Mental health problems can have a profound impact on your quality of life. There are many types of medications to treat mental health concerns, and antipsychotics are one class that offers hope to millions of people with anxiety, depression, bipolar disorder, and psychotic disorders such as schizophrenia.
Antipsychotics have been around since the 1950s but became more widely used in the 1970s to treat mental health conditions.
This article is designed to demystify antipsychotics and explain their uses, mechanisms of action, side effects, and the impacts that they may have on mental health.
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What Are Antipsychotics?
So, what are these antipsychotic medications that have improved the lives of so many people?
Definition and Overview
Antipsychotics are medications that were first designed to treat psychosis conditions, but they are also used to treat other conditions such as bipolar disorder and also as adjunct medications for anxiety and depression.
Antipsychotic medications were introduced in 1949 to try to calm patients prior to anesthesia for surgery. In 1952, they were first tried on a bipolar patient who was manic. Over time, they became more common, and medications such as haloperidol and fluphenazine were used. In the 1970s, antipsychotics were studied for use in psychotic conditions. In the 1990s, more atypical antipsychotics such as risperidone, olanzapine, quetiapine, and ziprasidone were introduced. These medications have more favorable side-effect profiles for many patients and are now used more frequently than traditional antipsychotic medications.
Types of Antipsychotics
Antipsychotics are generally split into three categories.
First-generation antipsychotics are the original antipsychotics, also called typical antipsychotics. These include:
- Chlorpromazine
- Fluphenazine
- Haloperidol
- Thiothixene
- Prochlorperazine
- Perphenazine
- Pimozide
- Molindone
- Thioridazine
- Trifluoperazine
These medications are less frequently used now because of their side effect profile.
Second-generation antipsychotics are also called atypical antipsychotics. These medications were introduced in the 1980s. Second-generation antipsychotics include:
- Aripiprazole
- Asenapine
- Clozapine
- Iloperidone
- Lurasidone
- Olanzapine
- Paliperidone
- Quetiapine
- Risperidone
- Ziprasidone
New-generation antipsychotics were first introduced in 2015. These medications include:
- Brexpiprazole
- Cariprazine
- Lumateperone
These medications are being used to treat schizophrenia and depression but are also being studied for other indications.
How Antipsychotics Work in the Brain
Each of the generations of antipsychotics affects different chemicals in the rain called neurotransmitters. They each have different reasons for use and side effect profiles.
The Science Behind Antipsychotics
First-generation antipsychotics work on dopamine receptors by blocking them and decreasing the transmission of dopamine, specifically the D2 receptors. They also affect noradrenergic, cholinergic, and histaminergic receptor function.
Second-generation antipsychotics also block D2 dopamine receptors, but they also block serotonin receptors. They also affect histamine-1, muscarinic-1, and alpha-1 receptors.
New-generation antipsychotic medications partially activate the D2 receptors and are believed to stabilize dopamine levels in the body. These medications are believed to be more selective, which may lead to fewer side effects.
Dopamine and serotonin are both neurotransmitters that are involved in the regulation of mood and psychoses. By affecting the levels of these neurotransmitters and their interactions with receptors, antipsychotic medications can improve certain mental health conditions.
Common Conditions Treated
Antipsychotic medications work on more than just psychotic conditions. While each medication has its own indications, some of the common conditions treated by antipsychotic medications include:
- Schizophrenia
- Bipolar disorder
- Hyperactivity
- Severe behavioral problems
- Generalized anxiety disorder
- Psychotic disorders
- Tourette syndrome
- Depression, especially treatment-resistant
For anxiety and depression, second-generation antipsychotic medications are considered adjunctive medications to be used in combination with other traditional therapies rather than stand-alone therapies.
Benefits and Risks of Antipsychotics
Like any medication, antipsychotic medications come with both risks and benefits.
Key Benefits
Some of the benefits of antipsychotic medications include:
- Decreased psychotic symptoms such as hallucinations and delusions
- Decreased abnormal behavior
- Improved social interactions
- Improved attention
- Improved quality of life
- Improved depression and anxiety
Antipsychotic medications may also help prevent relapses of both depression and psychosis.
