Explore and compare different medications below so you and your healthcare team can decide which medication is best for you.
Amisulpride
Amisulpride carries a higher risk of hormonal side effects, especially in younger people, so it can be harder to use this medicine in adolescents and young adults. Amisulpride is sometimes used in combination with other antipsychotics such as clozapine.
Amisulpride
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Aripiprazole
Aripiprazole carries a very low risk of weight gain and hormonal side effects. Sometimes it is even used to manage these side effects caused by other antipsychotics. It can help people feel more alert, which may be a good thing, but can also make falling asleep difficult. Restlessness can also be a problem, especially in the first few weeks after starting aripiprazole but it improves with time for most people.
Aripiprazole
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Chlorpromazine
Chlorpromazine is the oldest antipsychotic. It was discovered in 1950 by accident during a search for new antihistamines (medicines for allergy). It is usually quite sedating, which can be helpful for sleep and calming effects - but not so good if this affects daily activities. It may cause dizziness and hormonal side effects.
Chlorpromazine
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Clozapine
Clozapine is very effective in treating psychosis for people who don't respond well to other antipsychotics. It is also the only antipsychotic proven to reduce the risk of self-harm. It tends to have more side effects than others including weight gain, sedation, constipation, too much saliva (spit) production and low white blood cells. Careful monitoring is needed including regular blood tests for the whole time a person takes clozapine.
Clozapine
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Flupenthixol
Flupenthixol is an older antipsychotic, only available as a long acting injection (also known as a depot) in New Zealand. It was also used as a treatment for depression back in the 70’s and 80’s. Movement side effects and hormonal side effects are common with this medicine.
Flupenthixol
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Haloperidol
Haloperidol is an older antipsychotic that is sometimes used as a short term treatment when people are distressed or agitated in hospital. It can also be used over a longer period of time as tablets, liquid or a long acting injection. Common side effects include muscle stiffness and restlessness. It doesn’t help much with motivation, focus and attention, and might actually make these worse in some people if the dose is too high.
Haloperidol
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Olanzapine
Olanzapine is often used for its calming effects when a person is distressed. It is available in tablets and a long acting injection. It seems to be slightly more effective than other antipsychotics (except clozapine). A lot of people find olanzapine makes them really hungry, which can lead to weight gain.
Olanzapine
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Paliperidone
Paliperidone is only available as a long acting monthly injection. It tends to cause less sleepiness than some of the other antipsychotics. However, movement and hormonal side effects are more common.
Paliperidone
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Pericyazine
Pericyazine is an older medicine not used very much for psychosis anymore - other medicines are usually preferred. Like all older antipsychotics, it can cause movement and hormonal side effects. Weight gain and drowsiness are also quite common.
Pericyazine
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Quetiapine
Quetiapine has some antidepressant effects, so might be good for people experiencing psychosis who also have a low mood or depression. It has a very low risk of movement and hormonal side effects, but often causes increased appetite and weight gain.
Quetiapine
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Risperidone
Risperidone is available as tablets, liquid and a fortnightly long acting injection. It tends to cause less drowsiness than some other antipsychotics but movement and hormonal side effects are more common.
Risperidone
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Ziprasidone
Ziprasidone causes less weight gain, sedation and movement and hormonal side effects than some other antipsychotics. It may even increase alertness in some people, especially at lower doses. It is more likely to cause irregular heartbeat than many other antipsychotics so a doctor or nurse may check this at the start of treatment.
Ziprasidone
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Zuclopenthixol
Zuclopenthixol is an older antipsychotic, which is available as tablets and long acting injection. It tends to be sedating and calming and can help reduce aggression and agitation. As with the other older antipsychotics, movement and hormonal side effects are quite common.
Zuclopenthixol
Drowsiness, lethargy
Increased appetite, weight gain
Stiff or shaky muscles
Restlessness
Dry mouth, constipation, blurred vision
Dizziness
Hormonal side effects
Medication information was compiled from the following sources:
Galletly C, Castle D, Dark F, Humberstone V, Jablensky A, Killackey E, et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian & New Zealand Journal of Psychiatry. 2016;50(5):410-72.
Haddad PM, Sharma SG. Adverse effects of atypical antipsychotics : differential risk and clinical implications. CNS drugs. 2007;21(11):911-36.
