Antipsychotics

Antipsychotic medications can reduce or relieve symptoms of psychosis including delusions (fixed false firm beliefs) and hallucinations (auditory and visual). Antipsychotic medications are the main class of drugs used to treat people with schizophrenia. Antipsychotics are also used to treat people with psychosis that can happen in bipolar disorder, severe depression, delirium and even Alzheimer’s disease. Other uses of antipsychotics include stabilizing moods in bipolar disorder and in small doses anxiety reduction in Anxiety disorders.

Antipsychotic medications help to clear confusion in acute psychosis and can add clarity within a few days. These medications can help to control symptoms such as hallucinations but unfortunately do not cure the underlying psychiatric condition. When taken over a long period of time antipsychotics can help prevent future episodes of psychosis.

Combining antipsychotic medication with other therapy and support can help people to manage psychotic symptoms and improve quality of life. Family therapy, peer support, occupational therapy, housing and employment supports can all be beneficial.

Psychosis is believed to be caused by an overactivity or high amount of a brain chemical called dopamine. For this reason certain drugs like cocaine which increase dopamine can cause psychosis in acute intoxication. Antipsychotics block this heightened dopamine effect. By blocking dopamine the symptoms of psychosis either go away completely or dissipate significantly. People with a partial response may still hear voices and have delusions, however they are more easily able to recognize what isn’t real (less fixation). They are also able to shift focus onto other things, such as their kids, spouse, career, and/or school.

Antipsychotic medications are generally divided into two categories:

• atypical (second generation) antipsychotics
• typical (first generation) antipsychotics

Most of these drugs are given in tablet form, some are liquids and others are given as injections. Some are available as long-lasting (depot) injections which may last from one week to others that last up to one month. The main difference between the two types of antipsychotics is that the first generation drugs block dopamine only. The second generation drugs block dopamine and also modulate serotonin levels. Second generation antipsychotics are usually with reduced side effects and can help with depression and mood as they target serotonin.

Atypical (second generation) antipsychotics

The second generation antipsychotics are usually the first choice for treatment. Although they may not be officially approved for these other uses, they are oftentimes used in the treatment of mood and anxiety disorders, such as bipolar disorder, posttraumatic stress disorder and obsessive-compulsive disorders.

Medications available in this class include:

• risperidone (Risperdal)
• quetiapine (Seroquel)
• olanzapine (Zyprexa)
• ziprasidone (geodon)
• paliperidone (Invega)
• aripiprazole (Abilify)
• clozapine (Clozaril)

Clozapine is exceptional in that it often works when other medications have failed. It is not the first choice for antipsychotics due to blood monitoring protocols.

Typical (first generation) antipsychotics

These older medications include:

• haloperidol (Haldol)
• perphenazine (Trilafon)
• trifluoperazine (Stelazine)
• thiothixene (Navane)
• fluphenazine (prolixin)