Potential Side Effects
Antipsychotic medications have many positive effects, but they also have potential side effects. Some of the potential side effects of antipsychotic medications include:
- Dizziness
- Fatigue
- Dry mouth
- Increased blood sugar and possibly type 2 diabetes
- Increased cholesterol
- Constipation
- Hormonal abnormalities such as increased prolactin levels which can cause abnormal breast tissue and lactation
- Abnormal movements, including tardive dyskinesia
- Inability to urinate
- Weight gain
There are ways that you may be able to mitigate some of the side effects of antipsychotic medications. Some side effects may require you to change medications or add additional medications to treat the side effects, such as medications to control abnormal movements.
Lifestyle medications such as decreasing sugar intake, getting regular exercise, and increasing water or fiber intake can also help improve some of the side effects of the medication.
In some cases, it may be necessary to stop medication altogether, though you should never stop medication without the recommendation of your healthcare provider.
Long-term Considerations
When taking antipsychotic medications long-term, you should be monitored regularly. Your healthcare provider will likely want to follow your weight, blood pressure, and blood sugar. Some medications require monitoring of the levels of the medication in your system or your liver function. The frequency of monitoring depends on how long you have been on medication, your other health conditions, and the recommendation of your healthcare provider.
Antipsychotic medications can potentially impact your metabolism with long-term use. This can increase your risk of type 2 diabetes as well as a condition called tardive dyskinesia, which is a permanent condition causing abnormal movements.
Antipsychotic medications are sometimes used for dementia-related psychosis, though use in these situations can increase the risk of death from all causes.
Alternatives to Antipsychotic Medications
Antipsychotics are not right for everyone. There are other medications that may be used for patients in some cases.
Non-Medication Approaches
There are several potential non-medication alternatives to antipsychotic medications. These include:
- Cognitive behavioral therapy
- Dialectical behavior therapy
- Creative therapies, such as art therapy
- Lifestyle changes such as diet and exercise
- Peer support groups
Family support is also important for patients with mental health conditions that may respond to antipsychotic medications.
Emerging Treatments
There are several new medications that are being released to treat psychotic conditions.
Precision therapies, which target specific genes and other biomarkers associated with the symptoms of psychoses, are also an emerging therapy.
Digital therapies are another way of monitoring medication responses and how people respond to the medications.
Complementary Strategies
Complementary and alternative therapies may also provide relief for people who suffer from psychotic diseases and other mental health conditions. It is important not to start any supplements without talking to your healthcare provider because of possible medication interactions.
Navigating the Journey with Antipsychotics
If you’re considering starting antipsychotic medications, knowing what to expect when you start medication can be a challenge.
For Patients
Early in the course of starting medication, you may experience dizziness, nausea, or fatigue. Many of these side effects will improve with time, but if you find the symptoms bothersome, you should talk with your healthcare provider. Your healthcare provider may recommend steps to mitigate the symptoms or may change the dose or even the medication you are taking. Talk openly with your provider about your concerns for the best outcomes.
For Caregivers
It can be daunting to care for someone with mental health concerns. If your loved one is starting antipsychotics, you may want to help monitor them to be sure that they are taking their medications regularly. You should also watch for abnormal movements or other side effects. Share your observations and concerns with your loved ones' healthcare provider. Mental health conditions are like any other chronic medical condition in that your loved one cannot control their symptoms. Approach your loved one without judgment to avoid the stigma associated with many mental health conditions.
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Key Takeaways
- Antipsychotic medications are used to treat psychotic conditions such as schizophrenia as well as depression, anxiety, and bipolar disorder
- There are three different categories of antipsychotic medications with different side effect profiles and indications
- Antipsychotic medications may increase your risk of diabetes or abnormal movements
- It is important to talk to your healthcare provider about any symptoms you may be experiencing
Antipsychotics offer hope to many people experiencing mental health conditions and may offer an option for reclaiming a higher quality of life. Your healthcare provider can help you determine what medication option is best for you or your loved one.
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