What are the key facts

Antipsychotic medications are generally used to treat the symptoms of schizophrenia and other psychotic disorders. They can also be used to treat bipolar disorder. Antipsychotics affect people differently. It can take time to find the right antipsychotic that works for you. You may experience some side effects with antipsychotics. You can talk to your healthcare professional if you are having challenges with side effects. They can also help if you feel like your antipsychotics are not working. You should talk to your healthcare professional if you want to stop your medication. You should not stop taking antipsychotics suddenly. You might take other medications, including supplements, or drink alcohol, or smoke. They can affect you and your antipsychotics. So, it is important you tell your healthcare professional about these things. This is so they can advise you. Antipsychotics can affect driving, pregnancy and breastfeeding. And psychotic related symptoms may worsen during menopause. You can get advice on these things.

What are antipsychotics?

You might experience schizophrenia or other psychotic disorders. Your doctor may offer you antipsychotic medication to help you with your symptoms. This includes psychotic depression. Some antipsychotics are used to treat mania. Mania is a symptom of bipolar disorder. What is psychosis? Psychosis is a medical term. If you live with psychosis, you might see or hear things that are not there. These are known as hallucinations. Or you might have firm beliefs that do not match up to the way others see the world. These are known as delusions. If you live with psychosis, you will process the world around you differently to other people. This can include how you experience, believe, or view things. Some people describe psychosis as a break from reality. Doctors may call these: ‘psychotic symptoms’, a ‘psychotic episode’ or a ‘psychotic experience’. Psychotic symptoms can be part of conditions like schizophrenia, schizoaffective disorder, personality disorder and bipolar disorder. But some people can experience psychotic symptoms without having any of these conditions. How can antipsychotics help manage symptoms of psychosis? Antipsychotics can help manage your symptoms of psychosis. This can help you feel more in control of your life, particularly if you are finding the psychotic symptoms distressing. Research suggests 4 out of 5 people with severe mental illness, who take antipsychotics, find they are successful in treating their symptoms. This is according to the Royal College of Psychiatrists . It is not possible to predict which type of antipsychotics will work best for you. So, you may have to try different ones before you find the one that works best for you. How long does it take for antipsychotics to work? You may feel better quickly. But it can take a few weeks or months for antipsychotics to work. Everyone responds to antipsychotics differently. It can take several days or weeks to reduce symptoms such as hallucinations or delusional thoughts. How do antipsychotics work? Your brain contains chemicals which help to carry messages from one part of the brain to another. One of these chemicals is called dopamine. It is thought that high levels of dopamine can make the brain work differently and cause the symptoms of psychosis. Antipsychotics work by blocking the effect of dopamine. This helps reduce psychotic symptoms for many people. The Royal College of Psychiatrists say that the evidence suggests that nothing works as well as antipsychotic medications to treat schizophrenia. For more information see our webpages on the following: Psychosis Schizophrenia Bipolar disorder Depression What are the NICE guidelines? NICE stands for the National Institute for Health and Care Excellence . NICE produce guidelines for the assessment and treatment of mental illnesses, such as psychosis and schizophrenia, and bipolar disorder. NICE recommend the use of antipsychotics to treat these conditions. You can find these NICE guidelines below: Psychosis and schizophrenia in adults : prevention and management Bipolar disorder : assessment and management

What are the different types of antipsychotics?

