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Antipsychotics: Uses, Benefits, Risks and Integrated Treatment

Date: May 5, 2025 | 6 Minute Read

Antipsychotics or neuroleptics are used to reduce and control psychotic symptoms by impacting certain neurotransmitters in the brain, such as dopamine, noradrenaline, acetylcholine, serotonin and glutamate. Antipsychotics can be categorized into two types: first generation or typical antipsychotics and second generation or atypical antipsychotics.

What are Antipsychotics?

First generation antipsychotics were developed in the 1950s. Most typical antipsychotics work by blocking dopamine, acetylcholine, histamine and noradrenaline receptors in the brain, which control affect thinking, cognitive behavior, learning, sexual and pleasure feelings and coordination of voluntary movement.

These drugs can be useful in treating severe psychosis and behavior problems; however, they have the potential for some serious side effects, including neuromuscular side effects similar to those in Parkinson’s disease.

First generation antipsychotics include:

  • Haldol (haloperidol)
  • Loxitane (loxapine)
  • Mellaril (thioridazine)
  • Moban (molindone)
  • Navane (thiothixene)
  • Prolixin (fluphenazine)
  • Serentil (mesoridazine)
  • Stelazine (trifluoperazine)
  • Trilafon (perphenazine)
  • Thorazine (chlorpromazine)
  • Prolixin or Permitil (fluphenazine)
  • Adasuve (loxapine)
  • Orap (pimozide)
  • Compro (prochlorperazine)
  • Mellaril (thiothixene)
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Second generation antipsychotics were first developed in 1959 and work by blocking serotonin receptors and also act on adrenergic, cholinergic and histamine receptors. These drugs have less severe neuromuscular side effects but can have metabolic side effects, including rapid weight gain and changes to blood sugar levels.

Second generation antipsychotics include:

  • Abilify, Aristada (aripiprazole)
  • Secuado, Saphris (asenapine)
  • Rexulti (Brexpiprazole)
  • Vraylar (cariprazine)
  • Clozaril, Versacloz (clozapine)
  • Fanapt (iloperidone)
  • Caplyta (lumateperone)
  • Latuda (lurasidone)
  • Geodon (ziprasidone)
  • Risperdal, Perseris (risperidone)
  • Seroquel (quetiapine)
  • Zyprexa, Lybalvi, Symbax (olanzapine)
  • Invega (paliperidone)
  • Nuplazid (pimavanserin)

Conditions Treated with Antipsychotic Medication

Antipsychotics are used to treat psychosis that can be present in conditions such as schizophrenia, borderline personality disorder, bipolar disorder, psychotic depression, senile psychoses and various organic and drug-induced psychoses.

Psychosis refers to a collection of symptoms that affect your ability to distinguish what is real and what isn’t. In some cases, antipsychotic drugs are used in conjunction with other medications to treat Tourette syndrome, Huntington’s disease, Parkinson’s disease, Leshch-Nyhan syndrome and obsessive compulsive disorder.

For schizophrenia, certain antipsychotics work by blocking the transmission of dopamine, which helps to reduce the primary symptoms of the disorder, hallucinations and delusions. These medications do not cure schizophrenia but improve symptoms, reduce the severity of psychotic episodes and help prevent future relapses.

For individuals with bipolar disorder, the use of certain antipsychotics blocks dopamine receptors and regulates serotonin pathways, which helps to stabilize moods, reduce the frequency and severity of mood episodes and improve overall functioning.

The use of antipsychotics for acute and chronic psychosis works by altering brain chemistry. This causes a reduction in the flow of messages to the brain, which lessens the symptoms of hallucinations, delusions, disordered thinking or other behaviors associated with psychosis.

Antipsychotics have also been used off label to treat other conditions. These include depression, anxiety, ADHD, substance use disorder, eating disorders and insomnia.

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FAQs

Are Antipsychotics Only for Schizophrenia?

