What You Should Know About Antipsychotics

Antipsychotic medications have been an essential part of modern psychiatry for decades. While they were originally developed to treat severe mental illnesses, their use today is far broader, helping millions of people manage a range of psychiatric and neurological conditions safely and effectively. If you or someone you care about is starting an antipsychotic, understanding how these medications work and what to expect can help you make informed decisions about treatment.

A Brief History

Antipsychotics have been used since the 1950s, when the first generation of these medications (often called “typical” antipsychotics) was introduced to treat conditions such as schizophrenia and other psychotic disorders. These early medications transformed psychiatric care, helping to reduce hallucinations, delusions, and agitation in patients who previously had very few treatment options.

Since then, newer classes of antipsychotics have been developed that are more targeted, better tolerated, and associated with fewer movement-related side effects than their older counterparts.

Antipsychotics Are Used for More Than Just Psychosis

While they remain a cornerstone of treatment for schizophrenia and related psychotic disorders, antipsychotics are now used to treat a much wider range of conditions, including:

• Mood disorders such as major depressive disorder (MDD) and bipolar disorder

• Personality disorders, particularly when symptoms like impulsivity, mood instability, or aggression are prominent

• Neurodevelopmental disorders, including autism spectrum disorder and Tourette syndrome

• Adjunctive treatment alongside other medications, such as antidepressants, when symptoms are only partially controlled

Depending on the condition, antipsychotics may be used as monotherapy (on their own) or as augmentation (in combination with other medications).

Newer Antipsychotics Are Generally Better Tolerated

The newer generation of antipsychotics (often called “atypical” antipsychotics), such as aripiprazole, quetiapine, lurasidone, brexpiprazole, and others, typically have lower risks of certain side effects seen with older agents, particularly movement disorders such as stiffness, tremors, and tardive dyskinesia. They also tend to be better tolerated overall, though all antipsychotics still carry potential side effects that require monitoring.

Use in Depression

Sometimes major depressive disorder (MDD) persists despite appropriate trials of antidepressants. In these cases, certain newer antipsychotics such as aripiprazole and brexpiprazole can be used in combination with antidepressants to enhance their effect.

In simple terms, these medications modulate how certain brain chemicals (especially dopamine and serotonin) signal in key brain circuits, helping antidepressants work more effectively. For many patients, this “boost” can lead to meaningful improvements in mood, energy, and overall functioning.

Common and More Serious Side Effects

Like all medications, antipsychotics can cause side effects. These can vary depending on the specific medication, dose, and individual factors. Some common side effects include:

• Drowsiness or fatigue

• Weight gain or increased appetite

• Dry mouth

• Constipation

• Dizziness when standing

• Restlessness or inner jitteriness (akathisia)

Some less common but more serious potential side effects can include:

• Metabolic changes, such as increased blood sugar, cholesterol, and triglycerides

• Weight gain, sometimes significant with certain medications

• Movement disorders, such as stiffness, tremors, or tardive dyskinesia (permanent, involuntary facial or body movements), especially with long-term use

• Elevated prolactin levels, which can affect menstrual cycles, libido, or breast tissue

• Rare but serious reactions such as neuroleptic malignant syndrome (NMS), which involves high fever, severe muscle stiffness, and confusion. This is a medical emergency.

What to Monitor as a Patient

If you’re taking an antipsychotic, it’s important to have regular follow-up appointments and communicate openly with your provider. You may be asked to monitor or have checked:

• Weight and BMI regularly

• Blood pressure and waist circumference

• Lab work such as fasting blood sugar, hemoglobin A1C, and lipid panel (typically at baseline, then periodically)

• Any new or unusual movements, restlessness, or stiffness

• Changes in mood, alertness, or energy levels

• Menstrual changes or breast changes if applicable

These checks help ensure that if side effects do occur, they’re caught early and managed appropriately.

Key Safety Information

• Do not stop these medications suddenly unless directed by your provider. Stopping abruptly can lead to symptom relapse or withdrawal effects.

• Alcohol and certain medications can interact with antipsychotics, sometimes increasing sedation or other risks.

• If you have a history of cardiovascular disease, diabetes, or metabolic concerns, inform your provider before starting.

• Take your medication exactly as prescribed, and store it safely out of reach of others, especially children.

Main Takeaways

• Antipsychotics have been in use since the 1950s and remain essential for many psychiatric conditions.

• Their use extends beyond psychosis to mood, personality, and neurodevelopmental disorders.

• Newer medications are generally better tolerated and have more favorable side effect profiles than older ones.

• They can play an important role in augmenting antidepressants for treatment-resistant depression.

• Monitoring for metabolic and neurological side effects is key to safe long-term use.

• Open communication with your provider is critical to tailoring treatment and minimizing risks.

Final Thoughts

Antipsychotics can be life-changing medications for many people when prescribed and monitored appropriately. Understanding their role, potential benefits, and safety considerations empowers you to be an active partner in your care. If you have questions or concerns about these medications, don’t hesitate to talk openly with your healthcare provider. Shared decision-making is at the heart of good psychiatric treatment.