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Antipsychotic medication

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Antipsychotic medications work by altering your brain chemistry to reduce psychotic symptoms like hallucinations, delusions and disordered thinking. They also help prevent those symptoms from returning.

Antipsychotic medication facts

  • Experiences vary: all antipsychotic drugs are designed to do the same thing — reduce psychotic symptoms and keep them away — but they’re known to affect people in different ways, so your experience of taking them will be unique to you.
  • Antipsychotic medications are common: in 2011, nearly 350,000 Australians had at least one prescription filled for antipsychotic medication. That’s 1.6% of the population.

Antipsychotic medication myths

  • Myth: ‘You can get addicted to them’
  • Reality: Antipsychotic medications aren’t addictive and you won’t need to take more over time to get the same effect.
  • Myth: ‘They cure you’
  • Reality: Antipsychotics reduce psychotic symptoms and distress, but they’re not a cure for mental illness.
  • Myth: ‘They’re happy pills’
  • Reality: Antipsychotics don’t make you feel happy no matter what. You’ll still feel normal ups and downs in your emotions.
  • Myth: ‘Medication is the only treatment’
  • Reality: There are many other forms of help: psychological therapies, support with housing and work, physical and occupational therapy and more.

Kinds of antipsychotic medication

Modern medications for treating psychosis are known as ‘second-generation’ or ‘atypical’ antipsychotics. Some common atypical antipsychotics include:

  • aripiprazole
  • clozapine
  • fluoxetine
  • olanzapine
  • quetiapine
  • risperidone
  • ziprasidone

These are the names of the drugs themselves, but they’re often sold under different brand names.

Older, ‘first-generation’ or ‘typical’ antipsychotic medications are generally only prescribed if the second-generation medications aren’t working for you.

I’m very grateful for the medication as it allowed me to sleep for the first time in five months

Carlo

How antipsychotic medications work

Antipsychotics change the levels of chemicals in your brain called neurotransmitters — the chemicals that carry messages around your brain. The neurotransmitter most targeted by antipsychotics is called dopamine.

Changing the levels of these chemicals reduces, in almost all cases, the hallucinations and delusions of psychosis. In some cases, they also improve your mood and reduce anxiety.

Talking to doctors about medication

Here’s a list of some useful things you might want to discuss with your doctor.

  • Tell your doctor about:
    • any other medications you’re taking
    • any other physical conditions you have
    • your allergies.
  • If your doctor suggests medication, ask:
    • how long will it take to start working?
    • what side-effects and benefits will it have?
    • how long will you need to take it for?
  • Ask your doctor what is or isn’t recommended while taking medication. For example:
    • if your medication can make you drowsy, your doctor might suggest you don’t drive
    • you may need to avoid alcohol with some medications. This can be a challenge if alcohol is a big part of your social life. Talk to your doctor about what is a safe amount to drink and whether other treatment options are available.
    • if you’re planning to become pregnant, tell your doctor in case any changes need to be made.
  • While you’re taking medication, tell your doctor immediately about:
    • any side-effects you experience
    • difficulty remembering to take your medication
    • any changes to your physical health.

How to take antipsychotic medication

There are two ways to take antipsychotic medication: by mouth or as a depot (sometimes called a ‘long-acting injectable’). The dose you take each time usually starts low. As your symptoms are monitored over time, your doctor might increase it or keep it at the same level.

  • Medication by mouth usually means a tablet, once or twice a day. Listen to any instructions you’re given and read the pamphlet that comes with medication to make sure you follow the right method for taking them.
  • Medication by depot is when you take your medication as a regular injection. The depot sits under your skin and releases the medication over two or four weeks, so you get a steady dose. It’s the same medication as the tablet.

Depots are used when there’s a risk you might forget or stop taking your medication, which can lead to a rapid worsening of your symptoms.

You can choose a depot yourself, but there are circumstances where a doctor can legally require you to take medication by depot, even without your consent. That’s only done rarely, and always with your health and safety in mind.

