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Antipsychotic Drugs: Should We Be Alarmed?

Updated on July 14, 2014
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Antipsychotic medications have been around since the 1950’s and were originally developed to use as a surgical anaesthetic. They are grouped by the terms “typical” (first generation) or “atypical” (new generation). The typical antipsychotics are still used today, but considerably less than the newer atypical drugs. They were originally known as neuroleptics and then major tranquillisers before being classed as antipsychotics.

Typical and Atypical Antipsychotics

(click column header to sort results)
Typical Antipsychotics  
Atypical Antipsychotics  
Haloperidol (Haldol)
Aripiprazole (Abilify)
Thioridazine (Mellaril)
Quetiapine (Seroquel)
Trifluoperazine (Stelazine)
Risperidone (Risperdal)
Chlorpromazine (Thorazine, Largactil)
Olanzapine (Zyprexa)
Oxapine (Loxitane)
Clozapine (Clozaril)
Fluphenazine (Prolixin)
Paliperidone (Invega)

A third generation drug known as Aripiprazole or abilify is now used to treat bipolar disorder and clinical depression. Antipsychotics are mainly used in the treatment of the following:

  • Schizophrenia
  • Schizoaffective disorder
  • Bipolar disorder
  • Clinical depression
  • Behavioural problems
  • Attention-deficit disorder
  • Tourettes syndrome
  • Dementia
  • Aspergers syndrome

Although primarily a type of drug used in mental health treatment, antipsychotics are also used in the treatment of nausea and can be found in some cough remedies and antihistamines.

Interesting consultation video with a lady who has tardive dyskinesia

Originally the neuroleptics would have been used to treat acute anxiety and they still are such is their sedatory effect, but eventually they began to target such symptoms as delusions, paranoia and hallucinations seen in psychotic conditions including psychotic depression. They are also used to treat mood swings as seen in bipolar disorder.

Many years ago, I had cause to wonder why so many mental health patients seemed to have a permanent stoop as they walked. Actually they didn’t walk; they seemed to be propelled forwards quite quickly! I saw patients grimacing and lip smacking constantly, trying to talk around facial tics and what appeared to me to be a case of gurning. I thought this was a “mental illness”! I truly thought those were the symptoms of their illness. Little did I know back then that these symptoms, visual to all, were side effects from antipsychotics. These kind of side effects sadly draw much attention.

I know several people quite well even now, who have such side effects. One 54 year old lady I know has developed the shifting foot movements of akathisia, whereby she repetitively moves her feet whilst standing in the same place. She also has a tendency to move her lips in a chewing type gesture. She has bipolar disorder and has been on and off antipsychotics for over thirty years.

It must be stressed that the aim of this article is not to scare people but to give them the facts; facts that most doctors don’t actually tell people when they first start taking antipsychotics.

Side Effects of Antipsychotics

Below is a list of some of the side effects encountered by patients who have been placed on either typical or atypical antipsychotics. The list is not exhaustive and it should be noted that some of the more serious side-effects such as tardive dyskinesia, can have a considerable delayed onset with both generations of drugs.

Typical Antipsychotics
Atypical Antipsychotics
Parkinson's disease symptons
Parkinson's disease symptoms
Akathisia - restlessness, urge to move
Akathisia - restlessness, urge to move
Dulled, slow thinking
Dulled, slow thinking
Tardive Dyskinesia
Tradive Dyskinesia (less often?)
Drowsiness - fatigue
Drowsiness - fatigue
Dry mouth
Dry mouth
Weight gain
Weight gain
Dystonia - movement disorder
Dystonia, movement disorder
Neuroleptic Malignant Syndrome (rare)
Neuroleptic Malignant Syndrome (rare)
Low blood sugar
A type of auto immune disease
Seizures
Cardiovascular problems

Video showing side effects Akathisia and Dystonia

Are Atypical Antipsychotics Better Than Typical Antipsychotics?

As you can see from the above, the old and newer generations of antipsychotics don’t differ much with regard to recorded side-effects.

Apparently those taking olanzapine and risperidone do have less chance of the side effect dystonia and tardive dyskinesia seems less likely with the newer drugs generally. It is difficult however, to believe this information, when you consider that most of the atypical drugs have only been in use for a few years. The lady I know did not start experiencing her worst side-effects for around twenty years!

The newer antipsychotic drugs are also supposed to have a better effect on things such as motivation and generally caring for oneself better.

Clozapine has a better record so far with some of the more serious effects like tardive dyskinesia and dystonia but there is a price to pay for that! Increased salivation is quite common and it can affect your bone marrow, making infections more likely. It is also more likely you will have epileptic fits on this drug and risk inflammation of the heart muscle. Although patients do admit to feeling much better on clozapine and despite the less serious side-effects, doctors are more likely to try one of the other atypicals first.

