Antipsychotics

This article provides a comprehensive overview of antipsychotic medications, including their benefits, how they work, the specific types, side effects, and how they’re implemented into a treatment plan.

Key Takeaways:

• Antipsychotics are used to treat symptoms of psychosis, such as delusions, hallucinations, and distorted thought patterns. They work by inhibiting the action of dopamine and other neurotransmitters.
• Antipsychotics are primarily used to treat schizophrenia and related disorders, and bipolar mania. But they can be used for several other conditions.
• They are often very effective, especially for severe symptoms, but there are several side effects that may occur, some of which are severe. Risk-benefit analysis is essential in determining antipsychotic use.

Understanding Antipsychotic Medications

Antipsychotic medications are a group of psychiatric medications specifically designed to treat psychosis, which is a mental state characterized by an altered sense of reality. Individuals with psychosis may experience disorganized thoughts, delusions, hallucinations, and altered behaviors. Thus, due to the significance and severity of these symptoms, antipsychotics play a vital role in helping patients function effectively and stabilizing their mental well-being. ^{[1] [2]}

How do Antipsychotics Work?

Antipsychotics work by influencing the levels of specific neurotransmitters in the brain. One of the primary mechanisms of antipsychotics is blocking dopamine receptors. Antipsychotics also often reduce the activity of other neurotransmitters, such as serotonin, acetylcholine, noradrenaline, and histamine. ^{[1] [2] [3]}

Reducing the activity of these neurotransmitters ultimately reduces excessive mental activity, which is thought to lead to a reduction in psychotic symptoms. Antipsychotics may not eliminate these symptoms, but they can often reduce them to a significant degree, so that they are not as noticeable and disruptive. ^{[1] [2] [3]}

Conditions Traditionally Treated with Antipsychotics

Antipsychotics are most commonly used to treat symptoms of schizophrenia and its related disorders, such as schizoaffective disorder. They are also approved to treat: ^[1]

• Manic and mixed episodes within bipolar disorder.
• Treatment-resistant depression.
• Major depressive disorder (MDD) with psychosis.
• Severe agitation.

Off-Label Uses

There are also several common off-label uses of antipsychotics. This includes: ^{[1] [4]}

• Anxiety disorders.
• Dementia.
• Eating disorders.
• Post-traumatic stress disorder (PTSD).
• Insomnia.
• Personality disorders.

Types of Antipsychotic Medications

There are two main types of antipsychotic medications: ^{[1] [5]}

• First-generation antipsychotics.
• Second-generation antipsychotics.

First-Generation Antipsychotics

First-generation antipsychotics (FGAs), which are an older class of medications, are also known as typical antipsychotics. They are particularly potent at blocking the effects of dopamine in the brain, and they also reduce the activity of histamine, acetylcholine, and norepinephrine. ^{[1] [5]}

Examples of FGAs include: ^[5]

• Chlorpromazine (Thorazine®)
• Fluphenazine (Prolixin®, Permitil®)
• Haloperidol (Haldol®)
• Loxapine (Adusuve®)
• Molindone (Moban®)
• Perphenazine (Trilafon®)
• Pimozide (Orap®)
• Prochlorperazine (Compro®)
• Thiothixene (Navane®)
• Thioridazine (Mellaril®)
• Trifluoperazine (Stelazaine®)

Second-Generation Antipsychotics

Second-generation antipsychotics (SGAs), which are a newer class of medications, are also known as atypical antipsychotics. They primarily block the action of dopamine and serotonin in the brain. ^[1]

SGAs generally have fewer side effects than FGAs. The vast majority (up to 95%) of antipsychotic prescriptions are from this type. ^{[1] [2]}

Examples of SGAs include:

• Aripiprazole (Abilify®, Aristada ®)
• Asenapine (Secuado®, Saphris®)
• Brexpiprazole (Rexulti®)
• Cariprazine (Vraylar®)
• Clozapine (Clozaril®, Versacloz®)
• Iloperidone (Fanapt®)
• Lumateperone (Caplyta®)
• Lurasidone (Latuda®)
• Olanzapine (Zyprexa®, Lybalvi®, Symbyax®)
• Quetiapine (Seroquel®)
• Paliperidone (Invega®)
• Pimavanserin (Nuplazid®)
• Risperidone (Perseris®, Risperdal®)
• Ziprasidone (Geodon®)

Newer Antipsychotics

There are some newer antipsychotics currently in development. One of the newer antipsychotics that is already approved for use is Cobenfy™, which is a combination of xanomeline and trospium chloride. It is thought to affect muscarinic receptors in the brain, as well as dopamine. ^[5]

How are Antipsychotics Prescribed?

Antipsychotics are prescribed based on someone’s specific symptoms and other important individual factors. They are most often prescribed by psychiatrists, especially for the first prescription. Your primary care doctor may also be able to prescribe antipsychotics. ^{[1] [6]}

Antipsychotics come in several forms, most commonly as tablets or a liquid. Sometimes, treatment will consist of a depot injection, which is a slower-release and slower-acting form compared to the other forms. ^{[1] [6]}

When to Seek a Prescription

Antipsychotics are primarily used to help control psychotic symptoms. Therefore, if you’re experiencing symptoms of psychosis that are negatively interfering with your ability to function and overall well-being, it is important to seek professional help. Common symptoms that warrant attention include:

• Delusions
• Hallucinations (auditory or visual)
• Severe agitation or irritability
• Unusual behavior changes
• Significantly disorganized thoughts
• Violent or disruptive behaviors
• Paranoia

