Which is the most commonly seen adverse side effect of typical antipsychotics?

Antipsychotic medications are generally used to treat psychotic disorders. But they can also be used to treat bipolar disorder and depression. This section explains more about antipsychotic medication. This section is for people who have been prescribed antipsychotics. And for their carers, relatives and friends who would like to understand antipsychotics better.

If you would like more advice or information you can contact our Advice and Information Service by clicking here.

• Overview
• About
• Types & side effects
• Stopping and other medication
• Other considerations
• Further reading
• Useful contacts

About Antipsychotics

What are antipsychotics?

Psychosis is a medical term. If you live with psychosis, you might see or hear things that aren’t there. This is known as hallucinations. Or you might have firm beliefs that don’t match up to the way others see the world. This is known as delusions.

If you live with psychosis, you will process the world around you differently to other people. This can include how you experience, believe or view things.

Some people describe psychosis as a break from reality. Doctors may call these ‘psychotic symptoms’, a ‘psychotic episode’ or a ‘psychotic experience’.

Psychotic symptoms can be part of conditions such as schizophrenia, schizoaffective disorder, personality disorder and bipolar disorder. But some people can experience psychotic symptoms without having any of these conditions.

If you experience psychotic symptoms, your doctor may offer you antipsychotic medication to help you with your symptoms. Antipsychotics can help manage your symptoms of psychosis. This can help you feel more in control of your life, particularly if you are finding the psychotic symptoms distressing.

Research suggests 4 out of 5 people with severe mental illness, who take antipsychotics, find they’re successful in treating their symptoms. This is according to the Royal College of Psychiatrists. It isn’t possible to predict which one will work best for you, so you may have to try a few before you find the right one.

It’s important to remember it can take a few weeks for antipsychotics to work. You may not feel better straight away. Everyone responds to antipsychotics differently. It can take several days or weeks to reduce symptoms such as hallucinations or delusional thoughts. The effects of antipsychotics can take several weeks or months to work.

Some antipsychotics are used to treat mania. Mania is a symptom of bipolar disorder and psychotic symptoms of depression.

How do antipsychotics work?

Your brain contains chemicals which help to carry messages from one part of the brain to another. One of these chemicals is called dopamine. It is thought that high levels of dopamine may cause the brain to function differently and may cause the symptoms of psychosis.

Antipsychotics work by blocking the effect of dopamine. This helps reduce psychotic symptoms for many people.

The Royal College of Psychiatrists say that the evidence suggests that nothing works as well as antipsychotic medications to treat schizophrenia.

You can find more information about:

• Psychosis by clicking here
• Bipolar disorder by clicking here
• Depression by clicking here

Types of antipsychotics

What are the different types of antipsychotics?

There are 2 types of antipsychotics. Your doctor might call them the following.

• Typical or ‘1st generation’. These medications have been used since the 1950s. These were the first type of antipsychotics made.
• Atypical or ‘2nd generation’. These medications have been used since the 1990s. These are newer types of antipsychotics.

The main difference between these types is in their side effects. 1st generation antipsychotics may have more of an effect on your body movement than newer antipsychotics. Although this doesn’t mean newer generation antipsychotics don’t have any side effects on your movement.

Recent research continues to suggest that side-effects for all antipsychotics are different. Your psychiatrist should work with you to find which medication works best for you.

It’s important to think about each antipsychotic individually. This is because everyone reacts differently to medication. You can never be certain how you will be affected by side effects. This can mean that the first medication you try may not be the right one for you.

If you are struggling to cope with side effects after a few weeks speak to your healthcare professional.

Your doctor may prescribe you a different type of antipsychotic. Or give you a medication to help deal with the side effects. You can read more about side effects further below.

You can find more information about ‘Medication – choice and managing problems’ by clicking here.

How are antipsychotics taken?

Antipsychotic medication can come as tablets, a syrup or as an injection. The injections are called a depot. You may find a depot injection useful if you struggle to remember to take your medication.

Your doctor should take your views about the way you would like to take medication into account when prescribing it to you.

We have listed below the antipsychotics which are licenced for use in the UK.