The Bad News

It is known that the atypical antipsychotics are as likely to cause weight gain as the typical drugs and usually this is rapid. They can also cause abnormalities in insulin sensitivity. It is a known fact that diabetes is more likely in those who are overweight and so type 2 diabetes is going to be a potential risk for those on antipsychotics for the long term. The lady I know with bipolar disorder has a problem with weight gain and has developed diabetes.

Similarly to other psychiatric medications, psychiatrists may need to try you on different antipsychotics when treatment commences. It may take time finding one that suits you and you can tolerate OK. This may even mean that you have to take one of the older antipsychotics which have a greater risk of the more serious side-effects, (if we can believe the latest facts on the atypical ones).


The fact of the matter is, that although antypsychotics do tend to stabilise some symptoms such as described, you risk a whole host of other physical symptoms in the process of taking them, whether from typical or atypical drugs. Not only that but you can also retain some of those more serious symptoms even after you have withdrawn from taking them. The longer you are on them, the higher the risks are for this.

You must not suddenly stop taking antipsychotics without a doctor’s advice as you risk a severe psychotic episode or other severe withdrawl effects.

Whilst I know there is a risk of side-effects with almost any prescription medication, the particular side effects when taking antipsychotics, especially long term, can be devastating and in some cases life threatening! It has been found that the practice of administering antipsychotics to the elderly with dementia, particularly in care homes, has been proving fatal for some.

Neuroleptic malignant syndrome is a rare reaction to antipsychotics and needs urgent medical attention.

Shrinkage of the grey and white matter of the brain has also been noted after long term use of antipsychotic drugs.

A presentation of tardive dyskinesia in a child

Use of Antipsychotic Drugs in Children and Adolescents

In the past few years there has been an increase in children and adolescents being treated with antipsychotics. In the US, twice as many children are apparently put on these medications than in Europe! The most usual reason for the prescribing of these drugs for children is for a behavioural problem. Given the long list of side effects, some potentially dangerous and debilitating, have all other avenues really been explored before using such potent medications? Is this kind of medicating justified?

Conclusion:

Antipsychotics have helped many people around the world to regain some quality of life when suffering with psychotic illness and even though we have a second and even a third generation of antipsychotic drugs, it is clear that they are still far from ideal medications. All antipsychotics have the potential to cause horrendous side effects. Only a small proportion will get the more serious side-effects, but should anyone have to suffer such life changing side-effects? The answer is that there is nothing to replace these drugs right now and that is a very worrying scenario.

Antipsychotics and children

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    • Emma Harvey profile image

      Emma Harvey 4 years ago from Berkshire, UK

      This is a really interesting hub. Many drugs have side effects which we may not know about, but some of these are quite extreme. It's interesting that the side effects to some drugs draw even more attention to patients in a negative way rather than improve their day to day lives.

      Very well written - up and useful.

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Thanks Emma. Yes, I agree in that these particular medications can actually change physical appearance negatively. With the stigma that still exists in mental health, this has got to be a huge drawback.

    • Patty Kenyon profile image

      Patty Kenyon 4 years ago from Ledyard, Connecticut

      Very Interesting and well researched!!! I am always amazed by the side effects of different medications...especially those that the side effects are worse than the actual disease or illness.

      Voted Up, Interesting, and Useful!!

    • catgypsy profile image

      catgypsy 4 years ago from the South

      A friend of mine is on one of these drugs and experiences some of these side effects. She has to take it because she has psychotic episodes, so you're stuck between the proverbial "rock and a hard place." It's such a complicated issue to deal with. Wonderfully informative Hub meloncauli.

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Thanks Patty. Worst of all, most of the people I have come across who take these medications, were not actually warned.

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Hi catgypsy and thanks for your comment. It is complicated and difficult when feeling so desperate. We just tend to take our general health safety for granted when it comes to drugs that have passed clinical trials etc.

    • catgypsy profile image

      catgypsy 4 years ago from the South

      I have no faith in the drugs they pass these days. I always ask for older medications...ones that have been around a long time. Just the side effects alone are enough to scare the you know what out of you on these new ones!

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      I know...nothing improves much on the medication front. There always seems a price to pay for medication...and I don't just mean the prescription price!

    • catgypsy profile image

      catgypsy 4 years ago from the South

      Well put meloncauli!

