Antipsychotic Medications

Antipsychotic medications reduce the psychotic symptoms of schizophrenia and other mental illnesses, usually allowing a person to function more effectively and appropriately. Antipsychotic drugs are the best treatment for schizophrenia right now, but they don't cure schizophrenia or ensure that there will be no further psychotic episodes.


The choice and dosage of medication can be made only by a qualified physician who is well trained in the medical treatment of mental disorders.

The dosage of medication is individualized for each patient, since people may vary a great deal in the amount of drug needed to reduce symptoms without producing troublesome side effects.

The Newer Antipsychotics: Better Options?

A number of new antipsychotic drugs (the so-called "atypical antipsychotics") have been introduced since 1990. The first of these, clozapine (Clozaril), has been shown to be more effective than other antipsychotics, although the possibility of severe side effects -- in particular, loss of infection-fighting white blood cells (agranulocytosis) -- requires that patients be monitored with blood tests every one or two weeks. After a year of stable white blood counts, blood can be drawn monthly.

Even newer antipsychotic drugs -- such as risperidone (Risperdal), aripiprazole (Abilify), quetiapine (Seroquel), and olanzapine (Zyprexa) -- are safer regarding tardive dyskinesia (TD) -- an involuntary movement disorder -- but many of the atypical drugs are more likely to contribute to metabolic side effects such as weight gain, increased glucose and lipids.

Targeting the Symptoms of Schizophrenia

Antipsychotic drugs are often very effective in treating certain symptoms of schizophrenia, particularly hallucinations and delusions. The drugs may not be as helpful with other symptoms, such as reduced motivation and emotional expressiveness.

The older antipsychotics, medicines like haloperidol (Haldol) or chlorpromazine (Thorazine), may even produce side effects that resemble the more difficult-to-treat symptoms.

Lowering the dose or switching to a different medicine may reduce these side effects. The newer medicines, including olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and aripiprazole (Abilify), appear less likely to cause this problem.

Sometimes when people with schizophrenia become depressed, other symptoms can appear to worsen. The symptoms may improve with the addition of an antidepressant medication.

Patients and families sometimes become worried about the antipsychotic medications used to treat schizophrenia. In addition to concern about side effects, they may worry that such drugs could lead to addiction. However, antipsychotic medications do not produce a "high" or addictive behavior in people who take them.

Another misconception about antipsychotic drugs is that they act as a kind of mind control, or a "chemical straitjacket." Antipsychotic drugs used at the appropriate dosage do not 'knock out' people or take away their free will.

Antipsychotic medications should eventually help an individual with schizophrenia to deal with the world more rationally.

How Long Should People With Schizophrenia Take Antipsychotic Drugs?

Antipsychotic medications reduce the frequency and intensity of future psychotic episodes in patients who have recovered from an episode. Even with continued drug treatment, some people who have recovered will suffer relapses. Higher relapse rates are seen when medication is discontinued. The treatment of severe psychotic symptoms can require a higher dosages than those used for maintenance treatment.

If symptoms reappear on a lower dosage, a temporary increase in dosage may prevent a full-blown relapse.

It is important that people with schizophrenia work with their doctors and family members to adhere to their treatment plan. Adherence to treatment refers to the degree to which patients follow the treatment plans recommended by their doctors. Good adherence involves taking prescribed medication at the correct dose and frequency each day, keeping all appointments, and carefully following other treatment procedures. Treatment adherence is often difficult for people with schizophrenia, but it can be made easier with the help of several strategies and lead to improved quality of life.

There are a variety of reasons that people with schizophrenia may not adhere to treatment. Patients may not believe they are ill and may deny the need for medication, or they may have such disorganized thinking that they cannot remember to take their daily doses.

Family members or friends may not understand schizophrenia and may inappropriately advise the person with schizophrenia to stop treatment when he or she is feeling better.

Physicians, who play an important role in helping their patients adhere to treatment, may neglect to ask patients how often they are taking their medications, or may be unwilling to accommodate a patient's request to change dosages or try a new treatment.

Some patients report that side effects of the medications seem worse than the illness itself. Further, substance abuse can interfere with the effectiveness of treatment, leading patients to discontinue medications.

When a complicated treatment plan is added to any of these factors, good adherence may become even more challenging.

There are many strategies that patients, doctors, and families can use to improve adherence and prevent worsening of the illness.

Some antipsychotic medications are available in long-acting injectable forms that eliminate the need to take pills every day. A major goal of current research on treatments for schizophrenia is to develop a wider variety of long-acting antipsychotics, especially the newer agents with milder side effects, which can be delivered through injection.

Medication calendars or pill boxes labeled with the days of the week can help patients and caregivers know when medications have or have not been taken. Using electronic timers that beep when medications should be taken, or pairing medication taking with routine daily events -- like meals -- can help patients remember and adhere to their dosing schedule.

Engaging family members in observing oral medication taking by patients can help ensure adherence as well. In addition, through a variety of other methods of adherence monitoring, doctors can identify when pill taking is a problem for their patients and can work with them to make adherence easier. It is important to voice any concerns about taking your medication to your doctor.

What About Side Effects?

Antipsychotic drugs, like virtually all medications, have unwanted effects along with their beneficial effects. During early treatment, patients may be troubled by side effects such as drowsiness, restlessness, muscle spasms, tremor, dry mouth, or blurring of vision. Most of these can be corrected by lowering the dosage or controlled by other medications. Different patients have different treatment responses and side effects to various antipsychotic drugs.

A patient may do better with one drug than another.

The long-term side effects of antipsychotic drugs may pose a considerably more serious problem. Tardive dyskinesia (TD), as mentioned, is a disorder characterized by involuntary movements most often affecting the mouth, lips, and tongue, and sometimes the trunk or other parts of the body such as arms and legs. It occurs in about 15% to 20% of patients who have been receiving the older, "typical" antipsychotic drugs for many years. But TD can also develop in patients who have been treated with these drugs for shorter periods of time. In most cases, the symptoms of TD are mild and the patient may be unaware of the movements.

Antipsychotic medications developed in recent years all appear to have a much lower risk of producing TD than their older counterparts, traditional antipsychotics. The risk is not zero, however, and they can produce side effects of their own such as weight gain.

In addition, if given at too high of a dose, the newer medications may lead to problems such as social withdrawal and symptoms resembling Parkinson's disease, a disorder that affects movement. Nevertheless, the newer antipsychotics are a significant advance in treatment, and their optimal use in people with schizophrenia is a subject of much current research.

Treatments for Schizophrenia

Information on Atypical Antipsychotic Medications


National Institutes of Mental Health

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