Jibson MD. Second-generation antipsychotic medications: Pharmacology, administration, and side effects. 2017 [last update May 15, 2017] In: UpToDate [Internet]. [cited 2 November 2017]. Available from: https://www.uptodate.com/contents/second-generation-antipsychotic-medications-pharmacology-administration-and-side-effects
Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, et al. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis.
Lancet (London, England). 2013;382(9896):951-62.
Leucht S, Tardy M, Komossa K, Heres S, Kissling W, Salanti G, et al. Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis. The Lancet. 2012;379(9831):2063-71.
Marder S, Stroup T. Pharmacotherapy for schizophrenia: Side effect management. 2017 [last update Dec 01, 2016] In: UpToDate [Internet]. [cited 2 November 2017]. Available from: https://www.uptodate.com/contents/pharmacotherapy-for-schizophrenia-side-effect-management
New Zealand Formulary (NZF). NZF v[64] [Internet]. 2017. Available from: www.nzf.org.nz [accessed 02 November 2017].
Robinson DG, Gallego JA, John M, Petrides G, Hassoun Y, Zhang JP, et al. A Randomized Comparison of Aripiprazole and Risperidone for the Acute Treatment of First-Episode Schizophrenia and Related Disorders: 3-Month Outcomes. Schizophrenia bulletin. 2015;41(6):1227-36.
Stahl SM. Stahl's Essential Psychopharmacology : Neuroscientific Basis and Practical Application. 4th ed. Cambridge: Cambridge University Press 2013.
Stahl SM. Stahl's Essential Psychopharmacology: The Prescriber's Guide. 6th ed. Cambridge: Cambridge University Press 2017.
Taylor D, Paton C, Kapur S. The Maudsley prescribing guidelines in psychiatry. Twelfth edition. West Sussex, England : Wiley Blackwell. 2015.
Zhu Y, Li C, Huhn M, Rothe P, Krause M, Bighelli I, et al. How well do patients with a first episode of schizophrenia respond to antipsychotics: A systematic review and meta-analysis. European Neuropsychopharmacology. 2017;27(9):835-44.
Like any other medication, antipsychotics can cause side effects. While side effects may seem scary, they can be managed. Overall, the benefits of antipsychotics outweigh the downsides for most people.
Common side effects
An electrocardiogram (ECG) is a test that checks for problems with the electrical activity of the heart. Several electrodes (sensors that detect electrical activity) are placed on the skin of the arms and chest. These are hooked up to a machine that traces the heart activity onto a paper. The test doesn’t hurt and only takes 5 to 10 minutes.
Rare side effects
Missing doses
It can be easy to miss doses especially when medication needs to be taken every day. Occasionally missing a dose isn’t usually a problem. When a dose is only a few hours late, take the dose and go on taking medication as usual. If one or more doses are missed, skip them and take the next dose when it’s due in the normal amount. Don’t try and catch up by taking more than one dose at a time.
When more than a couple of doses are missed, the level of medication in the body will drop and it may start to lose effect. This could increase the chance of having a relapse. It’s best to be open and honest about missed doses. Otherwise the care team might think the medication isn’t working properly, and make unnecessary changes which might lead to more side effects.
Stopping medication
If a person wants to stop taking their medication, the first step is to talk to their doctor. It’s important to stop slowly, over at least a few weeks, rather than suddenly. Exactly how slowly a medication needs to be stopped depends on the particular medication, and the reasons for wanting to stop. Antipsychotics are not addictive, but a person's body does get used to having them in their system. Stopping suddenly can make people feel physically and/or mentally unwell quite quickly.
Things to keep an eye on after stopping medication:
- Make a list of feelings, thoughts and behaviours that may indicate that the signs of psychosis are returning. These signs are often similar from one episode to another.
- Make a similar list with someone you trust, and who knows you well, of what they might notice if you start to experience psychosis again.
Medication information on this page was compiled from the following sources:
Are antipsychotics safe to take?
Antipsychotics go through many years of testing to prove they are safe before they can be prescribed, but there is no one medication that suits everybody. There are some situations where extra care may be needed when taking antipsychotics.
People taking antipsychotics should let their care team know if any of these apply to them:
- If they have epilepsy, diabetes, depression, myasthenia gravis, pheochromocytoma, Parkinson’s disease, glaucoma, or suffer from heart, liver, breathing, kidney or prostate problems.
