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:
Who can help?
There are many options for getting help from health experts, but if a person feels like they may not yet be comfortable seeking professional help, it may be helpful to start by talking to someone they are close with, such as a friend or someone in their family/whānau (like a sibling or a grandparent) or community. It can be quite reassuring for the person experiencing psychosis if family/whānau and friends take time to listen and validate what the person is feeling and experiencing, and offer support, hope and encouragement.
A person experiencing psychosis and their family/whānau and friends can do a lot themselves to help recovery, even before they decide to contact a health professional, such as:
- Learning about psychosis in order to understand it and how to get better
- Building a strong support network - this may involve turning to trusted friends and family members. Loved ones can help a person experiencing psychosis get the right treatment, keep their symptoms under control, and function well in their community. Most people will be flattered that they are being asked for support.
- Taking care of oneself through getting enough sleep, regular exercise, eating healthy, nutritious meals and reducing sugar and carbs in one’s diet (foods that quickly lead to a crash in mood and energy), avoiding caffeine, alcohol and drugs.
- Learning to manage day-to-day stress - often learning own warning signs or triggers of stress helps with finding ways to manage it. Sometimes this means simply not taking on more than a person can handle and taking time to themselves if they feel overwhelmed, finding artistic hobbies, exercising or using simple relaxation techniques such as deep breathing.
Pursuing self-care strategies may not seem like effective tools in dealing with such a challenging thing as psychosis, but they can have a hugely positive impact on how often and to what extent a person experiences psychosis. The more the person experiencing psychosis does for themselves, the more manageable things will become, the more empowered and positive they’ll feel, and the more likely they’ll find the other treatments to be more successful.
Family/whānau and friends are awesome but sometimes when a person is feeling really bad, they may need help from other people, too. The good news is that there are plenty of professionals who can help. If it feels like things are getting pretty grim, it may be a good time to talk to someone right away.
People who seek professional help early on are more likely to experience:
- Faster and more complete recovery
- Less disruption to daily activities and long term goals
- Less disruption to family and social relationships
- Less likelihood of getting unwell again and hospitalisation
When a person is ready to seek professional help, a family doctor (GP) may be a good starting point. People normally see their GP when they’re physically sick, but they can be useful for helping with mental health issues, too. They can make a referral to the local child and adolescent mental health team. Some cities also have specialty early intervention first episode psychosis services.
What are Early Intervention Services?
Early Intervention for Psychosis are services that aim to help young people when they experience psychosis for the first time. They are a team of healthcare professionals who have skills in listening to and helping a person experiencing psychosis understand what they are going through, and what they can do if they are experiencing distress.
Early Intervention teams aim to work together with the young person and families/whānau to ensure they receive the best possible support which can include:
- Help to understand what psychosis is
- How to recognise when things are not going so well
- What to do if a person starts to become unwell
- Providing support when someone needs it
- Information about what can be done to support recovery and stay well
- Accessing other services that may be beneficial, e.g., assistance with drug and alcohol issues, cultural support
- Assisting a person to participate in groups or activities that can help their wellness and recovery
- Helping a person to set and achieve goals, such as returning to work/school; getting into study; returning to past interests and finding new ones; sustaining a healthy lifestyle.
A person contacting the Early Intervention Services may be assigned a keyworker to support them to become an expert at helping themselves to get well and lead a fulfilling life. The contact details for Early Intervention Services in New Zealand can be found here.
Who can help?
There are many options for getting help from health experts, but if a person feels like they may not yet be comfortable seeking professional help, it may be helpful to start by talking to someone they are close with, such as a friend or someone in their family/whānau (like a sibling or a grandparent) or community. It can be quite reassuring for the person experiencing psychosis if family/whānau and friends take time to listen and validate what the person is feeling and experiencing, and offer support, hope and encouragement.
What other people find helpful
What is an electrocardiogram?
A person experiencing psychosis and their family/whānau and friends can do a lot themselves to help recovery, even before they decide to contact a health professional, such as:
- Learning about psychosis in order to understand it and how to get better
- Building a strong support network - this may involve turning to trusted friends and family members. Loved ones can help a person experiencing psychosis get the right treatment, keep their symptoms under control, and function well in their community. Most people will be flattered that they are being asked for support.
- Taking care of oneself through getting enough sleep, regular exercise, eating healthy, nutritious meals and reducing sugar and carbs in one’s diet (foods that quickly lead to a crash in mood and energy), avoiding caffeine, alcohol and drugs.
- Learning to manage day-to-day stress - often learning own warning signs or triggers of stress helps with finding ways to manage it. Sometimes this means simply not taking on more than a person can handle and taking time to themselves if they feel overwhelmed, finding artistic hobbies, exercising or using simple relaxation techniques such as deep breathing.
Pursuing self-care strategies may not seem like effective tools in dealing with such a challenging thing as psychosis, but they can have a hugely positive impact on how often and to what extent a person experiences psychosis. The more the person experiencing psychosis does for themselves, the more manageable things will become, the more empowered and positive they’ll feel, and the more likely they’ll find the other treatments to be more successful.
Family/whānau and friends are awesome but sometimes when a person is feeling really bad, they may need help from other people, too. The good news is that there are plenty of professionals who can help. If it feels like things are getting pretty grim, it may be a good time to talk to someone right away.
People who seek professional help early on are more likely to experience:
- Faster and more complete recovery
- Less disruption to daily activities and long term goals
- Less disruption to family and social relationships
- Less likelihood of getting unwell again and hospitalisation
When a person is ready to seek professional help, a family doctor (GP) may be a good starting point. People normally see their GP when they’re physically sick, but they can be useful for helping with mental health issues, too. They can make a referral to the local child and adolescent mental health team. Some cities also have specialty early intervention first episode psychosis services.
What are Early Intervention Services?
Early Intervention for Psychosis are services that aim to help young people when they experience psychosis for the first time. They are a team of healthcare professionals who have skills in listening to and helping a person experiencing psychosis understand what they are going through, and what they can do if they are experiencing distress.
Early Intervention teams aim to work together with the young person and families/whānau to ensure they receive the best possible support which can include:
- Help to understand what psychosis is
- How to recognise when things are not going so well
- What to do if a person starts to become unwell
- Providing support when someone needs it
- Information about what can be done to support recovery and stay well
- Accessing other services that may be beneficial, e.g., assistance with drug and alcohol issues, cultural support
- Assisting a person to participate in groups or activities that can help their wellness and recovery
- Helping a person to set and achieve goals, such as returning to work/school; getting into study; returning to past interests and finding new ones; sustaining a healthy lifestyle.
A person contacting the Early Intervention Services may be assigned a keyworker to support them to become an expert at helping themselves to get well and lead a fulfilling life. The contact details for Early Intervention Services in New Zealand can be found here.
