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Antipsychotic Medicines

Antipsychotics are medicines that are mainly used to treat schizophrenia or mania caused by

bipolar disorder. There are two main types of antipsychotics: atypical antipsychotics and olderantipsychotics. Both types are thought to work as well as each other. Side-effects are common with

antipsychotics. You will need regular tests to monitor for side-effects while you take thesesmedicines.

What are antipsychotics?

Antipsychotics are a group of medicines that are mainly used to treat mental health illnesses such asschizophrenia, or mania (where you feel high or elated) caused by bipolar disorder. They can also be used totreat severe depressionand severe anxiety. Antipsychotics are sometimes also called major tranquillisers.

There are two main types of antipsychotics:

Newer or atypical antipsychotics. These are sometimes called second-generation antipsychoticsand include: amisulpride, aripiprazole, clozapine, olanzapine, quetiapine, risperidone and sertindole.Older typical well-established antipsychotics. These are sometimes called first-generationantipsychotics and include: chlorpromazine, flupentixol, haloperidol, levomepromazine, pericyazine,perphenazine, pimozide, sulpiride, trifluoperazine, and zuclopenthixol.

Antipsychotics are available as tablets, capsules, liquids, and depot injections (long-acting). They come in variousdifferent brandnames.

Older antipsychotics have been used since the 1950s and are still prescribed today. Newer antipsychotics weredeveloped in the 1970s onwards. It was originally thought that these medicines would have fewer side-effectsthan the older type of antipsychotics. However, we now know that they can also cause quite a few side-effects.

How do antipsychotics work?

Antipsychotics are thought to work by altering the effect of certain chemicals in the brain, called dopamine,serotonin, noradrenaline and acetylcholine. These chemicals have the effect of changing your behaviour, moodand emotions. Dopamine is the main chemical that these medicines have an effect on.

By altering the effects of these chemicals in the brain they can suppress or prevent you from experiencing:

Hallucinations (such as hearing voices).Delusions (having ideas not based on reality).Thought disorder.Extreme mood swings that are associated with bipolar disorder.

When are antipsychotics usually prescribed?

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As discussed above, antipsychotics are usually prescribed to help to ease the symptoms of schizophrenia,mania (caused by bipolar disorder), severe depression or severe anxiety. Normally they are started by aspecialist in psychiatry, or your GP will ask a specialist for advice on when to start them.

Also, for many years antipsychotics were used to calm elderly people who had dementia, but this use is nolonger recommended. This is because these medicines are thought to increase the risk of stroke and early death- by a small amount. Risperidone is the only antipsychotic recommended for use in these people. Even then, itshould only be used for short period of time (less than six weeks) and for severe symptoms.

Which antipsychotic is usually prescribed?

The choice of antipsychotic prescribed depends upon what is being treated, how severe your symptoms are, andif you have any other health problems. There are a number of differences between the various antipsychoticmedicines. For example, some are more sedating than others. Therefore, one may be better for one individualthan for another. A specialist in psychiatry usually advises on which to use in each case. It is difficult to tell whichantipsychotic will work well for you. If one does not work so well, a different one is often tried and may work well.Your doctor will advise.

It is thought that the older and newer types of antipsychotics work as well as each other. The exception to this isclozapine - it is the only antipsychotic that is thought to work better than the others. Unfortunately, clozapine has anumber of possible serious side-effects, especially on your blood cells. This means that people who takeclozapine have to have regular blood tests.

In some cases, an injection of a long-acting antipsychotic medicine (depot injection) is used once symptomshave eased. The medicine from a depot injection is slowly released into the body and is given every 2-4 weeks.This aims to prevent relapses (recurrences of symptoms). The main advantage of depot injections is that you donot have to remember to take tablets every day.

How well do antipsychotics work?

It is thought that for every 10 people who take these medicines, 8 will experience an improvement in their

symptoms. Unfortunately, antipsychotics do not always make the symptoms go away completely, or for ever. A lotpeople need to take them in the long term even if they feel well. This is in order to stop their symptoms fromcoming back. Even if you take these medicines on a long-term basis and they are helping, sometimes yoursymptoms can come back.

Symptoms may take 2-4 weeks to ease after starting medication, and it can take several weeks for fullimprovement. The dose of the medicine is usually built up gradually to help to prevent side-effects (includingweight gain).

What is the usual length of treatment?

This depends on various things. Some people may only need to take them for a few weeks, but others may needto take them long-term (for example, for schizophrenia). Even when symptoms ease, antipsychotic medication isnormally continued long-term if you have schizophrenia. This aims to prevent relapses, or to limit the number andseverity of relapses. However, if you only have one episode of symptoms of schizophrenia that clears completelywith treatment, one option is to try coming off medication after 1-2 years. Your doctor will advise.

Stopping antipsychotics

If you want to stop taking an antipsychotic you should always talk to your doctor first. This is in order to help youdecide if stopping is the best thing for you, and how you should stop taking your medicine. These medicines areusually stopped slowly over a number of weeks. If you stop taking an antipsychotic medicine suddenly, you maybecome unwell quite quickly. Your doctor will usually advise you to reduce the dose slowly to see what effect the

lower dose has on your symptoms.