How long until they work

It commonly takes up to six weeks from your first dose for medication to start reducing symptoms, and several months before you feel their full effect.

How long to take antipsychotic medication

If your psychotic symptoms reduce or go away, it doesn’t mean your medication is unnecessary. It means your medication is working — part of its job is to stop your symptoms coming back.

When people stop taking their medication too soon or too suddenly, they are at very high risk of having another episode. You should have completely recovered from psychosis and had 12 months of good mental health before even starting the discussion about stopping medication.

To give yourself the best possible chance of recovery and good health, take your doctor’s advice and, where advised, take your medication.

If you feel you need to change your medication, always do this in consultation with your doctor.

Side-effects

All antipsychotic medications have potential side-effects. They vary from person to person, but can include:

  • drowsiness
  • weight gain
  • unusually dry or watery mouth
  • restlessness
  • trembling, especially in the limbs
  • muscle stiffness
  • dizziness
  • eyesight problems
  • moving more slowly
  • changed interest in sex, problems having sex
  • nausea
  • constipation
  • increased sweating
  • pain or irregularity in menstruation.

If you’re taking antipsychotic medication, it’s very likely you will experience some side effects. Work is being done to improve medications, but at the moment it’s often necessary to live with side-effects to reduce your active psychotic symptoms.

If you start experiencing side-effects, make sure you tell your doctor about them straightaway.

Changing medications

For some people, it can take months to find the right medication — that’s normal.

If the side-effects of the medication you’re taking are too severe, or if your psychotic symptoms don’t subside, it might be possible to try other options.

Talk to your doctor. Changing medicine can take time and will need careful guidance and observation from a health professional.

Within three months of the change in his medication, Jock took over his own life. He didn’t look back

Jock’s mother Dianne

Safety with medication

There are a few things you can do to make sure your experience with medication is safe:

  • Tell your doctor everything: your allergies, other medication you take, your alcohol, smoking and recreational drug habits, if you’re pregnant or breastfeeding, and anything else they ask. It all helps with finding the right medication plan for you.
  • Store your medication carefully: medicine doesn’t like heat or damp, so keep your medication out of bathrooms and cars. Keep it in a container in a cool, dry place. Store it high to make sure children can’t reach it.
  • Don’t share medication: your medication is designed for you and no one else. Don’t take anyone else’s medication and don’t let anyone take yours. It can do real harm.
  • Take the right dose: taking too little or too much reduces how effective your medicine is, and can do harm. Stick to the instructions on the packet.

Limits of antipsychotic medication

Some people with psychotic illness find that the usual antipsychotic medications don’t reduce their symptoms over time. If this happens, your doctor may suggest clozapine, a drug which is very effective but comes with a greater risk of side effects.

Antipsychotic medications are designed to reduce and prevent the return of psychotic symptoms, including hallucinations, delusions and disordered thinking. They may not affect the other symptoms of your illness, so you may need to get other treatments for these symptoms.

Antipsychotic medication is considered the main treatment for psychosis, but other treatments are available.

Related: Psychosis factsheet

Other medication you might need to take

Along with psychosis, you may experience other mental health issues, like depression, mania, anxiety, and the ‘negative’ symptoms of schizophrenia.

So you may be prescribed anti-anxiety medications, anti-depressants or mood stabilisers along with your antipsychotics. This is relatively common — the medications are often used together.

This SANE factsheet is currently being reviewed by industry professionals, carers and people with lived experience of psychosis.

References

‘4329.0.00.003 - Patterns Of Use Of Mental Health Services And Prescription Medications, 2011’ Abs.gov.au. Australian Bureau of Statistics, 2017. Accessed 17 March 2017.

Galletly et al (2016) ‘Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders.’ Aust NZ J Psychiatry, Vol. 50(5) 1-117

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Content last reviewed: 11 May, 2017

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