First generation or typical antipsychotics

The following medications are typical antipsychotics. They are the older types of antipsychotics licensed for use in the UK. They have been listed by their generic name with the brand name in brackets.

• chlorpromazine (Largactil)
• flupentixol (Depixol)
• haloperidol (Haldol)
• levomepromazine (Nozinan)
• pericyazine
• perphenazine (Fentazin)
• pimozide (Orap)
• prochlorperazine
• promazine
• sulpiride (Dolmatil, Sulpor)
• trifluperazine (Stelazine)
• zuclopenthixol (Clopixol)

Second generation or atypical antipsychotics

The following medication are atypical antipsychotics. They are the newer types of antipsychotics licensed for use in the UK. They have been listed by their generic name with the brand name in brackets.

• amisulpride (Solian)
• aripiprazole (Abilify, Abilify Maintena)
• clozapine (Clozaril, Denzapine, Zaponex)
• lurasidone (Latuda)
• risperidone (Risperdal & Risperdal Consta)
• olanzapine (Zypadhera. Zyprexa)
• quetiapine (Seroquel, Seroquel XL)
• paliperidone (Invega, Xeplion)

Clozapine
Clozapine works slightly differently to others. It is usually given to people who are treatment resistant. Treatment resistant means other medication haven’t helped reduce or control symptoms.

The National Institute for Health and Care Excellence (NICE) says that people with schizophrenia should only be offered clozapine after having tried 2 other antipsychotics.

Clozapine can cause your white blood cell numbers to drop. But this is rare. If your white blood cells drop, this may mean you can get infections more easily. If you take clozapine, you will need regular blood tests to make sure your white blood cell count is healthy.

Your GP surgery should invite you to have blood tests at least once a year. It’s important that you attend your check-ups as regular monitoring helps to manage the risks. If you aren’t being invited to have regular blood tests by your GP surgery you can contact them to ask for these.

If your white blood cell numbers start dropping, you will be asked to stop taking the medication. You will have another blood test after you have stopped clozapine to make sure they are back to normal. Your doctor might decide to change your dose of clozapine or offer you another type of medication.

There is research to suggest that white blood cell numbers are more likely to drop in people from an ethnic minority. This is because some Black and ethnic minority people already have a lower-than-average white cell count. This may mean your psychiatrist may not prescribe you clozapine. Your psychiatrist will discuss the best options with you.

If you have missed any doses of your clozapine contact a health professional as soon as possible.

There has been a lot of research to suggest the effectiveness of clozapine in treatment resistant schizophrenia.

NICE produce guidelines for the assessment and treatment of mental illnesses, such as psychosis and schizophrenia. Doctors use these guidelines to decide which medication to offer you. You can find these in the further reading section at the bottom of this page.

What side effects might I experience from taking antipsychotics?

Your medication should come with a leaflet called a ‘patient information leaflet’. This leaflet will tell you what the side effects are and explain what to do if you are experiencing any side effects.

Side effects of antipsychotics can include the following.

• Uncontrollable movements of the jaw, lips and tongue. This is known as tardive dyskinesia. This includes shakiness. This can often be reduced by lowering the dose. But, if a high dose is necessary, the shakiness can be treated with antimuscarinic medication.
• Uncomfortable restlessness, known as akathisia.
• Sexual problems due to hormonal changes.
• Sedation. Such as sleepiness and slowness.
• Weight gain.
• A higher risk of getting diabetes.
• Constipation.
• Dry mouth.
• Hyperprolactinaemia, such as the production of milk in both men and women from their breasts.
• Blurred vision.

Not all antipsychotics will have these side effects and medication can affect different people in different ways. Second generation or atypical antipsychotics are less likely to cause movement side effects, but you might still experience them. If you do, then your doctor might change your medication. Or they may give you medication to help manage the involuntary movements.

You can find more information about ‘Medication – choice and managing problems’ by clicking here.

To learn more about the side effects of antipsychotics you may find the following NHS website helpful. It contains a handy chart that helps you to see some of your options for antipsychotics. This could also help you to make choices about your treatment. A healthcare professional can help explain what the following chart means:
www.choiceandmedication.org/nsft/generate/handychartpsychosis.pdf

You may also find the following websites helpful learn more about antipsychotics:

• NHS Medication search: www.choiceandmedication.org/nsft/
• British National Formulary (BNF): www.bnf.nice.org.uk/drug/
• Medicines and Healthcare products Regulatory Agency (MHRA) have helpful information leaflets about antipsychotics: www.products.mhra.gov.uk/substance-index

How might antipsychotics effect my physical health?

