Antipsychotics are a group of medications that are used to treat patients who experience psychosis.
- Treat psychosis.
- Take some effect within hours.
- May take several weeks to become fully effective.
If you have any concerns relating to mental health, you can speak with one of our registered clinicians via our online video consultation service, from 9.30am-4.30pm, five days a week.
What are antipsychotics?
Antipsychotics are prescribed to treat psychosis in adult patients, but may not be suitable for people under the age of 13. They are typically the first line of treatment for people who experience symptoms associated with the condition.
What is psychosis?
Psychosis is defined as a severe mental health issue that can have serious consequences for your health. It presents with three major symptoms: hallucinations, delusions and disturbing thoughts.
If you notice any psychotic symptoms in yourself or others it is important to seek immediate help as early treatment can be more effective.
Hallucinations entail seeing, hearing and feeling things that are not there, the most common being the experience of hearing voices. Other typical hallucinations experienced during psychosis include seeing shapes or people, the sensation of being touched by someone, smelling an aroma that is not present and tasting something that is not in your mouth.
Delusions are defined as a strong belief in something that is not true. For instance, a belief that someone or an organisation is trying to kill you. Delusions of grandeur are a further example, and may consist of a belief that you can do things that you can’t, in reality. For instance, that you are the leader of a nation, or possess a superpower, such as being able to bring people back from the dead. Disturbed thoughts often present as incoherent talking, speaking very quickly and incoherently, and constantly losing your train of thought, resulting in long pauses and confusion.
What causes psychosis?
Psychosis can be triggered by various conditions. Psychological triggers include schizophrenia, extreme stress or anxiety, depression (including post-natal depression) and bi-polar disorder. A lack of sleep may also create psychotic symptoms. Some medical conditions are understood to instigate psychotic episodes; malaria, syphilis, HIV and AIDS, lupus, Parkinson’s, Alzheimer’s, brain tumours and low blood sugar levels have all shown to increase this risk.
Substance misuse is another common trigger. Alcohol consumption and recreational drugs can both lead to severe psychotic episodes. Rare side effects of certain prescription medications have also been shown to cause some of the symptoms described above.
How is psychosis diagnosed?
Diagnosis requires speaking with your doctor, who can ascertain whether the symptoms you are describing relate to a psychotic episode. They will seek to establish what the cause of these symptoms is, and may ask if you have taken any substances, legal or illegal, if you have experienced any mental health difficulties previously and what the details are surrounding your hallucinations. A referral is then likely to be made, and usually involves a psychiatrist, a psychologist and a community mental health nurse.
How is psychosis treated?
Treatment for psychosis is essential and combines many different elements. Early intervention teams can provide medication, psychological therapies and access to social interventions. There is no one standard practice for psychosis as the causes and severity of the condition differ from person to person, but with a full assessment, they can help identify a treatment that suits you.
Antipsychotics are often the first line of treatment, although they are not suitable for everyone. They can be administered by injection or orally through tablets. Psychological treatment may include one or several types of therapy, with cognitive behavioural therapy (CBT) one of the most effective. It focuses on how we perceive the information around us, such as processing our interaction with others. This can help reduce anxiety and upsetting feelings that can result in psychotic episodes. It may also be helpful to speak with other people who have the same condition in self-help groups.
It’s unlikely that people who experience psychosis become violent or aggressive, but in the rare cases that this does occur, mental health staff are trained to deal with these situations to prevent you from harming yourself or others. If you are considered at risk of experiencing further psychotic episodes, you can inform other people of how you wish to be treated, and provide what is known as an “advanced decision”. This allows consensual treatment to take place when you are not in a position to make rational decisions during a psychotic episode.
If you would like to speak to a doctor about psychosis or antipsychotic treatments, our GMC-registered clinicians are available via our online video consultation service. You can book an appointment with them from 9.30am-4.30pm, Monday to Friday. Our clinicians can also issue referrals for treatment and fit notes, where suitable.
What side effects can antipsychotics cause?
Because there are numerous antipsychotics available, it’s not possible to provide an accurate list of all the possible risks relating to side effects. You should speak with your prescribing clinician about any potential side effects before you start treatment to ensure that you are aware of the risks involved. The following information relates to the antipsychotic aripiprazole.
You should stop using aripiprazole and seek immediate medical attention if you experience any of the following: swelling of the mouth, tongue, face and throat, itching, hives, suicidal thoughts, a combination of fever, muscle stiffness, faster breathing, sweating, reduced consciousness, sudden changes in blood pressure and heart rate, fainting, seizures, irregular heartbeat, heart attack and blood clots
If any of the following symptoms occur, you should inform your doctor as soon as possible: restlessness, fidgeting, twitching, jerking, restless legs, uncontrollable movements, weight gain, a compulsion to perform an action that could be harmful to you or others, increased sexual interest, a compulsion to spend money, binge eating and a tendency to wander.
