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
- Write down exactly what has been happening and what you have observed. Include what actions you may have taken up to now. Bring this with you.
- Write down key personal information
- Write down questions you may have (you'll probably find that you have more during the interview).
- Take paper and pen with you to write down what is said so you don't have to rely on your memory afterwards.
- Take a family member or friend along
- Make a list of all medications and drugs you are taking, if you are taking any
- Discuss all of your symptoms with your clinician and describe how they are affecting your life (e.g. racing thoughts that cause you to lose focus and not get things done). Make sure to discuss all of the available treatments and their benefits and side effects before making any decisions.
- Ask if the clinician has or knows of any good books or other resources that can help you get a better understanding of psychosis.
- Families are an important source of support but need to know about psychosis and how they can assist. To do this effectively, they will likely need to have some information. This could include information as to the diagnosis, medications and general progress. You will likely need to sign a consent form that gives permission for health professionals to share information with your family. Not all information needs to be shared and this can be changed at any time.
Rare side effects
What may happen during the first appointment
During the initial assessment a lot of information will be gathered. As well as asking a bunch of questions around the person’s current health and lifestyle, their family and home/school/work situation, the doctor will also perform a physical exam. They will most likely:
- Check the person’s weight
- Take their temperature
- Check for unusual movements, such as uncontrollable body or facial twitches
- A person may also have to have a blood and/or a urine (pee) test
The reason for the physical exam is for the doctor to make sure that what the person is experiencing is not a sign of some physical illness. All mental health professionals as well as the person’s GP are guided by the rules of confidentiality. That means that whatever is discussed will not be shared with anyone outside the person’s treatment team. They should be able to talk about this in more detail during the appointment.
Medication information on this page was compiled from the following sources:
Useful hints & tips
Once an appointment has been made for a person experiencing psychosis to have an assessment to learn more about what might be going on for them, it may be helpful to have some hints for preparing for and attending the initial meeting. As GPs and Emergency Department clinicians are not specialist mental health professionals, knowing what to ask may make it easier for them to provide the right kind of advice. See a list of health professionals here.
- Write down exactly what has been happening and what you have observed. Include what actions you may have taken up to now. Bring this with you.
- Write down key personal information
- Write down questions you may have (you'll probably find that you have more during the interview).
- Take paper and pen with you to write down what is said so you don't have to rely on your memory afterwards.
- Take a family member or friend along
- Make a list of all medications and drugs you are taking, if you are taking any
- Discuss all of your symptoms with your clinician and describe how they are affecting your life (e.g. racing thoughts that cause you to lose focus and not get things done). Make sure to discuss all of the available treatments and their benefits and side effects before making any decisions.
- Ask if the clinician has or knows of any good books or other resources that can help you get a better understanding of psychosis.
- Families are an important source of support but need to know about psychosis and how they can assist. To do this effectively, they will likely need to have some information. This could include information as to the diagnosis, medications and general progress. You will likely need to sign a consent form that gives permission for health professionals to share information with your family. Not all information needs to be shared and this can be changed at any time.
Useful hints & tips
Once an appointment has been made for a person experiencing psychosis to have an assessment to learn more about what might be going on for them, it may be helpful to have some hints for preparing for and attending the initial meeting. As GPs and Emergency Department clinicians are not specialist mental health professionals, knowing what to ask may make it easier for them to provide the right kind of advice. See a list of health professionals here.
What other people find helpful
What is an electrocardiogram?
- Write down exactly what has been happening and what you have observed. Include what actions you may have taken up to now. Bring this with you.
- Write down key personal information
- Write down questions you may have (you'll probably find that you have more during the interview).
- Take paper and pen with you to write down what is said so you don't have to rely on your memory afterwards.
- Take a family member or friend along
- Make a list of all medications and drugs you are taking, if you are taking any
- Discuss all of your symptoms with your clinician and describe how they are affecting your life (e.g. racing thoughts that cause you to lose focus and not get things done). Make sure to discuss all of the available treatments and their benefits and side effects before making any decisions.
- Ask if the clinician has or knows of any good books or other resources that can help you get a better understanding of psychosis.
- Families are an important source of support but need to know about psychosis and how they can assist. To do this effectively, they will likely need to have some information. This could include information as to the diagnosis, medications and general progress. You will likely need to sign a consent form that gives permission for health professionals to share information with your family. Not all information needs to be shared and this can be changed at any time.
What may happen during the first appointment
During the initial assessment a lot of information will be gathered. As well as asking a bunch of questions around the person’s current health and lifestyle, their family and home/school/work situation, the doctor will also perform a physical exam. They will most likely:
- Check the person’s weight
- Take their temperature
- Check for unusual movements, such as uncontrollable body or facial twitches
- A person may also have to have a blood and/or a urine (pee) test
The reason for the physical exam is for the doctor to make sure that what the person is experiencing is not a sign of some physical illness. All mental health professionals as well as the person’s GP are guided by the rules of confidentiality. That means that whatever is discussed will not be shared with anyone outside the person’s treatment team. They should be able to talk about this in more detail during the appointment.
