Antipsychotics
Wellness & SelfcareDrugs

Antipsychotics

Antipsychotics
Getty Images
By
Updated on October 14, 2024
by

Antipsychotics are medications that change how your brain uses chemical messengers called neurotransmitters. These medications treat disorders such as schizophrenia and mania, which involve psychosis — symptoms that impair your ability to distinguish reality from things that aren’t real. Doctors also use these medications to treat dementia, certain types of depression, and Parkinson’s disease, among other mental health conditions.

Read on to learn more about antipsychotics, including the conditions they treat, the types, and how they work.

What Are Antipsychotics?

Antipsychotics change how your brain uses and responds to the neurotransmitters serotonin and dopamine. These medications work by blocking and activating complex systems of neurotransmitters — systems that may cause different mental illnesses when they don’t work properly.

Antipsychotics treat a range of brain-related and mental health conditions. They’re especially important in treating psychotic symptoms, like hallucinations and delusions, which are common in schizophrenia and bipolar disorder.

Psychosis is a severe collection of symptoms that make daily functioning very challenging.

 While antipsychotic medications don’t cure mental health disorders, they significantly improve symptoms, giving you the chance to live a full, productive life.

What Conditions Do Antipsychotics Treat?

Antipsychotics treat mental health disorders that involve psychosis, but doctors also use them for other conditions too.

Conditions With Psychosis

Someone experiencing psychosis may hear or see things that aren’t really there. Or they may have deeply held false beliefs about things that aren’t true, such as believing something or someone is controlling their thoughts or actions. Examples of these conditions are:

  • Schizophrenia and schizoaffective disorder
  • Bipolar disorder
  • Major Depressive disorder with psychotic features
  • Delusional disorder
  • Borderline personality disorder
  • Dementia
  • Delirium
  • Substance-induced psychotic disorder

Conditions Without Psychosis

Dysfunctional neurotransmission, metabolic conditions, or genetic disorders sometimes result in depressive disorders, mental health or brain disorders. These don’t involve psychosis but cause severe agitation, memory problems, and emotional changes. Antipsychotics are approved by the U.S. Food and Drug Administration (FDA) for major depressive disorders, and are often used to treat behavioral symptoms of the following non-psychotic disorders as well, including:

  • Depressive disorders
  • Tourette syndrome
  • Huntington’s disease
  • Parkinson’s disease
  • Lesch-Nyhan syndrome
  • Obsessive-compulsive disorder (OCD)

Types of Antipsychotics

There are two main types of antipsychotics: first-generation (typical) and second-generation (atypical). First-generation antipsychotics have been around since the 1950s, while second-generation antipsychotics are relatively newer, emerging in the 1980s.

First-Generation Antipsychotics

First-generation antipsychotics block the way several neurotransmitters, especially dopamine, work in your brain. You can take all of them in oral form (by mouth), but healthcare providers may administer them as an injection.

  • chlorpromazine
  • fluphenazine
  • haloperidol (Haldol)
  • loxapine
  • molindone
  • perphenazine
  • pimozide
  • prochlorperazine (Compro)
  • thiothixene
  • thioridazine
  • trifluoperazine

Second-Generation Antipsychotics

Similar to first-generation antipsychotics, these medications also change the way neurotransmitters work, specifically by blocking and activating dopamine and serotonin receptors.Second-generation antipsychotics have far fewer side effects than first-generation, so doctors prescribe them much more frequently.
  • aripiprazole (Abilify, Aristada)
  • asenapine (Secuado, Saphris)
  • brexpiprazole (Rexulti)
  • cariprazine (Vraylar)
  • clozapine (Clozaril, Versacloz)
  • iloperidone (Fanapt)
  • lumateperone (Caplyta)
  • lurasidone (Latuda)
  • olanzapine (Zyprexa, Lybalvi, Symbyax)
  • quetiapine (Seroquel)
  • paliperidone (Invega)
  • pimavanserin (Nuplazid)
  • risperidone (Perseris, Resperdal)
  • ziprasidone (Geodon)

Muscarinic Agonists

Muscarinic agonists are a new class of medicines, with a recent FDA approval. They target cholinergic receptors rather than dopamine receptors in the brain. Other antipsychotics tend to cause weight-gain as a side effect, which is not an issue with these medicines.


  • xanomeline and trospium chloride (Cobenfy)

How Do Antipsychotics Work?

In the brain, information travels as electrical impulses between nerve cells called neurons. When the impulse reaches the end of a neuron, it releases a small amount of a chemical called a neurotransmitter. A receptor on the next neuron in line captures the neurotransmitter and generates a new electrical impulse to pass the message along.

This system malfunctions when there is too much activity of dopamine-sensitive neurons, leading to psychosis and other psychiatric symptoms. Antipsychotics work by blocking dopamine and serotonin receptors and activating other receptors.

What Are the Possible Side Effects of Antipsychotics?

Antipsychotics can reduce severe psychiatric symptoms that may disrupt your life. But there are serious side effects and complications to look out for.

 Some of these are outlined below.


