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Antipsychotics: Effects, Uses & Side Effects

Antipsychotics are medications used to treat psychosis, schizophrenia, and bipolar disorder. They act on the brain to reduce symptoms such as delusions and hallucinations.

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Things worth knowing about "Antipsychotics"

Antipsychotics are medications used to treat psychosis, schizophrenia, and bipolar disorder. They act on the brain to reduce symptoms such as delusions and hallucinations.

What are Antipsychotics?

Antipsychotics (also known as neuroleptics) are a class of medications primarily used to manage psychotic disorders. These include schizophrenia, schizoaffective disorder, and severe episodes of bipolar disorder. They may also be used as adjunctive therapy in certain anxiety disorders, severe depression, and other psychiatric conditions.

Indications

Antipsychotics are prescribed for a range of conditions, including:

Schizophrenia and schizoaffective disorders
Bipolar disorder (manic episodes)
Severe depression with psychotic features
Agitation and behavioral disturbances in dementia
Tourette syndrome
Severe anxiety or obsessive-compulsive disorders (as adjunctive treatment)

Mechanism of Action

Antipsychotics work by modulating the activity of neurotransmitters in the brain. The primary mechanism involves blocking dopamine receptors (particularly D2 receptors). Excessive dopaminergic activity is associated with positive psychotic symptoms such as hallucinations and delusions.

Typical Antipsychotics (First Generation)

First-generation antipsychotics such as haloperidol and chlorpromazine primarily work through potent D2 receptor blockade. They are effective against so-called positive symptoms (hallucinations, delusions) but are associated with significant motor side effects known as extrapyramidal symptoms (EPS).

Atypical Antipsychotics (Second Generation)

Atypical antipsychotics such as olanzapine, risperidone, quetiapine, and clozapine block both dopamine and serotonin receptors (5-HT2A). They are also effective against negative symptoms (social withdrawal, lack of motivation) and carry a lower risk of movement-related side effects, although metabolic side effects such as weight gain are more common.

Dosage

Dosage varies considerably depending on the specific medication, the condition being treated, and the individual response of the patient. Treatment typically begins at a low dose and is gradually adjusted. Some antipsychotics are available as depot injections administered every two to four weeks, which can improve treatment adherence.

Side Effects

Like all medications, antipsychotics can cause side effects. Common and clinically important side effects include:

Extrapyramidal symptoms (EPS): Tremor, muscle rigidity, and involuntary movements (more common with first-generation antipsychotics)
Tardive dyskinesia: Involuntary, repetitive movements after prolonged use
Metabolic effects: Weight gain, elevated blood glucose and lipid levels (more common with second-generation antipsychotics)
Sedation and fatigue
Elevated prolactin levels: May lead to menstrual irregularities or breast tissue changes
Cardiac effects: QTc prolongation (risk of arrhythmia)
Drop in blood pressure upon standing (orthostatic hypotension)

Treatment Context and Guidance

Treatment with antipsychotics should always be carried out under medical supervision. Abrupt discontinuation can trigger relapse and should be avoided. Regular monitoring (blood counts, blood glucose, ECG) is recommended throughout therapy. The full therapeutic effect often takes several weeks to develop, making patience and regular follow-up with a healthcare professional essential.

References

Leucht S. et al. - Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia. The Lancet, 2013. DOI: 10.1016/S0140-6736(13)60733-3
National Institute for Health and Care Excellence (NICE) - Psychosis and schizophrenia in adults: prevention and management. Clinical Guideline CG178 (2014, updated 2023). Available at: https://www.nice.org.uk
World Health Organization (WHO) - Model List of Essential Medicines, 23rd Edition (2023). Available at: https://www.who.int

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