Some antipsychotic medications can affect your heart. If you have a heart condition, or you are at risk of having difficulties with your heart, doctors might scan your heart at check-ups. They might want to do this annually, or more regularly. This is done by having an electrocardiogram gram (ECG). This is a painless scan.

GP surgeries have a register of people with severe mental illness, such as psychosis or schizophrenia. If you are on the register your GP should offer you an annual physical health check. They might check your heart in these appointments.

Speak to your GP or psychiatrist if you want a heart check-up before you start taking antipsychotics. Or if you have any concerns about your heart or blood vessels.

If you live with psychosis or schizophrenia your doctor should offer to check your heart before you start antipsychotics if:

• the manufacturers of your medication say you should,
• a physical health check has found you have a higher risk of heart or blood vessel problems, such as high blood pressure,
• you have heart or blood vessel problems or someone in your family has had them, or
• you have to go into hospital.

Stopping and other medication

What if I want to stop taking antipsychotics?

If you want to stop taking antipsychotics, you should discuss this with your doctor.

Your doctor should discuss the negatives and benefits of stopping antipsychotics. You can ask them about these things. It’s important to think about the negatives and benefits of stopping antipsychotics.

If you decide to come off antipsychotics your doctor will help you come off the medication gradually by reducing the dose over a period of time.

If you stop antipsychotics suddenly it can cause 'rebound psychosis'. This means that the symptoms of your illness return suddenly, and you may become unwell again. This is also known as ‘relapse’.

If you or your family or friends think you are becoming unwell again, you should speak to your doctor.

You may find that stopping your medication can lead to your symptoms returning within 3-6 months. Your doctor may suggest that you keep taking the medication because it is keeping you well. If this is the case, you could ask about trying another type of medication.

If you want to stop taking antipsychotics, it is important to consider what happened during previous episodes of illness. The risk of the same symptoms occurring again needs to be weighed up against not having the side effects of the medication and any other things important to you. Your doctor can talk these things through with you to help you come to the best decision.

Can I experience withdrawal symptoms from stopping antipsychotics?

Antipsychotics aren’t addictive, but your body may get used to them. This is why you may experience ‘withdrawal symptoms’.

The withdrawal symptoms you may experience depends on each individual antipsychotic. Some antipsychotics are unlikely to cause you significant withdrawal symptoms. This is especially the case with depot injections.

You should discuss with your GP or psychiatrist if you might experience withdrawal symptoms. And what you can do to help manage withdrawal symptoms.

Do I have to take antipsychotics?

It’s your choice whether you take antipsychotics.

But you can be forced to take them if you’re detained in hospital under the Mental Health Act if professionals think it’s right for you.

You might lack the mental capacity to make a decision about whether to take antipsychotics. If you do, professionals and people involved in your care will decide if it’s in your best interests to take them.

You can find more information about:

• Mental Health Act by clicking here
• Mental capacity and mental illness by clicking here

Do antipsychotics affect other medication?

Antipsychotics can interact with many different medications. This means if you take an antipsychotic and another medication, they can affect each other.

For example, some antipsychotics can interact with tricyclic antidepressants. In some cases, this means they shouldn’t be prescribed together.

Some antipsychotics can cause drowsiness, so doctors should be careful about prescribing benzodiazepines too. It could make you feel drowsier.

Your doctor may prescribe you different medications with antipsychotics, which is common. Your doctor will carefully monitor this to ensure your safety.

You should tell your doctor about all the medicines you are taking. This includes any supplements. This will allow your doctor to prescribe the right antipsychotic. It is important to note that supplements, such as ‘natural health products’ can interact with antipsychotics.

If you’re taking a supplement, which your doctor agrees with, always get the same brand. Switching brands, even if it’s the same supplement, can have an effect your antipsychotics.

