Mental health
Antipsychotics
Neuroleptics — Drugs for psychosis, bipolar disorder and other conditions — balanced against movement and metabolic side-effects.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
Antipsychotics are used to treat schizophrenia and other psychoses, mania in bipolar disorder, and sometimes severe agitation or as an add-on in depression. They are broadly grouped into older "typical" (first-generation) and newer "atypical" (second-generation) agents.
How it works
Most work mainly by blocking dopamine signalling in the brain, which dampens the hallucinations and delusions of psychosis. The atypical agents also act on serotonin and other receptors, which tends to soften the movement side-effects but adds metabolic ones.
In practice
In practice the choice turns on the side-effect profile rather than potency: older "typical" agents are more likely to cause movement disorders, while newer "atypical" agents more often drive weight gain, raised glucose and lipids. So before and during treatment we track the metabolic picture (weight, blood pressure, glucose and lipids) and watch the QT interval, and we use the lowest effective dose for the shortest sensible time — particularly in older people with dementia, where these drugs carry a recognised stroke and mortality risk and are used only when truly justified.
Examples
Practical use
How to take it & use it well
- Take your antipsychotic regularly as prescribed, often once daily, and frequently at night if it makes you drowsy.
- Keep taking it even when you feel better, as stopping suddenly can cause symptoms to return or withdrawal effects.
- Attend appointments for weight, blood pressure, blood glucose and cholesterol checks, as these medicines can affect metabolism.
- Discuss any troublesome side effects with your team rather than stopping on your own.
- Stand up slowly when starting treatment, as some antipsychotics can lower blood pressure and cause dizziness.
Common uses
- Schizophrenia and other psychoses
- Mania and maintenance in bipolar disorder
- Severe agitation (short-term)
- Adjunct in treatment-resistant depression
Monitoring
- Weight, blood pressure, glucose and lipids before and during treatment
- ECG/QT where risk factors exist
- Movement side-effects and mental-state response
Weighing it up
Advantages & disadvantages
Advantages
- They can reduce distressing symptoms such as hallucinations, delusions and severe agitation.
- They help stabilise mood in conditions such as bipolar disorder and can prevent relapse.
- Regular use can support recovery and help people stay well in the community.
- A range of options means treatment can often be tailored to suit the individual.
Disadvantages
- Many can cause weight gain and increase the risk of diabetes and raised cholesterol.
- Some cause drowsiness, movement side effects such as stiffness or restlessness, or sexual difficulties.
- They require ongoing monitoring of physical health markers.
- Stopping abruptly can lead to relapse or withdrawal symptoms.
Key safety principles
What to watch for
- Movement disorders (especially with older agents) and rarely the serious neuroleptic malignant syndrome.
- Metabolic effects — weight gain, raised glucose and lipids — particularly with several atypicals.
- QT prolongation; increased stroke and death risk when used for behavioural symptoms in elderly dementia.
Key interactions
What to avoid or check alongside
- Combined with other sedating medicines, alcohol or opioids they increase drowsiness and the risk of breathing problems.
- Several can affect heart rhythm, and combining them with other rhythm-affecting drugs raises that risk.
- Some interact with smoking or with medicines that change liver enzymes, altering antipsychotic levels.
- Taken with blood pressure-lowering medicines they can add to the risk of dizziness and fainting.
- With certain antidepressants the combined effect on mood and side effects needs careful monitoring.
Patient & carer advice
- These can take a few weeks to work fully — keep taking them and do not stop suddenly
- Report stiffness, restlessness or abnormal movements, and attend metabolic blood tests
- Tell us about drowsiness before driving or operating machinery
Use with
Related clinical calculators
Dose and risk decisions for this class often depend on renal function, weight or bleeding/stroke risk. These tools help:
Answers
Antipsychotics: frequently asked questions
Why do I need regular health checks on antipsychotics?
These medicines can raise weight, blood glucose and cholesterol, so your team monitors these and your blood pressure to catch and manage any changes early.
Can I stop my antipsychotic once I feel well?
Do not stop without advice. Symptoms often return when treatment stops, and abrupt withdrawal can cause unpleasant effects. Any change should be planned with your team.
Do antipsychotics cause weight gain?
Many can, some more than others. Your prescriber can discuss options, monitoring and lifestyle support, and may review the medicine if weight gain is significant.
What movement side effects can occur?
Some people get stiffness, tremor, restlessness or slowed movements. Tell your team, as the dose can be adjusted or treatments given to ease these effects.
Are antipsychotics addictive?
They are not addictive in the way some drugs are, but stopping suddenly can cause withdrawal symptoms and relapse, so they should be reduced gradually if being stopped.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
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