- If they are pregnant, breastfeeding, or wish to become pregnant
Are antipsychotics addictive?
Antipsychotics are NOT addictive. They don't cause cravings or dependence like recreational or illicit drugs. They may cause some withdrawal symptoms if they are stopped too suddenly, but these can be managed.
What if they don’t work?
Most antipsychotics seem to be equally as good at treating the signs of psychosis. Even so, because everyone is different, people can react differently to them.
Antipsychotics are not “one size fits all” medicines. We cannot predict how well a particular person will respond to a particular medication. It often takes some time, negotiation and ‘trial and error’ to find the best antipsychotic and the best dose. This can be frustrating but it pays to keep working with the care team to find the best solution.
Reasons some people don’t take antipsychotics
Forgetting medication doses is a problem for many people regardless of what they take medication for. People who are experiencing psychosis may also experience changes with attention and memory which can make it harder to get into a routine with taking medication. There are many ways to help remember to take medication. Pharmacists and other members of the care team can provide more information about this. It may be helpful to link medication-taking with an existing habit, such as brushing teeth, or to set a phone reminder.
People who have experienced psychosis sometimes say they feel like they are not in control of things and that their freedom to make decisions is affected. For some people, refusing to take medication may be a way to assert their autonomy. However, refusing medication can also slow down getting better or contribute to the signs of psychosis coming back.
Having a good understanding of side effects and how to manage them is important as this can be a reason why people don’t want to continue with medication. People usually feel more in control and empowered to make the best choices if they learn about the ways to deal with psychosis and become an expert themselves.
For some people, taking medication each day can be a reminder of having psychosis. Some people may think "if I am OK then I don't need to take medication. So, if I don't take medication, then I am OK". Unfortunately, this kind of logic isn’t helpful over the long term as it can lead to a return of the signs of psychosis (relapse), and may make psychosis more difficult to treat the next time round.
An electrocardiogram (ECG) is a test that checks for problems with the electrical activity of the heart. Several electrodes (sensors that detect electrical activity) are placed on the skin of the arms and chest. These are hooked up to a machine that traces the heart activity onto a paper. The test doesn’t hurt and only takes 5 to 10 minutes.
Stigma is when people within society have negative and unfair beliefs, views or attitudes about individuals that belong to a certain group. Stigma is very common when we talk about mental health. It happens when society doesn’t understand what is really going on for the person. Because they don’t understand it, they might be afraid of it and treat the person differently as a result.
Nobody wants to be treated differently, and the stigma around psychosis can make it harder for the person to accept that they are experiencing it. This may make them not want to take antipsychotics. It’s important to remember that if medication helps with the signs of psychosis, then a person doesn’t seem any different to anyone else. You could compare this to a medication for a condition like asthma. You wouldn’t know someone had asthma if they were managing it really well and weren’t getting lots of asthma attacks.
If you or someone you know is worried about stigma or is being treated unfairly, talk to the care team. They will have ideas on how to get support with this.
Some people who experience psychosis struggle with sexual dysfunction, which can be caused or made worse by antipsychotics. Sexual dysfunction can include low desire for sex, difficulty maintaining an erection (for men), and difficulty achieving an orgasm. In some cases sexual dysfunction is mild and not too much of a problem. In other cases it can be more distressing, affect sexual relationships and make people want to stop antipsychotics. If this happens, it is important to discuss any concerns with the care team. Some medicines have a lower risk of sexual dysfunction and these may be a more suitable option.
Are antipsychotics safe to take?
Antipsychotics go through many years of testing to prove they are safe before they can be prescribed, but there is no one medication that suits everybody. There are some situations where extra care may be needed when taking antipsychotics.
People taking antipsychotics should let their care team know if any of these apply to them:
- If they have epilepsy, diabetes, depression, myasthenia gravis, pheochromocytoma, Parkinson’s disease, glaucoma, or suffer from heart, liver, breathing, kidney or prostate problems.
- If they are pregnant, breastfeeding, or wish to become pregnant
Are antipsychotics addictive?
Antipsychotics are NOT addictive. They don't cause cravings or dependence like recreational or illicit drugs. They may cause some withdrawal symptoms if they are stopped too suddenly, but these can be managed.
What if they don’t work?
Most antipsychotics seem to be equally as good at treating the signs of psychosis. Even so, because everyone is different, people can react differently to them.