No, antipsychotics are used to treat other mental health conditions by stabilizing mood, reducing agitation and managing behavioral disturbances.

What’s the Difference Between Typical and Atypical Antipsychotics?

Typical or first generation antipsychotics work by reducing dopamine in the brain and have more severe side effects, such as extrapyramidal symptoms, which are movement disorders that impact the way the body moves.

Atypical antipsychotics work by blocking both dopamine and serotonin receptors in the brain. They tend to be better tolerated than typical antipsychotics due to less severe side effects and have been successful in treating a broader range of conditions, including mood and anxiety disorders.

Can I Stop Taking Antipsychotics if I Feel Better?

No. Antipsychotics are used to treat symptoms, not cure disorders. Discontinuing the drug will result in the return or worsening of symptoms. In most cases, tapering of the medication must be done over an extended period.

The longer an individual takes an antipsychotic, the longer it will take to wean off the medication. It is important to remember that this is a decision that should be made under the supervision and guidance of a medical provider.

Are Antipsychotics Addictive?

The short answer is no. They can, however, cause physical dependence that can result in withdrawal symptoms when stopped. Withdrawal symptoms may include nausea, vomiting, return of psychotic symptoms, hypertension and sleep disturbance.

How Long Will I Need to Take Antipsychotic Medication?

This depends on the reason for taking the medication. Some of these medications can be used for a short term, while others can be taken for years. For example, for individuals with schizophrenia, the use of antipsychotics is a lifetime commitment, as these medications treat symptoms but do not cure the disease.

Benefits of Antipsychotic Drugs

Individuals in acute psychosis benefit from the use of antipsychotic drugs because they help provide the stabilization needed when in crisis. Some antipsychotics, such as Haldol or Zyprexa, can be fast acting, especially when given in intramuscular or sublingual methods. This can make them very effective in de-escalating severe agitation or aggression caused by the psychosis.

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When an antipsychotic is used long term, not only does it help lessen the symptoms of psychosis, but it also decreases the likelihood of future severe crises. Once an individual has found an antipsychotic that works for them and takes the medication consistently, many find an overall improvement in their quality of life.

They are able to achieve long-term stabilization and reduce the potential for relapse.

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Risks and Side Effects of Antipsychotic Medications

While antipsychotic medications have many beneficial uses, they also have many side effects. The side effects tend to be more severe with typical antipsychotic medications. For this reason, regular monitoring and supervision by a medical provider are important, as some side effects can be life threatening.

Potential side effects include:

  • Abnormal movements
  • Constipation
  • Dizziness and sedation
  • Drug-induced movement disorders
  • Drug interactions
  • Dry mouth
  • Heart and circulatory problems
  • High blood sugar
  • High cholesterol
  • High prolactin levels
  • Immune disruption
  • Jaundice
  • Painful muscle contractions (dystonias)
  • Tardive dyskinesia
  • Type 2 diabetes
  • Urinary retention
  • Weight gain
  • Fever
  • Confusion

Antipsychotics in a Comprehensive Treatment Plan

Individuals who are experiencing schizophrenia, bipolar disorder, borderline personality disorder, psychotic depression, various organic/drug induced psychoses and some other mental health disorders may benefit from the use of antipsychotic drugs. However, the use of these medications is not enough.

A comprehensive treatment plan includes the use of antipsychotic medications along with psychotherapy such as cognitive behavioral therapy (CBT), social skills training, family therapy and psychoeducation that is individualized to address the unique needs and challenges of each individual.

Consistent monitoring of symptoms, adherence to a medication regimen and regular appointments with medical and mental health providers are crucial for maintaining stabilization and prevention of relapse.

Psychiatrists and therapists play important roles in this treatment plan development and implementation. These experts can provide diagnosis and prescribe the appropriate antipsychotic drugs based on your situation. They can also monitor progress and make medication adjustments as needed.

To connect with a qualified provider and learn more about antipsychotic treatment options, find therapists and psychiatrists near you.

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