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What to know about antipsychotic medications for schizophrenia

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How do antipsychotics work?Antipsychotic drugsFirst-generation antipsychotics Second-generation antipsychotics Side effectsdrowsinessCognitive effects Heart related side effects Sexual challengesEffects of high prolactinSeizures Syndrome complicationsMovement-related challengesSummary
Drugs like haloperidol, chlorpromazine, trifluoperazine, and aripiprazole help manage symptoms of schizophrenia. They may cause mild side effects.
Medically reviewed by Yalda Safai, MD, MPH
Updated on March 27, 2023

While there is no cure for schizophrenia, psychotherapy and antipsychotic medications can help manage symptoms.

Psychosis is the main symptom of schizophrenia. It means there is difficulty in processing information, which might lead you to perceive events and objects differently than other people in the same situation.

You may see or hear things that other people in the same room may not be able to see or hear. This symptom is medically known as hallucination.

Psychosis may also make you firmly believe things despite evidence to the contrary. This is called delusion.

Antipsychotic drugs aim to help you reduce hallucinations, delusions, and other schizophrenia symptoms. The side effects may range from serious to mild, for example, movement-related side effects, drowsiness, heart-related or cognitive side effects.

This article discusses the different types of antipsychotic drugs, the most commonly used drugs to treat schizophrenia, and their possible side effects.

How do antipsychotics work?

Six different pill pots in different colors. Each pot has pills that are the same color as the pot. The pots are transparent and in two rows of three. Top row is green, blue, and yellow. Second row is pink, white, and orange. These could be antipsychotic drugs for schizophrenia in a particular order.
Marc Tran/Stocksy United

Antipsychotics block dopamine in the brain, which may reduce symptoms of psychosis.

Dopamine is a chemical produced by the body that helps nerve cells communicate with each other. These messages are typically associated with pleasure and reward sensations.

People with schizophrenia may have more dopamine in the mesolimbic pathway, the part of your brain that manages pleasure, emotions, attention, and motivation.

The cause of schizophrenia is currently unknown, but experts suspect that one of the main contributing factors is this overactivity of dopamine. 

Many antipsychotic drugs target dopamine receptors in the mesolimbic pathway, specifically the D2/D3 receptors. 

By balancing dopamine levels in the brain, antipsychotic drugs help lower the chance of experiencing hallucinations, delusions, and mood changes.

About 75% of people with schizophrenia who take D2 antagonist drugs have experienced an improvement in their symptoms.

Doctors usually advise taking antipsychotic drugs for at least 6 weeks. After starting the treatment, one can notice changes in the first few days

List of antipsychotic drugs

There are two types of antipsychotic drugs:

  1. First-generation antipsychotic drugs are known as typical antipsychotics or dopamine receptor antagonists.
  2. Second-generation antipsychotic drugs are known as atypical antipsychotics or serotonin-dopamine antagonists.

These two types of drugs work equally well for schizophrenia symptoms. The main difference between the two is that first-generation antipsychotics target only dopamine receptors, while second-generation antipsychotics target dopamine and other chemical receptors. 

Though they work well for schizophrenia symptoms, these drug types may have different side effects. The first-generation antipsychotics may be more prone to cause movement-related side effects.

Common first-generation antipsychotic drugs

The first-generation antipsychotic medications for schizophrenia approved by the Food and Drug Administration (FDA) include:

Common second-generation antipsychotic drugs

The second-generation antipsychotic medications that are FDA-approved for schizophrenia include the following:

Doctors prescribe atypical antipsychotic medications for other mental health conditions, like in some cases of depression and anxiety. Antipsychotics and other drugs not on this list can also help address other symptoms of schizophrenia, like agitation.

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Side effects of antipsychotic drugs

Although rare, antipsychotic medications may cause mild and severe side effects, especially over a long period. 

The side effects of first-generation antipsychotic medications are typically movement-related, while second-generation antipsychotic drugs are more likely to affect the metabolic system.

Some of the most common side effects associated with antipsychotic medications include:

Drowsiness

Drowsiness or sedation is a common side effect of antipsychotic medications, especially at higher doses. This sedative effect can sometimes cause dizziness, confusion, or vertigo. 

Cognitive effects

You might find it difficult to focus on tasks or experience partial cognitive impairment. However, these symptoms may also come from living with schizophrenia. Consider discussing your situation with your doctor.

Antipsychotic medications can have an adverse effect on your heart health. Orthostatic hypotension (low blood pressure that causes dizziness when you stand up) may be a side effect of some antipsychotic drugs. 

Other cardiovascular side effects may include: 

  • cardiomyopathy (heart muscle thickening)
  • heart palpitations
  • cardiac arrhythmias

Sexual challenges

Antipsychotic medications may increase a hormone called prolactin which can lead to challenges such as: 

  • decreased libido
  • erectile dysfunction
  • changes in ejaculation or orgasm

Over 40% of people taking antipsychotic medications have reported some sexual change. 

Effects of high prolactin

Heightened prolactin levels (called hyperprolactinemia) may further cause other side effects, including: 

  • acne
  • infertility
  • loss of bone density and osteoporosis
  • irregular menstrual periods
  • excess facial hair in women
  • increased breast gland tissue in men

Seizures

Although antipsychotic drugs do not cause seizures, some may lower the seizure threshold, which means that if you’re prone to seizures or have a condition that involves seizures, you may experience them more frequently.
Discussing your history of seizures with the doctor is highly advisable before taking certain antipsychotic drugs.

Metabolic syndrome complications

Second-generation antipsychotic drugs may affect your metabolic system, which converts foods into energy. 

Possible side effects include:

  • rapid weight gain
  • higher chance of developing diabetes
  • high cholesterol

Discuss with your doctor if you have a medical history of these symptoms before taking antipsychotic medications.

First-generation antipsychotic drugs, when taken over a long period, may cause challenges related to how you move and navigate the physical world. 

Some movement disorders that are associated with antipsychotic drug use include:

  • akathisia: a general sense of restlessness or inability to sit still.
  • dystonic reactions: muscle contractions in different body parts that may lead to uncoordinated movements.
  • pseudo parkinsonism: tremors in hands and feet that mimic Parkinson’s disease symptoms.
  • tardive dyskinesia: involuntary tics and jerks, especially when agitated or aroused, may become chronic and permanent.

Although many of these side effects of antipsychotic drugs are manageable, some may not be reversible even after you stop taking them. Consider discussing possible movement-related side effects with your doctor.

Other side effects

Other mild side effects of antipsychotic medications may include:

  • dry mouth
  • urinary retention
  • constipation
  • nausea
  • lack of motivation

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Summary

Antipsychotic medications work on dopamine receptors in the brain and lead to an improvement in symptoms of schizophrenia. Although effective, these drugs may cause side effects like uncontrollable movements, dry mouth, and low motivation.

Speaking with your doctor and the health team can help you create a treatment plan that fits your lifestyle and medical history, reducing the chances of experiencing serious side effects of antipsychotic medications.

Download the free Optum Perks Discount Card to save up to 80% on some prescription medications.

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