There are 2 broad types of antipsychotics. New types – known as ‘atypical’ or ‘2nd generation’. These types of antipsychotics have been used since the 1990s. Older types – known as ‘typical’ or ‘1st generation’. These antipsychotics were the first ones used, starting from the 1950s. The main difference between these types is in their side effects. Older types of antipsychotics may: have more of an effect on your body movement, and they may cause a treatable condition called hyperprolactinaemia. Newer antipsychotics are less likely to affect your movement. They may affect your weight and glucose intolerance. Side-effects for different antipsychotics can vary. See the following section for more information on side-effects. Antipsychotics affect people in different ways. You may have to try different ones. Your psychiatrist should work with you to find which medication works best for you. If after a few weeks you are still having problems with side affects you can speak to your healthcare professional. Your psychiatrist may offer you a different type of antipsychotic. They can also offer you a medication to help with the side effects. You can read more about side effects in the following section. See our webpage on Medication – Choice and managing problems for more information. How are antipsychotics taken? Antipsychotic medication can come as tablets, a syrup or as an injection. The injections are called a depot. They are long acting, so you only need to have one between once a week and once every 6 months. It is most common to have an injection every 4 weeks. You may find a depot injection useful if you find it hard to remember to take your medication. For more information on depot injection antipsychotics, you can read information from the Royal College of Psychiatrists click here . Your doctor should take your views into account about the form of medication you would like. What are the newer types of antipsychotics? The following antipsychotics are the newer types known as ‘atypical’ or ‘2nd generation’. The newer types of antipsychotics licensed for use in the UK are shown in the table below. Antipsychotic name Trade name or names Amisulpride Solian Aripiprazole Abilify, Abilify Maintena Clozapine Clozaril, Denzapine, Zaponex Lurasidone Latuda Risperidone Risperdal, Risperdal Consta, Okedi Olanzapine Zypadhera, Zyprexa Quetiapine Seroquel, Seroquel XL Paliperidone Invega, Xeplion, Trevicta, Byannli What is Clozapine? Clozapine works slightly differently to others. It is usually given to people who are treatment resistant. Treatment resistant means other medication has not helped reduce or control symptoms successfully. The NHS say Clozapine is the most effective antipsychotic for treatment resistant schizophrenia. NICE says that people with schizophrenia should only be offered Clozapine after having tried 2 other antipsychotics. NICE stands for the National Institute for Health and Care Excellence . Why will I need regular blood tests if I take Clozapine? Clozapine can cause your white blood cell numbers to drop. Drops in white blood cells can lead to infections. You will need regular blood tests to make sure your white blood cell count is healthy. Your healthcare professional should invite you to have blood tests during Clozapine treatment. You will need weekly blood tests for the first 18 weeks. For the next year, you will need blood tests every 2-weeks. Then, blood test should be done once a month. You will be asked to stop taking the Clozapine if your white blood cell numbers start dropping. You will have another blood test after you have stopped clozapine to make sure they are back to normal. Your healthcare professional might decide to change your dose of clozapine or offer you another type of medication. What should I do if I have missed a dose of Clozapine? If you have missed any doses of your Clozapine, contact a healthcare professional as soon as possible. What is Wim’s protocol Wim’s protocol is a guide to help doctors prescribe clozapine safely and reduce the risk of serious health problems. If you take clozapine, it is useful for you and your carers and relatives. It explains: the health checks if you should have if you take clozapine, and what warning signs to look out for that might mean clozapine is affecting your health. The guide helps carers and relatives spot problems early and know when to get help. Its aim is to make clozapine treatment safer and prevent avoidable deaths. What are the older types of antipsychotics? The following antipsychotics are the older types known as ‘typical’ or ‘1st generation’. Most are not usually used for treating psychosis anymore. The older types of antipsychotics licensed for use in the UK are. chlorpromazine flupentixol haloperidol levomepromazine pericyazine perphenazine pimozide prochlorperazine promazine sulpiride trifluperazine zuclopenthixol

What side effects might I experience?

