Antipsychotic medication

Quick facts 

• Antipsychotic medication can help manage symptoms of psychosis. 
• Antipsychotic medication can be helpful for some, but may not suit everyone. 
• It can take time to find the best medication and dose for you.  
• It is important to talk to a doctor about different options, side effects, and how to use medication. 

• About antipsychotic medication 

  Antipsychotic medication refers to a few types of medication that can reduce symptoms of psychosis, like hallucinations and delusions. They also help prevent those symptoms from returning. 

  These medications work on brain chemistry – neurotransmitters that influence thoughts, mood and emotions. 

  Antipsychotic medication is often used for the treatment of schizophrenia spectrum disorders, but can also be used as part of treatment for other mental health issues. They can be used alongside other forms of help such as psychological therapies or community support. 

• When are antipsychotic medications used? 

  Antipsychotic medication can be life-changing for some people, although it may not suit everyone. It is ok if you need, or want to try, medication for your mental health. 

  Antipsychotic medications are considered a front-line treatment for psychosis. They can be prescribed for an episode of psychosis, or as part of longer-term treatment. They help reduce symptoms such as delusions and hallucinations, and can also help with mood, memory, planning, and other thinking problems. Antipsychotic medication can also be helpful in the treatment of other mental health issues, such as bipolar disorder and depression. 

  They are not addictive, do not make you euphoric, or change your personality. All antipsychotic drugs are designed to do the same thing — reduce psychotic symptoms and keep them away. However, they’re known to affect people in different ways, so your experience of taking them will be unique to you. 

  Antipsychotic medication can be prescribed alone, or with other medications. Many people use antipsychotic medication to feel more stable and find it helps them engage with other support services. People often use them alongside other forms of help like psychological therapies, support with housing and employment, physical and occupational therapy, and more. 

• Is antipsychotic medication effective? 

  Antipsychotic medication is generally effective. Most people with psychosis have fewer symptoms after starting medication. 

• What treatment with antipsychotic medication involves 

  Initial consultation and prescription 

  Antipsychotic medication is prescribed by a medical doctor (a GP or a psychiatrist). A doctor can discuss options for you, and prescribe you a dosage that they feel matches your symptoms and circumstances.  

  Different medications work for different people; you and your doctor can talk over to help decide which is most likely to be right for you. While there is usually a period of trial and adjustment, there are some things that can be worth discussing to help decide on a treatment plan: 

  • The impact and severity of symptoms. 
  • What different types of medication are available  
  • What your doctor recommends, and why 
  • How long it might take to start working 
  • How long you will need to take it for 
  • Any side-effects and how to manage these 
  • What to do if you wish to stop taking the medication 
  • Any allergies or physical health problems you may have 
  • If you are pregnant or planning to become pregnant 
  • Any other medications that you are taking, or have taken previously 
  • How and when to take the medication  
  • How to store medication safely 
  • Other factors such as foods which may need to be avoided. 

• Taking the medication 

  There are two ways to take antipsychotic medication: by mouth or as a depot (sometimes called a ‘long-acting injectable’).  

  • Medication by mouth usually means a tablet. It is important to take medication as directed.  
  • Medication by depot is a regular injection, meaning you don’t have to remember to take it. It is a slow-release medication, so it lasts a lot longer than a tablet. 

  Depots are used if there are challenges swallowing medication. They are also used if there’s a risk of forgetting or stopping taking medication, which can lead to a rapid worsening of symptoms. You can choose to take medication by depot. There are also circumstances where a doctor can legally require someone to take medication by injection, even without consent. That’s only done rarely, and always with health and safety in mind. 

  It can take several weeks, or even a few months, after the first dose of medication before it has an effect. Checking in with your doctor over time can help keep an eye on how you’re going, and monitor any side effects.  

  If you have any challenges – such as struggling to remember to take medication – it important to raise these with your doctor. 
   
  Choosing the best medication is not always straightforward because the way people respond to medication is different. This means that finding the right one for you may involve trying one or more types, or making adjustments. 
   

  Coming off the medication 

  Antipsychotic medication is often long term. Many people with psychosis need to take medication as prescribed on an ongoing basis to ensure their symptoms don’t return. 

  When medication starts working and symptoms reduce, people can be tempted to stop taking it. Some people may also want to stop taking medication due to side effects. Others might find that memory problems, or the symptoms of psychosis interfere with their decision-making.  

  Before stopping or reducing any medication it is important that you discuss with a doctor. They can help with decisions about the best path forward. Stopping antipsychotic medication suddenly can cause problems, and lead to a return of psychosis. So any changes need to be done step-by-step under your doctor’s supervision.  

• Types of antipsychotic medication 

  There are two key types of antipsychotic medication available:  

  • A newer group known as ‘second generation’ or ‘atypical’ antipsychotics 
  • An older group, known as ‘first-generation’ or ‘typical’ antipsychotic medications. These are generally only prescribed if the second-generation medications aren’t working for you. 

• Risks and side effects of antipsychotic medication 

  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 weigh up the benefits of medication against how side effects might impact you 

  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, or problems having sex 
  • nausea 
  • constipation 
  • increased sweating 
  • pain or irregularity in menstruation. 

  It’s important to tell a doctor about side-effects as soon as possible, and discuss any concerns.  

  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. 

• Finding out more 

  To learn more, a GP or psychiatrist can provide a personalised discussion about whether antipsychotic medication is the right option for you.  

• Resources 

  • 1300 MEDICINE (1300 633 424) – Medicines Line 
  • Schizophrenia and Psychosis (SANE Fact Sheets) 
  • The patient-psychiatrist relationship: it's a matter of trust (SANE Blog) 
  • Stopping and switching antipsychotic drugs - NPS Medicine Wise 

• References

  1. 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.
  2. 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