    • nurseleah profile image

      Leah Wells-Marshburn 4 years ago from West Virginia

      Interestingly enough, people seem to talk more about the side effects of psychiatric drugs than any other drugs on the market. General anesthesia is a drug and people die from it daily. Many people will say, "Well, he had to have surgery or he would have died." What those same people fail to recognize is that depression, schizophrenia, bipolar disorder, and many other psychiatric illnesses can be fatal as well in the form of suicide and accidents, especially if untreated. I agree wholeheartedly that some of the side and adverse effects can be intolerable, and yes, with some drugs there is the risk of death. People who take any prescription and/or over-the-counter drugs and herbs need to make themselves well informed of those potential effects. And there is absolutely no excuse for a prescriber to gloss over or leave out pertinent information such as this. I appreciate you taking the time to write this ever-important article.

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Thanks nurseleah. That's an interesting argument re the anaesthetic. The trouble with psychiatric drugs is that they tend to be over prescribed whereas anaesthetic is only used when absolutely necessary. Many years ago I had depression and was in hospital. I was put on largactil and I have never seen the sense of that other than it knocked me out and therefore I couldn't think! Largactil made me feel disgusting and I protested but I had to take it anyway.

      It would be interesting to see the death statistics from anaesthetic and those from antipsychotics.

    • nurseleah profile image

      Leah Wells-Marshburn 4 years ago from West Virginia

      meloncauli, I believe the highest death rates from prescription drugs are from narcotics. Doing a quick search, I haven't found anything comparing different prescription drugs. It may be out there, but I haven't looked hard enough yet.

      I am very sorry to hear that you felt forced to take largactil. This is a common concern. I do not know what patient rights are like in the UK, but in the US, patients have the right to refuse any medication, unless they have become an imminent danger to themselves or others (e.g. patient punches another patient or patient is stabbing himself). This is a matter of community and patient education. Just because a doctor or practitioner orders a medication, many people feel they must take it. This is not the case. As adults, we have a responsibility to educate ourselves and be assertive in our healthcare.

    • gsidley profile image

      Dr. Gary L. Sidley 4 years ago from Lancashire, England

      As you know, a topic very close to my heart.

      It is interesting that over the years I have worked in mental health I have heard a number of professionals, including psychiatric nurses, express the view that if they should become floridly psychotic they would wish to be temporarily tranquillised with valium rather than be prescribed anti-psychotic medication. The research evidence suggests that arousal reduction from tranquillers might be as effective as anti-psychotic drugs in reducing acute psychotic symptoms, so these expressed preferences may not be irrational. But, of course, the unholy alliance of drug companies and biological psychiatrists continue to peddle the myth that anti-psychotic medications rectify some underlying biochemical imbalance - I'll stop now as I know you've heard me rant about this before!

      Quality hub - voted up!

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Thanks nurseleah. The largactil business was many years ago, but I do know that when you are severely mentally ill and perhaps other psychiatric medications clouding your thoughts, it is difficult to resist at times or rationalise anything regarding treatment. Some of the most severe mental illness cases I have seen wouldn't have even known what year it was, never mind what drugs they were taking. I am in the personal business of promoting rights all the way for psychiatric patients, but I do know that often patients don't even know their rights. The best way around this meds business is of course is to have a care plan and making advance decisions about any future treatment ( were called advance directives in the UK).

      Thanks again for your input.

    • nurseleah profile image

      Leah Wells-Marshburn 4 years ago from West Virginia

      Absolutely, meloncauli! I couldn't agree more. I am all about education and awareness, especially as it relates to mental health and illness. You are so right that there are people whose minds are in such a state that they are not capable of thinking of refusing or asking what their rights are. As with any treatment in medicine, it is imperative for the practitioner to provide the consumer with all the available information and if the consumer is able, he must educate himself.

      It is nice to know I am not alone in fighting this fight!

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Thanks gsidely. You speak my thoughts! What goes unnoticed or is unspoken about, is how little these drugs are tried and tested before being given to the masses. Psychiatric drugs are notoriously given much less time with respect to clinical trials than other medications.

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      I am with you all the way nurseleah... thanks so much for your comments.

    • Rfordin profile image

      Rfordin 4 years ago from Florida

      Antipsychotic drugs are used for so many off label purposes it's scary. Mainly because they work on the seditive side of the brain and "calm" someone down. I have seen them prescribed for sleeping, anxiety and a bunch of other things. I think when it boils down to it they have their place, however like every medication I think they are shighly over prescribed...not to mention all the side effects that are assocaited with them. Granted the "newer" antipsychotics are much safer then the older one's (in hindishgt) but it's still a drug to step lightly with. Messing with our brain chemicals for extended periods of time is NEVER a good thing (with a prescribed medication or a self medicating nature). Good article.

      Thanks for sharing.

      ~Becky

    • meloncauli profile image
      Author

      meloncauli 4 years ago from UK

      Thanks for your comment Becky. I agree totally with all you said. Thanks for dropping by :)

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