Different antipsychotics can have different side effects. So, in this section we only give a general overview of some of the side effects of antipsychotics. How can I find out about side effects for my medication? If you want to know more about the side effects off your antipsychotic medication you can. Talk to your psychiatrist, GP, or pharmacist. You can ask them any questions you have. If you are unsure about anything you can ask them to explain it. Most pharmacies have a private room where you can discuss things confidentially. Read the patient information leaflet for the medication. There should be one in the box the medication comes in. It says what the side effects are and explains what to do if you are experiencing any side effects. You can find the patient information leaflet for your medication on this website . Look up your medication on this NHS website . Each medication has a section on side effects. What side effects can be included? Below is a list of possible side effects of antipsychotics. But it is important to remember: people who take the same medication can get different side effects, people who take the same medication might get the same side effect. But one person might be affected more than the other, The risk of a side effect can depend on the type of antipsychotic you take. Before you start to take antipsychotics, it is important to weigh up: the benefit the medication will have, and the possible side effects of it. You can discuss this with your psychiatrist, GP, or pharmacist. The National Institute of care excellence (NICE) recommend treatment to the NHS. NICE say side effects of antipsychotics include: Extrapyramidal symptoms . They include: abnormal movements of the face and body tremor slowness of movement and speed being rigid restlessness irregular movements which you cannot control Weight gain . Raised levels of cholesterol in the blood . Hyperprolactinaemia . This is higher-than-normal levels of prolactin in your blood. It can lead to: a milky nipple discharge missed periods men’s breasts getting larger than normal the body not producing enough testosterone, sperm, or both sexual dysfunction an increased risk of osteoporosis, a health condition that weakens bones. Sedation . Feeling sleepy and relaxed. Sleep apnoea syndrome . A condition in which your breathing stops and restarts many times while you sleep. Anticholinergic effects . Such as dry mouth, blurred vision, urinary retention, constipation, skin flushing and problems emptying all the urine from your bladder. Postural hypotension . A form of low blood pressure that happens when standing after sitting or lying down. High blood pressure . Seizures . Less glucose tolerance . Issues with your heart or blood vessels . Stroke risk . Blood clots in the veins . Neuroleptic malignant syndrome (NMS) . This is a rare but potentially fatal adverse effect of all antipsychotics. Signs and symptoms of NMS include: fever increased sweating rigidity confusion fluctuating consciousness fluctuating blood pressure fast heartbeat an increased white blood cell count raised creatine kinase, a type of protein in the blood. Pneumonia . Neutropenia . A condition where you have a low number of white blood cells called neutrophils in your blood. Effects on liver function . Photosensitivity . Heightened skin sensitivity. Skin disorders . Double vision . Increase in drug or alcohol use . Restless legs syndrome . An overwhelming urge to move your legs. This NHS chart explains side effects of antipsychotics. It helps you to see some of your options for antipsychotics. This could also help you to make choices about your treatment. A healthcare professional can help explain what the following chart means . Can aripiprazole increase the risk of gambling addiction? The Medicines and Healthcare products Regulatory Agency is responsible for making sure that medicines are safe in the UK. They say up to December 2023, there have been 63 reports that aripiprazole has been linked to gambling issues. Aripiprazole is a frequently prescribed antipsychotic medication. In July 2024 alone, 150,000 items of it were prescribed. Do not stop taking aripiprazole without first talking about it with your doctor. Tell your doctor as quickly as you can if you take aripiprazole and: you have a history of excessive gambling behaviour or impulse control disorders, or you or your loved ones notice that you are getting urges to behave in ways that are unusual for you. This includes behaviours such as addictive gambling, excessive eating or spending, or an abnormally high sex drive. How might antipsychotics effect my physical health? Some antipsychotic medications can affect your heart. Doctors might scan your heart at check-ups, if: you have a heart condition, or you are at risk of having difficulties with your heart. They might want to do this once every year, or more regularly. This is done by having an electrocardiogram gram (ECG). This is a painless scan. GP surgeries have a register of people with severe mental illness, such as schizophrenia. If you are on the register your GP should offer you an annual physical health check. They might check your heart in these appointments. You can speak to your GP or psychiatrist if: you want a heart check-up before you start taking antipsychotics, or if you have any concerns about your heart or blood vessels. If you live with psychosis or schizophrenia your doctor should offer to check your heart before you start antipsychotics if: the manufacturers of your medication say you should, a physical health check has found you have a higher risk of heart or blood vessel problems, you have heart or blood vessel problems or someone in your family has had them, or you have to go into hospital. For more information see our webpage on Severe mental illness and physical health checks What can I do if I have issues with side effects? You might get side effects that are unpleasant or distressing. Side effects might go away after a few weeks or months of taking medication. Some side effects might last longer. It is important that you find the right balance between medication that helps your symptoms and has the least side effects. You can talk to your psychiatrist or GP if you have issues with side effects. They might change your dose or suggest a different medication. They may also be able to give you other drugs to help with the side effects. You can use a scale like the Glasgow antipsychotic side effects scale to monitor your side effects. It is a questionnaire with 22 questions about different side effects. You can take this to your doctor to help you decide how to manage the side effects. You can download the GASS here . What is the yellow card system? The Medicines and Healthcare Products Regulatory Agency (MHRA) make sure medicines, and medical devices work and are safe. The MHRA runs the yellow card system . You can use the system to report bad side effects. By doing this you can help the MHRA to make sure medicines are safe. You can report bad side effects online by clicking on the following link . You may also find the following website helpful to learn more about antipsychotics: British National Formulary (BNF) . See our webpage on Medication – choice and managing problems for more information.

What if I want to stop taking antipsychotics?

