Antipsychotic medications are prescribed drugs used to treat people with some form psychosis. Psychosis is an umbrella of mental disorders that are characterized by radically impaired emotions and thought patterns, so convoluted that the afflicted person actually loses touch with reality. These mental disorders include bipolar disorder, borderline personality disorder (BPD), schizophrenia, and paranoia, all of which include the psychotic marks of delusions and hallucinations in their roster of symptoms.
How Do Antipsychotic Drugs Work?
Antipsychotic drugs target the neurotransmitters in the brain which are dopamine, noradrenaline, serotonin, and acetylcholine. These brain chemicals have the main hand in regulating moods, emotions, and behaviour. Of all these neurotransmitters, dopamine is the most important target.
By changing the effect these neurotransmitters currently have on an individual’s brain, antipsychotic drugs can suppress, reduce, or even prevent the onslaught of:
- hallucinations (ex. hearing voices)
- delusions (perceiving things, situations, and events not based on reality. Ex. A delusional person may firmly believe that the restaurant waitresses are laughing at him because they know his spouse has been cheating with someone else…even if they do not know him.)
- Extreme mood swings
- Thought disorders
What antipsychotics cannot do is cure a patient of his mental disorder. These drugs can only act on the symptoms not on the entire illness.
Types and Side Effects
Antipsychotic medication was introduced in the 1950s and has to a large extent been successful in alleviating hallucinatory and delusional symptoms in psychotic patients so much so that these individuals have been able to lead a relatively normal life. Although a boon to the mental health field at that time, early antipsychotics (termed typical) possessed its fair share of mild to severe side effects which manifested as:
- muscle stiffness
- tremors and spasms
- restlessness
- increased skin sensitivity to sunlight
- low blood pressure
- liver poisoning; so with some typical medications, liver tests may be mandatory
- Parkinson’s disease-like symptoms
- gastrointestinal disturbance
- weight loss
- skin rashes, ranging from mild to serious cases which may develop into Stevens-Johnson syndrome, a life-threatening illness (rare side effect)
- spontaneous ejaculation
- tinnitus (ringing in the ears)
- vertigo
- drooling
- excessive thirst
These typical drugs are still prescribed today because there are patients who tolerate these better than the newer atypical drugs.
Atypical antipsychotic drugs are considered the newbies in its category although the first, clozapine (Clorazil) was formulated over twenty years ago in 1990. Atypicals have fewer side effects than
the older typical antipsychotics and are thus more often prescribed as a first-line treatment.
Most of the atypical drugs were developed for the treatment of schizophrenia and mania. These are contraindicated for people with cardiovascular problems or with a history of epilepsy or Parkinson’s disease. Many of these drugs such as risperidone and olanzapine should not be prescribed to older people as they increase the risk for stroke. Atypical drugs may also compromise cognitive skills such as driving or operating heavy machinery.
The most noteworthy side effect of atypical antipsychotics is weight gain, increased appetite, and other metabolic issues. Other side effects are:
- dizziness
- extreme sleepiness
- low blood pressure when standing
- fainting
- rapid heartbeat (tachychardia); slow heartbeat, irregular heartbeat
- tardive dyskinesia — uncontrollable movements of the lips, tongue, face, trunk, and limbs. Usually a side effect of long-term drug use.
- Parkinsonism
- insomnia
- anxiety; restlessness; agitation
- raised prolactin levels provoking milk production
- sexual problems
- seizures
- indigestion
- headache
- lethargy; lack of energy; tiredness
- drooling
- impulsive behaviour like gambling (attributable to Aripiprazole)
- unusual taste sensations
- numb lips and mouth
- still muscles
- raised levels of enzymes in liver
- loss of menstrual periods
- blurred vision
Side effects vary from individual to individual. Other symptoms not on the common list may manifest as well; so, medical monitoring is crucial.
Withdrawing Intake of Antipsychotic Drugs
It is highly inadvisable to suddenly stop taking the prescribed drugs once already under antipsychotic medication. Doctor’s approval is highly recommended as one has to follow a medical plan for a gradual and slow withdrawal from the drug over a period of several weeks or months. While there are people who can stop taking their prescriptions without issues, the majority usually experience a recurrence of psychotic symptoms when suddenly going off their medications.
Furthermore, withdrawing from the drug is not a simple matter of gradual decrease of intake. Situational factors such as timing of circumstances and availability of support from family and friends are crucial to making this huge leap. Withdrawal can begin when there are no life-changing events or stressful things going on such as moving house, getting a new job, travelling to a new place, etc. But as people can never be pigeon-holed, there are some patients that do withdrawals well when preoccupied with new things going on in their life. No matter what type of patient one is, it is important to know that the manner of withdrawing from antipsychotic drugs is crucial because the aim is to avoid relapses.
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