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
Rare side effects
Medication information on this page was compiled from the following sources:
Recognising the first signs
When a family member or a friend is going through the experience of psychosis and recovery, parents/whānau and other support persons are likely to experience quite a range of emotions. These may include feelings of confusion, guilt, anxiety, sadness and anger. Indeed, the experience can sometimes divide a family, as the family’s emotions often change quite dramatically during this period. This is why mutual support is vital at this time and it is very important that everyone understands and agrees on a common approach, so that options can be discussed and responsibility shared.It is important to know that families do not cause psychosis. No one is to blame.
Often, the young person who is experiencing psychosis may not feel like they need help. They may find it difficult to recognise, or believe that something is not quite right, even though others around them can see that things have changed for them.
Families often sense that there may be something going on with their loved one even though they don’t know exactly what the problem is. Recognising that something may be amiss may be difficult at first as it is easy to mistake early psychosis for the normal ups and downs that young people go through.
Family and friends may notice when:
- a person’s behaviour changes
- a person’s studies or work deteriorates
- a person becomes more withdrawn, isolated and no longer interested in socialising
- a person becomes less active, has problems sleeping, or stops taking care of their personal hygiene
These behaviours might be a brief reaction to stressful events like hassles at school or work or trouble with relationships. If the changes in the young person persist and the family/friends are worried, it is worth seeking help from the family GP or local mental health services.
Families/whānau are an invaluable part of the care team and every effort is made to include them as collaborators in the process of getting better.
The information in this section comes from the following sources:
St. Lukes First-Episode Psychosis Team, Auckland, New Zealand
Orygen Youth Health, Melbourne, Australia
Centre for Addiction and Mental Health (CAMH), Canada
Recognising the first signs
When a family member or a friend is going through the experience of psychosis and recovery, parents/whānau and other support persons are likely to experience quite a range of emotions. These may include feelings of confusion, guilt, anxiety, sadness and anger. Indeed, the experience can sometimes divide a family, as the family’s emotions often change quite dramatically during this period. This is why mutual support is vital at this time and it is very important that everyone understands and agrees on a common approach, so that options can be discussed and responsibility shared.It is important to know that families do not cause psychosis. No one is to blame.
Often, the young person who is experiencing psychosis may not feel like they need help. They may find it difficult to recognise, or believe that something is not quite right, even though others around them can see that things have changed for them.
Families often sense that there may be something going on with their loved one even though they don’t know exactly what the problem is. Recognising that something may be amiss may be difficult at first as it is easy to mistake early psychosis for the normal ups and downs that young people go through.
Family and friends may notice when:
- a person’s behaviour changes
- a person’s studies or work deteriorates
- a person becomes more withdrawn, isolated and no longer interested in socialising
- a person becomes less active, has problems sleeping, or stops taking care of their personal hygiene
These behaviours might be a brief reaction to stressful events like hassles at school or work or trouble with relationships. If the changes in the young person persist and the family/friends are worried, it is worth seeking help from the family GP or local mental health services.
Families/whānau are an invaluable part of the care team and every effort is made to include them as collaborators in the process of getting better.
The information in this section comes from the following sources:
St. Lukes First-Episode Psychosis Team, Auckland, New Zealand
Orygen Youth Health, Melbourne, Australia
Centre for Addiction and Mental Health (CAMH), Canada