What if I want to stop taking antipsychotics? You should talk to your doctor if you want to stop taking antipsychotics. Your doctor should tell you how stopping antipsychotics may affect you. You can ask them about these things. Before you stop taking antipsychotics it is important to understand: the benefits of continuing to take them, and what might happen if you stop. Your doctor will help you come off the medication if you decide to stop taking antipsychotics. Your doctor can do this by gradually reducing the dose over a period of time. Stopping antipsychotic medication suddenly may mean that your symptoms return, and you become unwell again. , This is also known as ‘relapse’. If you or your family or friends think you are becoming unwell again, you should speak to your doctor. You may find that stopping your medication can lead to your symptoms returning. Your doctor may suggest that you keep taking the medication because it is keeping you well. If this is the case, you could ask about trying another type of medication. If you want to stop taking antipsychotics, it is important to consider what happened during previous episodes of illness. The risks of relapsing need to be weighed up against the side effects you may be having. This includes other things that are important to you. Your doctor can help you talk about these things and help you make the best decision. Can I experience withdrawal symptoms from stopping antipsychotics? Antipsychotics are not addictive, but your body may get used to them. This is why you may experience withdrawal symptoms. The withdrawal symptoms you may experience depends on each individual antipsychotic. You can talk to your GP or psychiatrist if you get withdrawal symptoms. They can advise you on how to manage them. Do I have to take antipsychotics? It is your choice whether you take antipsychotics. If you are detained in hospital under the Mental Health Act medical professionals should still involve you in decisions about your treatment. But they might be able to treat you if you: refuse the treatment, or do not have the mental capacity to give your consent. For more information see our webpages on the following: Mental Health Act Mental capacity and mental illness - The Mental Capacity Act 2005

Do antipsychotics affect other medication?

Antipsychotics can interact with many different medications. This means if you take an antipsychotic and another medication, they can affect each other. For example, some antipsychotics can interact with tricyclic antidepressants. In some cases, this means they should not be prescribed together. You should tell your doctor about all the medicines you are taking. This includes any supplements. This will allow your doctor to prescribe the right antipsychotic. Health supplements, including natural health products, can interact with antipsychotics. If you are taking a supplement, always get the same brand. Switching brands can have an effect your antipsychotics. Even if it is the same supplement. You might already take antipsychotics. Get advice from your doctor before you: start any new prescription medication, or try a new health supplement. You may benefit from keeping an up-to-date medication list. This should include all the medication you are currently taking so you can give it to healthcare professionals. It is also very important to not stop or start any medication without checking with a healthcare professional. This could be a doctor or a pharmacist. You can find out more from Mind about interaction risks between antipsychotics and different medications here . Your doctor may prescribe you different medications with antipsychotics, which is common. Your doctor should carefully monitor this to ensure your safety.

Does alcohol affect antipsychotics?

Alcohol can affect antipsychotics. So, you should: discuss with your doctor how alcohol use can affect you if you take antipsychotics, and carefully read your medication patient information leaflet to see what it says about alcohol use. The box your medication comes in should include the patient information leaflet . Drinking alcohol can make it harder for your body to absorb medication. This could increase the effects alcohol has on you. Drinking alcohol with antipsychotics might increase the sedative effects. This means you might feel very tired. How can I get a copy of the patient information leaflet for my medication? You can get a copy of the patient information leaflet for you medication online. You can do best by visiting the Medicines and Healthcare Products Regulatory Agency (MHRA) website here . Be sure to search for exactly the right type of medication. There might be several different types of the same medication. What about alcohol use and clozapine? If you take clozapine drinking alcohol can be very dangerous. There are risks when drinking alcohol while taking clozapine. It can cause central nervous system depression. This is when the brain and nervous system slows down. If it slows down too much, it can be life-threatening. It is very important you: discuss alcohol use with your doctor, and carefully read your medication patient information leaflet to see what it says about alcohol use. The box your medication comes in should include the patient information leaflet. The symptoms of central nervous system depression are shown below. You should get help straight away by calling NHS 111 if you show signs of them. Or in an emergency by going to A&E or calling 999. Over sedated or inappropriately sleepy. Unusually confused or forgetful. Un-coordinated, with slurred speech, slow reflexes or difficulty moving. Breathing unusually slowly or have other breathing difficulties. A slow pulse or heart rate. A dry mouth. Blue lips. Clammy, cold skin.

Does smoking affect antipsychotics?

Smoking can interact with the way medication is absorbed in your body. So, it is best to tell your doctor if you smoke. If you are thinking of quitting smoking, you should discuss this with your doctor. If you stop smoking suddenly, this can affect the levels of medication in your body. This can cause serious side effects. You can find more information on our webpage Smoking and mental health

Can menopause affect psychotic disorders?

There is research to suggest that symptoms of schizophrenia, and psychotic related symptoms, may worsen during menopause. So, treatment may need to be modified and closely monitored for women during this period.

Can antipsychotics affect driving?

Antipsychotics can affect your concentration and make you feel drowsy. This could affect how well you are able to drive. Especially when you first start taking the medication. You should consider stopping driving during this time if you are affected. You must tell the DVLA if you live with certain mental health conditions. Including psychosis, paranoid schizophrenia and bipolar disorder. See our webpage on Driving and mental illness for more information.