Other side effects include:
Common side effects (may affect up to 1 in 10 people): diabetes mellitus, insomnia, anxiety, trembling, headaches, fatigue, insomnia, light-headedness, blurred vision, complications with defecating, indigestion, nausea, abnormal production of saliva, vomiting and fatigue.
Uncommon side effects (may affect up to 1 in 100 people): higher levels of prolactin, elevated blood sugar levels, depression, heightened sexual desire, double vision, rapid heartbeat, a drop in blood pressure, light-headedness, fainting and hiccups.
The following symptoms have been reported but there is not enough data to suggest their frequency: low white blood cell levels and blood platelets, onset or worsening of diabetes, ketoacidosis, coma, low sodium in the blood, loss of appetite, weight loss, aggression, agitation, nervousness, serotonin syndrome, speech disorders, sudden unexplained death, slower heartbeat, high blood pressure, fainting, accidental inhalation of food with risk of pneumonia, spasm around the voice box, inflammation of the pancreas, difficulty swallowing, diarrhoea, abdominal or stomach discomfort, liver failure, inflammation of the liver, yellowing of the skin and white part of eyes, abnormal liver tests values, skin rash, sensitivity to light, hair loss, sweating, abnormal muscle breakdown, kidney problems, muscle pain, stiffness, incontinence, difficulty in passing urine, withdrawal symptoms in newborn babies, prolonged and/or painful erection, core body temperature or overheating problems, chest pain, swelling of the hands, ankles or feet and increased or fluctuating blood sugar, increased glycosylated haemoglobin in test results.
Is it safe to use antipsychotics alongside other treatments?
Because antipsychotics vary in terms of their ingredients and potential side effects, it’s important that you read the patient information leaflet that is provided with your medication carefully. If you have any concerns, you should consult your prescribing clinician and inform them of any treatments you are currently taking, including supplements.
The following information relates to the antipsychotic aripiprazole, and taking any of the following medications may mean that this treatment is unsuitable for you or that the dosage may need to be adjusted: medicines to correct heart rhythm, antidepressants, antifungals, medicines to treat HIV, protease inhibitors, anticonvulsants, certain antibiotics, triptans, tramadol, tryptophan and some pain killers.
It should also be noted that aripiprazole may increase the effects of hypertension drugs.
Warnings and precautions when using antipsychotics
Your doctor should be informed about any conditions you currently have or are prone to before prescribing you with any antipsychotics, as well as any allergies you suffer from.
In the case of aripiprazole, it may be unsuitable for you if you experience any of the following: suicidal thoughts, high blood sugar, fits, involuntary muscle movements, cardiovascular diseases, abnormal blood pressure, blood clots (including a family history of them) and a gambling addiction.
What types of antipsychotics are available?
Antipsychotics date back to the 1950’s, with many newer forms developed over the years since. There are numerous options available on prescription.
Older types include haloperidol, flupentixol, pimozide, promazine, chlorpromazine, levomepromazine, zuclopenthixol, sulpiride, trifluoperazine, levomepromazine, periciazine, prochlorperazine and perphenazine.
Newer types of antipsychotics, which were first developed in the 1970’s, result in less movement disorders, although higher dosages may still cause issues. These include clozapine, lurasidone, risperidone, quetiapine, amisulpride, aripiprazole, paliperidone and olanzapine.
Are antipsychotics safe to use if you are pregnant?
Use of antipsychotics during pregnancy will need to be carefully considered, and you should speak to your prescribing doctor about your circumstances before starting treatment. You should not breastfeed and take antipsychotics at the same time.
Do antipsychotics affect my ability to drive?
It’s unlikely that you will be able to drive immediately after a psychotic episode, and the risks involved will need to be assessed. The side effects of antipsychotics may cause dizziness and problems with your vision, so it’s important that you avoid operating any heavy machinery until you are sure how this treatment affects you.
Can antipsychotics trigger allergic reactions?
It’s possible to experience an allergic reaction to any medication, and you should make your prescribing
clinician aware of any relevant allergies you have. Different forms of antipsychotics may also contain substances that you are intolerant to; for example, aripiprazole tablets contain lactose.
Can I consume alcohol whilst using antipsychotics?
No. Antipsychotics are not safe to use whilst consuming alcohol.
Can I buy antipsychotics over the counter?
No. Antipsychotics are a prescription-only treatment in the UK.
How can I buy antipsychotics online?
Our GPhC-registered clinicians can discuss antipsychotics with you via our online video consultation service. They are available for appointments from 9.30am to 4.30pm, five days a week. Our clinicians are also able to provide fit notes and referral to specialists for treatment, where appropriate.
Please note that if we are able to issue treatment for psychosis, our prescriber or pharmacist will need to access your summary care record to make sure that you’re already taking it. We can only provide a prescription for antipsychotics if you are already using this treatment.