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:
Ways to help a person experiencing psychosis
It may feel frightening or bewildering being around a person when they are going through psychosis and friends and relatives are often not sure how best to help. Sometimes trying to help may be frustrating and difficult, for example when a loved one is withdrawn, ‘lost’ in their experiences, or acts in an embarrassing or disruptive way. However, it is important to remember that they are still your son, daughter, brother, sister, wife, husband, partner or friend. It is very difficult for a person who is going through the experience to be the person they usually are.
Family members and friends can play a significant role in helping to identify early signs of psychosis, in seeking prompt and appropriate treatment for their relative/friend, and in promoting the recovery process.
Often families and friends ask how they should behave and talk to a person who is going through psychosis. There are no set rules; however some general guidelines can be helpful:
- Knowledge is power. Learn as much as possible, as soon as possible about psychosis.
- Try to be calm, patient, supportive, and non-judgemental, and give your loved one some space as it can be a frightening and confusing time for a young person who is experiencing psychosis. Believe the person will getter better – even if it takes some time.
- Try to separate the person from their experiences of psychosis and appreciate and accept your relative as he or she is in the present.
- Try to focus on your relative’s strengths and positive qualities rather than emphasising their problems. There will be improvements and setbacks. It is important not to put too much emphasis on either one.
- It is important to remember that the young person experiencing psychosis may be responding to things that are real to them but may not make sense to the people around them. Being there for a young person and understanding that their experiences may be influencing their actions can help.
- When a person is going through an acute episode of psychosis they may seem fixed in their beliefs and ideas. Don’t get involved in long disagreements, but listen with interest to gain an understanding of their current reality – to show sympathy and for future reference, to discuss when they are better.
- Try not to take it personally if the person says hurtful words to you when they are unwell.
- Readjust expectations according to the person’s stage of recovery.
- Get to know the stressors that could have contributed to the person becoming unwell.
- Support the young person to get professional help as early as possible as this helps in reducing the effects of psychosis and aids recovery.
- When a person is in the midst of an acute episode they may seem child-like. Sometimes they need to be in a safe, comforting environment and sometimes they need others to help with decisions as they may find it more difficult to be organised. It may be helpful to assist the young person practically with things such as helping them to pay bills/rent and assisting them to get to appointments.
- Contact the care team to discuss alternative strategies and medication options, or where you have any questions or concerns.
- Ask for regular meetings with the key people in the care team and prepare a list of questions to take with you. Feel free to write the answers down at the meeting.
- If you don’t understand what is being discussed in meetings with the care team, say so, and ask for a clearer explanation. Ask where you can obtain additional information, for example, are there specific educational sessions available?
- Talk openly about the use of alcohol and drugs with your relative and the care team. Ask the young person if they think that substance misuse will delay their getting better. Let them know where you stand about their substance use.
Ways to help a person experiencing psychosis
It may feel frightening or bewildering being around a person when they are going through psychosis and friends and relatives are often not sure how best to help. Sometimes trying to help may be frustrating and difficult, for example when a loved one is withdrawn, ‘lost’ in their experiences, or acts in an embarrassing or disruptive way. However, it is important to remember that they are still your son, daughter, brother, sister, wife, husband, partner or friend. It is very difficult for a person who is going through the experience to be the person they usually are.
Family members and friends can play a significant role in helping to identify early signs of psychosis, in seeking prompt and appropriate treatment for their relative/friend, and in promoting the recovery process.
Often families and friends ask how they should behave and talk to a person who is going through psychosis. There are no set rules; however some general guidelines can be helpful:
- Knowledge is power. Learn as much as possible, as soon as possible about psychosis.
- Try to be calm, patient, supportive, and non-judgemental, and give your loved one some space as it can be a frightening and confusing time for a young person who is experiencing psychosis. Believe the person will getter better – even if it takes some time.
- Try to separate the person from their experiences of psychosis and appreciate and accept your relative as he or she is in the present.
- Try to focus on your relative’s strengths and positive qualities rather than emphasising their problems. There will be improvements and setbacks. It is important not to put too much emphasis on either one.
- It is important to remember that the young person experiencing psychosis may be responding to things that are real to them but may not make sense to the people around them. Being there for a young person and understanding that their experiences may be influencing their actions can help.
- When a person is going through an acute episode of psychosis they may seem fixed in their beliefs and ideas. Don’t get involved in long disagreements, but listen with interest to gain an understanding of their current reality – to show sympathy and for future reference, to discuss when they are better.
- Try not to take it personally if the person says hurtful words to you when they are unwell.
- Readjust expectations according to the person’s stage of recovery.
- Get to know the stressors that could have contributed to the person becoming unwell.
- Support the young person to get professional help as early as possible as this helps in reducing the effects of psychosis and aids recovery.
- When a person is in the midst of an acute episode they may seem child-like. Sometimes they need to be in a safe, comforting environment and sometimes they need others to help with decisions as they may find it more difficult to be organised. It may be helpful to assist the young person practically with things such as helping them to pay bills/rent and assisting them to get to appointments.
- Contact the care team to discuss alternative strategies and medication options, or where you have any questions or concerns.
- Ask for regular meetings with the key people in the care team and prepare a list of questions to take with you. Feel free to write the answers down at the meeting.
- If you don’t understand what is being discussed in meetings with the care team, say so, and ask for a clearer explanation. Ask where you can obtain additional information, for example, are there specific educational sessions available?
- Talk openly about the use of alcohol and drugs with your relative and the care team. Ask the young person if they think that substance misuse will delay their getting better. Let them know where you stand about their substance use.
