Antipsychotic Medications

What are Antipsychotic Medications?

Antipsychotic medications are mainly used to manage psychosis. Psychosis is a condition where the mind experiences delusions (false/fixed beliefs) or hallucinations (hearing or seeing imaginary things).

Psychosis can be a symptom of a physical condition like drug abuse or a mental disorder like schizophrenia, bipolar disorder or severe manic depression. Antipsychotics are also used to treat symptoms associated with psychotic depression, senile psychoses or drug-induced psychoses, anxiety or depression.

Antipsychotic medications are also known as neuroleptics.

The prescription of antipsychotics has increased in the last 20 years, both in pediatrics as well as in adult populations.

Antipsychotics have short-term benefits of calming or slowing the person and long-term beneficial effects of reducing the occurrence of psychotic episodes.

Antipsychotic medications are available as oral dosage forms, like tablets, capsules, liquids as well as parenteral dosage forms, like intravenous and intramuscular injections.

The choice of category of medication depends on factors like:

• Frequency of psychotic episodes
• Symptoms due to psychotic disorders
• Growth development
• Intensity of side effects

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How do Antipsychotics Work?

Antipsychotics influence chemicals in the body known as neurotransmitters.

These chemicals play a vital role to help brain cells communicate with each other. They affect mood, behavior, and emotions.

Dopamine is the primary neurotransmitter affected by antipsychotic medications. Dopamine is involved in making a person feel satisfied, contented or motivated. If dopamine levels increase, the person gets hallucinations, delusions, voices and bad thoughts.

In such situations, the antipsychotic medications help the person feel better, without making them feel sleepy or slowed down.

Some medications block serotonin receptors in the brain, which play an essential role in schizophrenia.

What do Antipsychotics Help With?

Antipsychotics help in the following situations:

• Difficulty in thinking clearly
• Extreme mood swings
• Attention-Deficit Hyperactivity Disorder (ADHD)
• Persons suffering from delusions and hallucinations
• Obsessive Compulsive Disorder (OCD)

Usually, antipsychotic medicines show best results with psychotherapy. The medication helps in treating symptoms, and the psychotherapy or counseling help in addressing behavioral issues and the leading causes of mental issues.

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What are the Types of Antipsychotic Medications?

The commonly known types of antipsychotic medications are:

Older or first-generation antipsychotics - As the name suggests, older antipsychotics are drugs that were used in the mid-1950s; they are also known as “Typical” or “Conventional” antipsychotics. They act by blocking the action of dopamine.

The commonly known typical or first-generation antipsychotics include:

• Chlorpromazine
• Haloperidol
• Trifluoperazine
• Pimozide
• Fluphenazine
• Perphenazine

Newer or second-generation antipsychotics - These drugs are newer compared to 'Typical' antipsychotics and were introduced in the 1990s. They are also called "Atypical" antipsychotics. They also act by blocking dopamine, but with lesser intensity, as compared to the older drugs. In addition to dopamine, they also act on other neurotransmitters like serotonin.

Second-generation antipsychotics also help a person overcome their negative feelings, like lack of motivation, and lack of self interest, areas where the older drugs had less effect.

The atypical or second-generation antipsychotics include:

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

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What are the Side Effects of Antipsychotic Medications?

Antipsychotic medications can have negative effects on various systems in the body:

Cardiovascular system:

• Chest pain
• Angina
• Tachycardia
• Cardiomyopathy
• Arrhythmias
• Enema

Liver (hepatic system):

• Jaundice
• Drug induced hepatitis
• Necrosis

Central Nervous System:

• Sedation
• Hypnosis
• Drowsiness
• Dementia
• Disturbed sleep
• Depression

Extrapyramidal effects:

• Tardive Dyskinesia
• Ataxia
• Muscle breakdown
• Tremors
• Rigidity

Gastrointestinal system:

• Dry mouth
• Weight gain
• Nausea
• Heartburn
• Constipation

Genito-urinary (urinary and reproductive) system:

• Premature ejaculation
• Impotence
• Polyuria
• Swelling and tenderness of breast
• Impotence

Other side effects:

• Restlessness or akathisia
• Slow in thinking
• Dermatological side effects
• High probability of suffering from diabetes
• Blurred vision

How Long Should One Take Antipsychotic Medications?

The duration of taking antipsychotic medications varies from person to person. Some may need it as a short-term therapy for about two weeks, while others may need to take it longer, at times, up to 5 years.

People who experience recurrent psychotic episodes may need to take the medication for life.

In situations, where the side effects are intense, the psychiatrist may

• adjust the dose
• prescribe alternate medications

What Precautionary Measures Need to be Taken When on Antipsychotic Medications?

One needs to follow certain precautions when on antipsychotic medications:

• The doctor or healthcare provider must be informed of the following when on antipsychotic medications:
• Other medications being consumed
• Any known allergies
• Alcohol drinking or smoking habits
• Any existing injuries or diseases
• Side effects noted when on antipsychotic medications:
• Any changes in physical health
• In case the antipsychotic medication has to be withdrawn, it must be done slowly and gradually. If they are discontinued suddenly, the person may again suffer from symptoms like nausea, hypertension and sleep disturbances.
• When on antipsychotic medications, one must keep a watch on the physical health and go for regular health-checkups, as these medications can increase the risk of diabetes and other health-related complications.
• Some of the routine tests which must be conducted include:
• Blood cell count
• Functioning of liver and kidneys
• Blood lipid profile
• Blood glucose level
• Regular exercise, getting good sleep and eating nutritious food help in controlling the side effects of antipsychotic medications.

Who Should Not Take Antipsychotic Medications?

Antipsychotics cannot be prescribed with other medications or substances like:

• Anti-anxiety drugs
• Anti-depressants
• Anticoagulants
• Hypotensive agents
• Alcohol
• Smoking

Antipsychotics are also not prescribed in patients who are suffering from

• Cardiovascular disease
• Epilepsy
• Myasthenia gravis
• Respiratory problems
• Coma
• History of jaundice