What Are Antipsychotic Medications?

Antipsychotics are medicines that help with symptoms of psychosis. They’re mostly used for mental health conditions where psychosis can happen, such as:

• Schizophrenia
• Schizoaffective disorder
• Some forms of bipolar disorder
• Severe depression (sometimes with psychotic features)
• Personality disorders with psychotic symptoms

They can also be used for other issues, like:

• Physical problems – such as stubborn hiccups, nausea, or balance problems
• Agitation and psychosis in dementia, but only if there’s a serious risk to the person or those around them

• Some think antipsychotics ‘turn you into a zombie’. In reality, doctors aim for the lowest dose needed so you can think more clearly and get back to daily life.

How Are They Taken?

Most antipsychotics come as tablets or liquid, but some are given as depot injections.

In hospital, a rare inhaled version called Loxapine Adasuve might be used, but it’s not common outside that setting.

Who Can Prescribe Antipsychotics?

In most cases, a psychiatrist will prescribe the medicine first. After that, your GP usually takes over with ongoing or repeat prescriptions.

There are also other trained professionals who can prescribe antipsychotics:

• Psychiatrists
• General Practitioners (GPs)
• Specialist nurse prescribers
• Specialist pharmacists

How Do They Work?

Antipsychotics don’t cure psychosis, but they can calm and control symptoms like:

• Delusions and hallucinations
• Anxiety and agitation
• Confused or jumbled thoughts
• Disruptive behaviour
• Mania

By easing these, they help people feel more stable and lower the chance of symptoms coming back.

The Science

Antipsychotics work in the brain by changing how certain chemicals (neurotransmitters) send signals. Different medicines work slightly differently, but most:

• Block dopamine in the brain – this helps reduce psychotic symptoms like hallucinations and delusions
• Affect other chemicals such as serotonin, noradrenaline and sometimes glutamate, which influence mood, energy, and stress
• Can cause Parkinson’s-like side effects (like stiffness or tremor), particularly with older medicines
• Help manage symptoms, but don’t address every cause, psychosis often links to life events, trauma, and environment too

Types of Antipsychotics

There are two main groups:

Older antipsychotics can cause strong movement side effects. Newer ones have fewer of those but might cause weight gain or changes in blood sugar.

Choosing the Right Antipsychotic: What Matters

Finding the right medicine depends on a few things:

Your Diagnosis and Symptoms

The type of mental health condition you have – and the symptoms you experience – plays a huge role in which antipsychotic is chosen. Doctors will match the medication to what needs the most support.

• Schizophrenia: Most antipsychotics help with ‘positive’ symptoms (like delusions and hallucinations). But second-generation medicines are often better at tackling ‘negative’ symptoms (like low motivation or flat mood).
• When others don’t work: If you’ve tried several antipsychotics for schizophrenia without success – including a second-generation one – clozapine is often considered next.
• Bipolar disorder and severe depression: For bipolar disorder or major depression, doctors usually start with second-generation antipsychotics, which tend to be better tolerated.

By looking at your diagnosis and symptoms together, your care team can choose a medicine that’s more likely to ease the problems causing you the most distress.

Your Medication History

What you’ve tried before matters. Doctors look at your past experiences with medication to help decide the safest and most effective option going forward.

• Previous prescriptions: If you’ve already taken an antipsychotic, your doctor will ask how well it worked.
• Side effects: Bad reactions (like severe weight gain, sedation, or movement issues) might rule out similar medicines.
• Gaps or stopping suddenly: If you’ve stopped medication before, your team may want to understand why — was it side effects, cost, or something else?
• Other mental health treatments: Past use of antidepressants, mood stabilisers or therapy can also guide the choice.

Sharing this history openly helps your team avoid repeating problems and find something that fits you better.

Your Health Background

Some medicines aren’t safe for everyone. Your doctor will look at your overall health before prescribing, because certain conditions or risks might mean some antipsychotics aren’t the best choice for you.

• Physical health: Heart problems, high blood pressure, diabetes, or liver issues can affect which medicines are safest.
• Age: Older adults may need lower doses or different options because of side effects or frailty.
• Pregnancy or breastfeeding: Some antipsychotics aren’t recommended during pregnancy or while feeding a baby.
• Other medications: If you’re already taking other medicines, doctors will check for harmful interactions.

This kind of health check isn’t about stopping you getting help, it’s about finding the medication that’s safest and works best for you.

Your Treatment Goals

Deciding on a medicine should be a joint choice with you, your doctor, and your psychiatrist. You can invite someone you trust to these talks.

Most people on antipsychotics have regular health checks – like blood tests, weight, and heart checks – to keep things safe.

Your history, health, and goals all matter – if you’re changing or stopping medicines.

Timing and Effectiveness

How fast antipsychotics work depends on how you take them:

• Tablets/liquid: Can start to help in a few hours.
• Depot injections: Release slowly over weeks.
• Emergency injections: Work within an hour.

Things like your metabolism, liver health and activity levels also play a part.

What Counts as an Emergency?

Sometimes situations escalate so quickly that there’s no time to wait for tablets or talking alone to work. In these moments, a doctor might use an emergency antipsychotic injection or another sedative to calm things down fast.

Emergency use is usually for when:

• There’s an immediate risk to you or someone else – like aggression, self-harm, or extreme distress.
• All other calming techniques (like talking, de‑escalation, or offering oral medication) haven’t worked.
• You can’t or won’t take oral medicine, or it hasn’t worked quickly enough.

These situations are rare, but the aim is to keep you and everyone around you safe in the moment.

Emergency Antipsychotic Options

In an emergency, doctors have a small group of antipsychotics they can give by injection. These medicines work quickly to reduce agitation or psychosis:

• Olanzapine
• Aripiprazole
• Haloperidol
• Risperidone

These are usually given in a hospital setting and in very controlled circumstances.

Other Medications Alongside

Emergency treatment isn’t always just one injection. Depending on your symptoms and how your body reacts, doctors might add:

• Antidepressants – to manage low mood or anxiety alongside psychosis.
• Mood stabilisers – if you have bipolar disorder or intense mood swings.
• Short-term sedatives or sleeping tablets – to help with severe distress or sleeplessness in the short term.

These medicines are meant to support recovery, not to overwhelm you with tablets. Doctors aim for the smallest number of medicines that will keep you safe and stable.

Polypharmacy

Polypharmacy means using more than one antipsychotic at the same time. Doctors usually try to avoid this because it raises the risk of side effects and makes it harder to know which drug is helping.

• When it might happen: Sometimes, a second medicine is added temporarily when switching from one antipsychotic to another.
• When it shouldn’t happen: Long-term use of two or more antipsychotics together is rarely recommended, except in very specific, treatment-resistant cases.

The goal is always to find a single antipsychotic that works for you, keeping your treatment as simple and safe as possible.

What If I Say No?

If you refuse an injection, the team might use restraint to give it — but this can only happen in certain situations.

In most cases, this level of intervention only happens if you are sectioned under the Mental Health Act, or being held under an emergency order for your safety or the safety of others.

Only trained staff should carry out restraint, and they must do everything possible to keep you safe while it happens.

This can be upsetting and distressing. According to NICE guidelines, you should always:

• Be able to talk to staff about what happened afterwards
• Have your own account written in your hospital records
• Know how to complain if you’re unhappy with how you were treated

You can also ask for your prescription to be reviewed, or write an ‘advance statement’ – a plan for how you’d like to be treated if this ever happens again.