What about side-effects from antipsychotics?

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Side-effects can sometimes be troublesome. There is often a trade-off between easing symptoms and having toput up with some side-effects from treatment. The different antipsychotic medicines can have different types ofside-effects. Also, sometimes one medicine causes side-effects in some people and not in others. Therefore, it isnot unusual to try two or more different medicines before one is found that is best suited to an individual.

The following are the main side-effects that sometimes occur. However, you should read the information leafletthat comes in each medicine packet for a full list of possible side-effects.

Common side-effects include:

Dry mouth, blurred vision, flushing and constipation. These may ease off when you get used to themedicine.Drowsiness (sedation), which is also common but may be an indication that the dose is too high. Areduced dose may be an option.Weight gain which some people develop. Weight gain may increase the risk of developing diabetesand heart problems in the longer term. This appears to be a particular problem with the atypicalantipsychotics - notably, clozapine and olanzapine.Movement disorders which develop in some cases. These include:

Parkinsonism - this can cause symptoms similar to those that occur in people withParkinson's disease- for example, tremor and muscle stiffness.Akathisia - this is like a restlessness of the legs.

Dystonia- this means abnormal movements of the face and body.Tardive dyskinesia (TD) - this is a movement disorder that can occur if you takeantipsychotics for several years. It causes rhythmical, involuntary movements. These areusually lip-smacking and tongue-rotating movements, although it can affect the arms andlegs too. About 1 in 5 people treated with typical antipsychotics eventually develops TD.

Atypical antipsychotic medicines are thought to be less likely to cause movement disorder side-effects thantypical antipsychotic medicines. This reduced incidence of movement disorder is the main reason why anatypical antipsychotic is often used first-line. Atypicals do, however, have their own risks - in particular, the risk ofweight gain. If movement disorder side-effects occur then other medicines may be used to try to counteractthem.

Will I need any tests while taking an antipsychotic?

Your doctor will want to monitor you regularly for side-effects if you take an antipsychotic. The tests needed andhow often you will need to have them depend on which antipsychotic you are taking.

In general, your doctor will take a sample of blood for certain tests before you start treatment. The tests look athow many blood cells you have, how well your kidneys and liver are working, how much lipid (fat) is in your blood,and if you have diabetes. These tests may be repeated in the first 3 or 4 months of treatment. After this they arenormally done every year. However, your doctor may advise you to have these tests more often.

Your weight and blood pressure are usually measured before you start treatment and every few weeks after this

for the first few months. After this they are normally measured every year.

The blood level of prolactin (a hormone) may also be measured before starting treatment and six months later.Usually it is then measured every year after this. The prolactin level is measured because sometimesantipsychotics can make you produce too much of this hormone. If you make too much prolactin it can lead toyour breasts growing bigger and breast milk being produced.

Note: people taking clozapine need weekly blood tests for the first six months and two-weekly blood tests afterthat. This is because it can have a serious effect on how many blood cells you make.

Who cannot take antipsychotics?

Antipsychotics are usually not prescribed for people who are comatose (in a coma), have depression of theircentral nervous system, and who have phaeochromocytoma (tumour on the adrenal gland).

Can I buy antipsychotics?

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No - they are only available from your pharmacist, with a doctor's prescription.

How to use the Yellow Card Scheme

If you think you have had a side-effect to one of your medicines, you can report this on the Yellow Card Scheme.You can do this online at the following web address: www.mhra.gov.uk/yellowcard.

The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side-effects that

your medicines may have caused. If you wish to report a side-effect, you will need to provide basic informationabout:

The side-effect.The name of the medicine which you think caused it.Information about the person who had the side-effect.Your contact details as the reporter of the side-effect.

It is helpful if you have your medication and/or the leaflet that came with it with you while you fill out the report.

Further help & information

Mind

15-19 Broadway, London, E15 4BQ

Tel: (Infoline) 0300 123 3393, (General) 020 8519 2122

Web: www.mind.org.uk

SANE

1st Floor, Cityside House, 40 Adler Street, London, E1 1EE

Tel: (Helpline) 0845 767 8000

Web: www.sane.org.uk

Rethink Mental Illness

15th Floor, 89 Albert Embankment, London, SE1 7TP

Tel: (Advice Service) 020 7840 3188, (General) 0845 456 0455

Web: www.rethink.org

Further reading & referencesBritish National Formulary; 63rd Edition (Mar 2012) British Medical Association and Royal Pharmaceutical Society of GreatBritain, LondonAntipsychotics,Royal College of Psychiatrists, March 2012Antipsychotic drugs, Medicines and Healthcare products Regulatory Agency (MHRA), 2009Schizophrenia; NICE CKS, October 2009

Disclaimer:This article is for information only and should not be used for the diagnosis or treatment of medicalconditions. EMIS has used all reasonable care in compiling the information but make no warranty as to itsaccuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.For details see our conditions.

Original Author:Dr Tim Kenny

Current Version:Mrs Jenny Whitehall

Peer Reviewer:Dr Tim Kenny

Document ID:13868 (v2)

Last Checked:19/07/2012

Next Review:19/07/2015

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