Movement Disorders

Tardive dyskinesia is irreversible, involuntary movement of the face muscles, arms, and legs that results from long-term antipsychotic use. Someone with this condition will uncontrollably pucker their lips and tongue and jerk their arms or legs. Another serious side effect are parkinson-like symptoms of muscle stiffness, tremors, and slow movement.

Neuroleptic Malignant Syndrome

This is a rare but potentially fatal side effect that causes muscle rigidity, fever, high blood pressure, and confusion.

Heart and Circulatory Problems

Long-QT syndrome is a heart rhythm disorder that can be fatal. Antipsychotics may also cause orthostatic hypotension, a drop in blood pressure when you stand or sit up quickly, that can make you fall or faint.

Immune Disruption

Leukopenia or agranulocytosis are side effects that decrease the number of white blood cells in your body, which are necessary to fight infections. This side effect is most often caused by Clozaril.

Other Symptoms

Less serious but common side effects of antipsychotics include:

  • Drowsiness
  • Dizziness
  • Weight gain
  • Dry mouth
  • Constipation
  • Urinary retention
  • Elevation in prolactin levels
  • Increased risk of diabetes
  • Increased cholesterol levels

Are There Any Risks Related to Antipsychotics?

Antipsychotic medications may not be safe to take with other medications and may worsen existing health conditions. If your healthcare provider prescribes an antipsychotic medication, be sure to discuss your current medications. Let your doctor know if you have any of the following:

  • History of seizures
  • Heart or blood pressure problems
  • Liver damage or disease
  • Enlarged prostate
  • Are pregnant or breastfeeding
  • History of diabetes

The Takeaway

Antipsychotics adjust brain neurotransmitters like dopamine and serotonin to treat conditions with psychosis, such as schizophrenia and bipolar disorder, as well as other disorders like Parkinson’s and OCD. These medications help reduce symptoms and improve daily life, but they can also cause side effects like movement issues, heart problems, and immune disruptions. Be sure to talk to your doctor about your health history and all the medications you take to avoid potential medication interactions or worsening existing health concerns.

Resources We Trust

Meet Our Experts
See Our Editorial PolicyMeet Our Health Expert Network
Angela-Harper-bio

Angela D. Harper, MD

Medical Reviewer
Castle Connolly Top Doctor

Angela D. Harper, MD, is in private practice at Columbia Psychiatric Associates in South Carolina, where she provides evaluations, medication management, and psychotherapy for adults.  

A distinguished fellow of the American Psychiatric Association, Dr. Harper has worked as a psychiatrist throughout her career, serving a large number of patients in various settings, including a psychiatric hospital on the inpatient psychiatric and addiction units, a community mental health center, and a 350-bed nursing home and rehab facility. She has provided legal case consultation for a number of attorneys.

Harper graduated magna cum laude from Furman University with a bachelor's degree and cum laude from the University of South Carolina School of Medicine, where she also completed her residency in adult psychiatry. During residency, she won numerous awards, including the Laughlin Fellowship from the American College of Psychiatrists, the Ginsberg Fellowship from the American Association of Directors of Psychiatric Residency Training, and resident of the year and resident medical student teacher of the year. She was also the member-in-training trustee to the American Psychiatric Association board of trustees during her last two years of residency training.

Harper volunteered for a five-year term on her medical school's admission committee, has given numerous presentations, and has taught medical students and residents. She currently supervises a nurse practitioner. She is passionate about volunteering for the state medical board's medical disciplinary commission, on which she has served since 2015.

She and her husband are avid travelers and have been to over 55 countries and territories.

See full bio
Angela McPhillips

Angela McPhillips, DNP

Author

Angela McPhillips is a registered nurse and doctor of nursing practice with over 15 years of healthcare experience. She earned her nursing degrees from the University of Illinois Chicago (UIC). Her postgraduate and doctoral specialty is advanced population health nursing, specifically meeting the needs of medically complex children and students with disabilities in school and community settings.

Angela’s clinical background includes pediatric emergency nursing, school nursing, and child welfare nurse consulting. Angela’s academic career includes six years of teaching a variety of nursing courses at UIC. As a freelance health writer, she excels at writing simple, easy-to-understand information that helps patients and consumers navigate their healthcare journeys and make well-informed decisions.

A native Chicagoan and recent Florida transplant, Angela enjoys spending time in nature exploring the beaches of southwest Florida with her husband and two young children.

See full bio
See Our Editorial PolicyMeet Our Health Expert Network
EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Antipsychotic Medications. Cleveland Clinic. February 2023.
  2. Psychosis. Cleveland Clinic. May 2022.
  3. First- and Second-Generation Antipsychotics in Children and Young Adults: Systematic Review Update. Agency for Healthcare Research and Quality. May 2017.
  4. Chokhawala K et al. Antipsychotic Medications. National Library of Medicine, National Center for Biotechnology Information: StatPearls. February 2023.
  5. Antipsychotic Medications . Cleveland Clinic. February 2023.
  6. Torjesen I et al. Schizophrenia: US approves first new treatment in decades. BMJ.
  7. Tamminga C. Antipsychotic Drugs. Merck Manual Consumer Version. September 2022.
Additional Sources