Antipsychotics are not “one size fits all” medicines. We cannot predict how well a particular person will respond to a particular medication. It often takes some time, negotiation and ‘trial and error’ to find the best antipsychotic and the best dose. This can be frustrating but it pays to keep working with the care team to find the best solution.
Reasons some people don’t take antipsychotics
What other people find helpful
What is an electrocardiogram?
An electrocardiogram (ECG) is a test that checks for problems with the electrical activity of the heart. Several electrodes (sensors that detect electrical activity) are placed on the skin of the arms and chest. These are hooked up to a machine that traces the heart activity onto a paper. The test doesn’t hurt and only takes 5 to 10 minutes.
Forgetting medication doses is a problem for many people regardless of what they take medication for. People who are experiencing psychosis may also experience changes with attention and memory which can make it harder to get into a routine with taking medication. There are many ways to help remember to take medication. Pharmacists and other members of the care team can provide more information about this. It may be helpful to link medication-taking with an existing habit, such as brushing teeth, or to set a phone reminder.
People who have experienced psychosis sometimes say they feel like they are not in control of things and that their freedom to make decisions is affected. For some people, refusing to take medication may be a way to assert their autonomy. However, refusing medication can also slow down getting better or contribute to the signs of psychosis coming back.
Having a good understanding of side effects and how to manage them is important as this can be a reason why people don’t want to continue with medication. People usually feel more in control and empowered to make the best choices if they learn about the ways to deal with psychosis and become an expert themselves.
For some people, taking medication each day can be a reminder of having psychosis. Some people may think "if I am OK then I don't need to take medication. So, if I don't take medication, then I am OK". Unfortunately, this kind of logic isn’t helpful over the long term as it can lead to a return of the signs of psychosis (relapse), and may make psychosis more difficult to treat the next time round.
Stigma is when people within society have negative and unfair beliefs, views or attitudes about individuals that belong to a certain group. Stigma is very common when we talk about mental health. It happens when society doesn’t understand what is really going on for the person. Because they don’t understand it, they might be afraid of it and treat the person differently as a result.
Nobody wants to be treated differently, and the stigma around psychosis can make it harder for the person to accept that they are experiencing it. This may make them not want to take antipsychotics. It’s important to remember that if medication helps with the signs of psychosis, then a person doesn’t seem any different to anyone else. You could compare this to a medication for a condition like asthma. You wouldn’t know someone had asthma if they were managing it really well and weren’t getting lots of asthma attacks.
If you or someone you know is worried about stigma or is being treated unfairly, talk to the care team. They will have ideas on how to get support with this.
Some people who experience psychosis struggle with sexual dysfunction, which can be caused or made worse by antipsychotics. Sexual dysfunction can include low desire for sex, difficulty maintaining an erection (for men), and difficulty achieving an orgasm. In some cases sexual dysfunction is mild and not too much of a problem. In other cases it can be more distressing, affect sexual relationships and make people want to stop antipsychotics. If this happens, it is important to discuss any concerns with the care team. Some medicines have a lower risk of sexual dysfunction and these may be a more suitable option.
Missing doses
It can be easy to miss doses especially when medication needs to be taken every day. Occasionally missing a dose isn’t usually a problem. When a dose is only a few hours late, take the dose and go on taking medication as usual. If one or more doses are missed, skip them and take the next dose when it’s due in the normal amount. Don’t try and catch up by taking more than one dose at a time.
When more than a couple of doses are missed, the level of medication in the body will drop and it may start to lose effect. This could increase the chance of having a relapse. It’s best to be open and honest about missed doses. Otherwise the care team might think the medication isn’t working properly, and make unnecessary changes which might lead to more side effects.
Stopping medication
If a person wants to stop taking their medication, the first step is to talk to their doctor. It’s important to stop slowly, over at least a few weeks, rather than suddenly. Exactly how slowly a medication needs to be stopped depends on the particular medication, and the reasons for wanting to stop. Antipsychotics are not addictive, but a person's body does get used to having them in their system. Stopping suddenly can make people feel physically and/or mentally unwell quite quickly.
Things to keep an eye on after stopping medication:
- Make a list of feelings, thoughts and behaviours that may indicate that the signs of psychosis are returning. These signs are often similar from one episode to another.
- Make a similar list with someone you trust, and who knows you well, of what they might notice if you start to experience psychosis again.