Common Side Effects of Antipsychotic Medications

There are several common side effects of antipsychotics to be aware of. In general, FGAs are associated with more severe side effects than SGAs, but they both have risks. Listed below are common side effects based on the type of antipsychotic: ^{[1] [2] [5] [7]}

FGAs:

• Extrapyramidal side effects (related to movement disorders):
• Restlessness
• Muscle spasms
• Dry mouth
• Constipation
• Urinary retention
• Sedation
• Abnormal heart rhythms
• Orthostatic hypotension
• Photosensitivity
• Impotence
• Sexual dysfunction
• Allergic dermatitis

SGAs:

• Weight gain
• Development of metabolic syndrome:
• Higher abdominal fat
• Elevated triglycerides
• Decreased HDL cholesterol
• High blood pressure
• Poorer insulin functioning
• Dizziness
• Anxiety
• Sedation
• Extrapyramidal side effects
• Temperature sensitivity
• Increased appetite
• Excessive sleepiness
• Orthostatic hypotension
• Agitation
• Headache
• Rapid heart rate

SGAs also carry a black box warning for an increased risk of stroke in elderly patients with dementia. ^[7]

Rare Side Effects

In rare cases, antipsychotics can also cause: ^[1]

• Blood dyscrasia (diseases of the blood, bone marrow, or lymph tissue)
• Low platelet count
• Seizures
• Low white blood cell count
• Cardiomyopathy
• Myocarditis

Some FGAs also carry the risk of severe side effects, such as sudden cardiac death and neuroleptic malignant syndrome. The latter is characterized by increased body temperature, severe muscle rigidity, confusion, agitation, kidney and liver disruption, and other severe effects that can be fatal. ^{[1] [2] [7]}

Risks vs Benefits

Whether or not you’re prescribed an antipsychotic depends on careful analysis of the risks-to-benefits ratio. Antipsychotics can be invaluable treatments for individuals with debilitating symptoms, but even the most effective medication isn’t worthwhile if it causes highly disruptive or damaging side effects, especially those that carry significant health risks.

Below is a table examining the risks and benefits of antipsychotics:

| Risks: | Benefits: |

| :---- | :---- |

| Several possible side effects (some severe and life-threatening) | Reduction in psychotic symptoms |

| Interactions with various medications | Improved daily functioning |

| Increased risk of side effects in children and adolescents | Improved life quality (sleep, anxiety, etc.) |

| Often unsuitable for pregnant or breastfeeding women | More stable mental health |

| Possibility of significant metabolic disturbances | Clearer cognitive function |

| Greater health risks in elderly with dementia | Reduced risk of mortality for schizophrenia |

The more severe someone’s symptoms, the more likely it is that the benefits will outweigh the risks. It’s essential to discuss all of your options with your doctor in order to develop the safest and most effective treatment plan.

Long-Term Treatment for Psychotic Symptoms

Some individuals only require short-term use of antipsychotics. Others may need to take antipsychotics long-term to promote the best outcomes and to reduce the risk of returning symptoms. ^[7]

Long-term use requires consistent monitoring of symptoms and side effects. Regular check-ups with your doctor or psychiatrist are needed to see how effective it’s working and to ensure you’re taking the medication as prescribed. If necessary, your healthcare provider will adjust the dose or change the type of medication. ^[1]

In addition to antipsychotics, long-term treatment for psychotic symptoms also often involves other measures, such as psychotherapy, social skills training, personal assistance, and access to community support/resources. These additional measures can improve overall well-being and functioning, and may also help to ensure medication adherence.

Final Thoughts

Antipsychotics are often effective for psychotic symptoms. Many times, they can help individuals with these symptoms to live normal lives, where this wouldn’t be possible otherwise. However, antipsychotics have several possible side effects, some of which are severe and life-threatening. Therefore, it’s essential to talk with your doctor about the risks and benefits, so that you can receive the safest and most effective mental health treatment possible.

Common Questions About Antipsychotics

How long does antipsychotic treatment last?

Length of treatment depends on symptom severity and how quickly they take effect. Some individuals are on antipsychotics for only a few weeks or other short-term periods, while individuals with chronic and remitting symptoms may be prescribed antipsychotics for months to years or even indefinitely in some cases. ^[5]

Which antipsychotics are most commonly prescribed?

The most commonly prescribed FGAs are: ^[5]

• Haloperidol
• Perphenazine

The most commonly prescribed SGAs are: ^[5]

• Aripiprazole
• Olanzapine
• Quetiapine
• Risperidone

Are antipsychotics harmful?

Antipsychotics can be harmful for some individuals, but they don't affect everyone the same way. There is a greater risk of side effects in children, adolescents, pregnant and breastfeeding women, and older adults. Always speak to your doctor to see what medication (if any) is right for you.

Is antipsychotic medication covered by insurance?

Most antipsychotic medications are covered by the vast majority of insurance plans, but the coverage of individual medications is determined by your plan’s formulary and can change year to year. Always check with your provider to make sure you’re covered.

Author

Jack Cincotta

Jack Cincotta holds a M.S. degree in Psychology. He is also a board-certified holistic health practitioner through AADP and an AFPA-certified holistic health coach and nutritionist.

Activity History - Last updated: March 19, 2026, Published date: March 19, 2026

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Reviewer

David MilesPharmD

David is a seasoned Pharmacist, natural medicines expert, medical reviewer, and pastor.

Activity History - Medically reviewed on March 29, 2026 and last checked on March 19, 2026