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?
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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.
First-generation antipsychotic drugs are known as typical antipsychotics or dopamine receptor antagonists.
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.
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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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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.
Heart-related side effects
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.
Movement-related challenges
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:
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.
