Explainer Link Copied 02.21.24

A Nice Lil Intro to Antipsychotics

These meds might sound scary, but they’re really helpful. BySam Brodsky

Shutterstock / Wondermind

For years, Esmé Weijun Wang, author of The Collected Schizophrenias, heard things that weren’t there and believed things that weren’t based in reality. Eventually she was diagnosed with schizoaffective disorder. While these hallucinations and delusions—symptoms of psychosis—aren’t totally gone now, she doesn’t have them as much anymore thanks to antipsychotic medications, she tells Wondermind. “For the most part, medication has helped me a lot,” she says. “I’m really grateful.”  

For people like Wang who’ve had hallucinations or delusions, it may be hard to sort out what’s real from what’s not. But antipsychotic meds can help them do life without those things getting in the way. If you’re hearing voices or truly believing that someone’s trying to hurt you when they aren’t, it’s going to be super difficult to go about your day, says psychiatrist Kamleh Shaban, MD. Antipsychotics “turn down this ‘noise,’” she explains. (It’s in the name after all: antipsychotics.) 

But these meds don't only make psychosis better. For example, antipsychotics can also help people who don’t have psychosis deal with mood symptoms that are really messing with them, according to experts. (More on that in a bit.) 

So, if you’re just curious about antipsychotic medications, think you might need them, or have an important person in your life who’s about to start them, we’re here to talk about the basics. Here’s how they work, side effects to look out for, and how long you can expect to be on them. Your doctor will ultimately help you suss out what makes the most sense for the symptoms you’re having, but this is a good place to start.  

What are antipsychotics?

Like we said, these meds treat outside-of-reality symptoms like hallucinations and delusions. This means they help people with conditions that can come with psychosis, like schizophrenia, bipolar disorder, and even severe depression, according to the National Institute of Mental Health (NIMH).

But you don’t actually need to experience psychosis to be on antipsychotics. These meds can also help stabilize the high highs and low lows of people with mood disorders, says Dr. Shaban. They’re prescribed to treat dementia and Tourette syndrome too, says psychiatrist Efraim Keisari, MD. And some are even FDA-approved to help with irritability in autism spectrum disorder. So don’t be shocked if you aren’t seeing or hearing weird things and your doctor brings up antipsychotics.

And, just so you know, there are two main classes of antipsychotics: older ones (called first-generation or typical antipsychotics), like haloperidol and chlorpromazine, and newer ones (called second-generation or atypical antipsychotics), like aripiprazole and risperidone. These newer ones can treat more kinds of symptoms compared to the older drugs, according to the NIMH.

So how do antipsychotics work? 

The specifics are still sort of murky, to be honest. That said, experts think that these meds prevent an overproduction of dopamine in certain parts of the brain that causes psychotic symptoms, Dr. Shaban explains. They do this by blocking some of the brain’s dopamine receptors, sorta like putting in earplugs, says Dr. Keisari.

The same dopamine-blocking powers can potentially help stabilize your mood if you’re manic—or at least that’s the theory, says Dr. Shaban. At the same time, atypical antipsychotics can be a green light for dopamine in certain parts of the brain, letting it be released instead of blocked, which might contribute to improved mood, she explains. Sometimes taking one of those atypical antipsychotics can also help your depression in a way your antidepressant can’t by affecting a few different types of receptors in your brain, Dr. Keisari says.

What are the side effects of antipsychotics?

It’s possible you won’t have too many side effects when starting antipsychotics, depending on what dose and medication you’re on, says Dr. Keisari. But there are  ones to know about.

Muscle jerks or cramps you can’t control are more likely to happen with first-gen antipsychotics, says Dr. Shaban. (FYI, this is one reason why a lot of psychiatrists prefer to prescribe second-gens now, Dr. Keisari notes.) But you’re more likely to experience higher cholesterol and weight gain (aka metabolic side effects) from certain second-gen antipsychotics rather than the older meds, says Dr. Shaban. Plus, you can have a dry mouth, constipation, blurry vision, and trouble peeing because of some first- and  second-gen antipsychotics, says Dr. Keisari. 

Because of potential side effects, psychiatrists may send you for bloodwork. For example, they’ll usually have you get blood sugar and cholesterol labs done every three to six months if you’re on antipsychotics that can mess with that, Dr. Shaban says. And doctors will need to monitor your white blood cell count super closely if you’re taking the atypical antipsychotic clozapine, since it can lower a specific type of infection-fighting white blood cell, says Dr. Keisari.  

You’ll also want to talk to your doctor about the risks versus benefits of being on antipsychotics if you’re planning on getting pregnant, says Dr. Shaban. Using antipsychotic meds while pregnant may increase the baby’s risk for birth defects, research suggests. That said, “untreated mental health in a mother can have really lasting effects,” Dr. Shaban says, so only you and your doctor can decide what’s best for you. (Just so you know, she’s personally had pregnant patients who stayed on antipsychotics, so it’s not unheard of.)

How long can you take antipsychotics?

It really depends on what you’re being treated for. Someone with schizophrenia or schizoaffective disorder, for example, will probably need to stay on antipsychotic meds to manage their psychosis, says Dr. Shaban. But someone who’s using an antipsychotic in addition to other medication for depression or manic episodes might wean off that antipsychotic when they’re feeling stable, she adds. 

Remember that everyone’s different, so it might take some trial and error to find an antipsychotic that manages your symptoms and doesn’t give you bad side effects, Dr. Shaban says. Once you do, your symptoms may start to get better in a few days, though it could take a number of weeks to get the full effects, Dr. Keisari says.

Bottom line: Antipsychotic medications are usually prescribed for treating psychosis in disorders like schizophrenia, but they’re also used for other mental health conditions. Regardless of what you’re taking antipsychotics for, be open with your doctor about side effects and any questions you have, says Dr. Shaban. They can help you find what works for you.