You may benefit from keeping an up-to-date medication list. This should include all the medication you’re currently taking so you can give it to healthcare professionals.

It’s also very important to not stop or start any medication without checking with a healthcare professional. This could be a doctor or a pharmacist.

Other considerations

Does alcohol affect antipsychotics?

You should tell your doctor if you drink alcohol. Drinking alcohol can make it harder for your body to absorb medication. This could increase the effects alcohol has on you. For example, drinking alcohol with antipsychotics might increase the sedative effects.

This means you might feel very tired. You may find more information about alcohol and your medication in the patient information leaflet.

Does smoking affect antipsychotics?

You should tell your doctor if you smoke. This is because smoking interacts with the way medication is absorbed in your body. If you are thinking of quitting smoking, you should discuss this with your doctor. If you stop smoking suddenly, this can affect the levels of medication in your body. This can cause serious side effects.

Can menopause affect psychotic disorders?

There is research to suggest that symptoms of schizophrenia, and psychotic related symptoms may worsen during menopause. Antipsychotic treatment may need to be modified and closely monitored for women during this period.

Can I drive when taking antipsychotics?

Antipsychotics can affect your concentration and make you feel drowsy. This could affect how well you are able to drive especially when you first start taking the medication. You should consider stopping driving during this time if you are affected.

You have to tell the DVLA if you live with certain mental health conditions including psychosis, paranoid schizophrenia and bipolar disorder.

You can find more information about ‘Driving and mental illness’ by clicking here.

What else should I consider before taking antipsychotics?

Can antipsychotics cause sexual problems?

Sexual problems have been reported as a side effect of antipsychotics. Evidence shows that many people taking antipsychotics experience sexual problems. But some antipsychotics have less sexual side effects than others.

Some antipsychotics can cause a hormone called ‘prolactin’ in your body to increase. This seems to be why antipsychotics can cause sexual side effects. The following side effects are common. Higher levels of prolactin can cause:

• periods to stop,
• a lack of sex drive,
• breast enlargement in both men and women,
• problems getting aroused, and
• erection and ejaculation problems for men.

If you are experiencing any of these problems, you should contact your doctor. They may reduce the dose or stop the medication. If you are advised to stay on it, you might be able to take medications to help with these problems.

What if I’m pregnant or planning on getting pregnant?

You can speak to your doctor about the risks of medication while pregnant or breastfeeding. You could also discuss this with your midwife or health visitor. Taking antipsychotics during pregnancy may have certain risks. You shouldn’t stop taking your antipsychotics without speaking to your doctor first.

It is thought that there may be a small risk of complications if you take antipsychotic drugs during pregnancy. Overall, the research isn’t clear whether first generation or second-generation drugs will affect your unborn child.

If you are pregnant or plan on getting pregnant, you should speak to your doctor. If possible, it is best to tell your doctor before you become pregnant so that you can discuss concerns you might have around medication. And agree a plan moving forward that will be healthy for you and your baby.

If you have had relapses in the past your doctor might suggest that you stay on your medication during and after pregnancy. This could reduce your baby’s exposure to the drug, because if you did relapse you would need a much higher dose. It’s important to discuss with your doctor the risk and benefits of continuing to take antipsychotics.

If you have a mental health condition, you may be seen by your local perinatal mental health service. This is if this team exists in your area. If you don’t have this team in your local area, your usual doctor can support you.

Can I breastfeed if I take antipsychotics?
If you are breastfeeding and taking antipsychotics, some antipsychotics could be passed to your child from your breast milk. Many drug manufacturers advise that you should stop breastfeeding while taking an antipsychotic.

There is evidence that the presence of some antipsychotics such as clozapine and olanzapine in breast milk may cause harmful effects. You should be monitored regularly and should stop breastfeeding if harmful effects are suspected. Speak to your doctor about the risk and benefits of continuing to take antipsychotics whilst pregnant.

Further reading

Psychosis and Schizophrenia in adults: prevention and management
This is the NICE guidance on Schizophrenia and Psychosis.

Website: www.nice.org.uk/guidance/cg178

Bipolar Disorder: assessment and management
This is the NICE guidance on Bipolar disorder.

Website: www.nice.org.uk/guidance/cg185

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