use has its drawbacks as the medication can have serious side effects on the elderly. When treated in this way, older patients have a heightened risk of stroke and death. Risperidone is generally used for treatment of elderly people who are experiencing behavioral issues as a result of dementia. To avoid side effects, the drug is only used for a short period of time, with a limit of six weeks usually placed on its administration. It is also used only when other medications to treat aggression due to Alzheimer’s fail to work effectively and where the condition involves a risk of harm to the patient or those around the patient.

A 2004 Committee on Safety of Medicines study found that the risk of stroke in elderly patients being treated with antipsychotics was more than three times the normal, untreated, risk. In 2005, an FDA analysis of 17 medical trials of newer antidepressants (developed after the 1970s) used with elderly patients determined that the mortality rate of those patients showed a 1 to 2 percent increase over that of untreated patients.

• Editors, experts, and contents pages from the guidelines

View Resources

• Ncbi.nlm.nih.gov – Antipsychotic Drugs
• Web.williams.edu – Dopamine Receptor Blockade: Antipsychotic Drugs
• Live.psu.edu – Reducing off-label use of antipsychotic medications may save money
• Healthpsych.psy.vanderbilt.edu – The Behavioral Side Effects of Antipsychotic Medication for Schizophrenia
• Health.harvard.edu – Antipsychotic drugs for dementia