What if I am pregnant or planning on having a baby?

There could be a very small increased risk of complications if you take antipsychotic drugs during pregnancy. You should speak to your doctor if you: become pregnant, or planning on having a baby You should not stop taking your antipsychotics without speaking to your doctor first. You can also talk to your midwife or health visitor. You are at a higher risk of becoming unwell after birth. You can talk to your doctor about this as you may need specialist care. This will usually come from an NHS perinatal mental health service. An NHS community mental health team might also support you. These services will talk to you about your care and treatment options during your pregnancy. You can find more information on our webpage New parents, pregnancy, and mental health Can I breastfeed if I take antipsychotics? All antipsychotics can be passed to your baby from your breast milk. So, if you take antipsychotics, you should speak to your doctor before breastfeeding your baby. Guidelines say that you should not breastfeed if you take Clozapine. This is because of the risk of: agranulocytocis, which is a problem affecting white blood cells, and seizures. Breastfeeding can benefit your baby, but it might affect your sleep. This could increase your risk of a relapse. If you do breastfeed after advice from your doctor, others could help with bottle feeding at night to help you to sleep. Drug manufacturers might advise that you should stop breastfeeding while taking an antipsychotic. When you are prescribed an antipsychotic, to see if you are safe to breastfeed, please: read the patient information leaflet . The box your medication comes in comes in should include the patient information leaflet, and ask your doctor or pharmacist about it. The Royal College of Psychiatrists have more information on ‘ Antipsychotics in pregnancy and breastfeeding ’ here .

Mood Swings Network This organisation provides a range of services for people affected by a mood disorder, including their family and friends. Phone : 0161 832 37 36 Address : 36 New Mount St, Manchester, M4 4DE. Email : info@moodswings.org.uk Website : www.moodswings.org.uk Bipolar UK This is a user led charity working to enable people affected by bipolar disorder to take control of their lives Address : Bipolar UK, 32 Cubitt Street, London, WC1X 0LR11 Phone : 0333 323 3880 Email : info@bipolaruk.org.uk Website : www.bipolaruk.org The Hearing Voices Network This organisation provides support and understanding for those who hear voices or experience other types of hallucination. Address : National Hearing Voices Network (HVN), 86-90 Paul Street, London, EC2A 4NE Email : info@hearing-voices.org Website : www.hearing-voices.org Action on Postpartum Psychosis A national charity for women and families affected by postpartum psychosis. They run a peer support service, provide information, training to health professionals, do research and promote awareness. Phone : 020 3322 9900 Address : Action on Postpartum Psychosis, PO Box 137, Swansea, SA3 9BT Email : app@app-network.org Website : www.app-network.org

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Antipsychotics

This information gives advice and information on the medication antipsychotics. It is for people who are 18 or over and affected by mental illness in England.

Download Antipsychotics factsheet

Frequently asked Qs

- Antipsychotic medications are generally used to treat the symptoms of schizophrenia and other psychotic disorders. They can also be used to treat bipolar disorder.
- Antipsychotics affect people differently. It can take time to find the right antipsychotic that works for you.
- You may experience some side effects with antipsychotics.
- You can talk to your healthcare professional if you are having challenges with side effects. They can also help if you feel like your antipsychotics are not working.
- You should talk to your healthcare professional if you want to stop your medication. You should not stop taking antipsychotics suddenly.
- You might take other medications, including supplements, or drink alcohol, or smoke. They can affect you and your antipsychotics. So, it is important you tell your healthcare professional about these things. This is so they can advise you.
- Antipsychotics can affect driving, pregnancy and breastfeeding. And psychotic related symptoms may worsen during menopause. You can get advice on these things.
You might experience schizophrenia or other psychotic disorders. Your doctor may offer you antipsychotic medication to help you with your symptoms. This includes psychotic depression.

Some antipsychotics are used to treat mania. Mania is a symptom of bipolar disorder.

What is psychosis?

Psychosis is a medical term. If you live with psychosis, you might see or hear things that are not there. These are known as hallucinations. Or you might have firm beliefs that do not match up to the way others see the world. These are known as delusions.

If you live with psychosis, you will process the world around you differently to other people. This can include how you experience, believe, or view things.

Some people describe psychosis as a break from reality. Doctors may call these:
- ‘psychotic symptoms’,
- a ‘psychotic episode’ or
- a ‘psychotic experience’.
Psychotic symptoms can be part of conditions like schizophrenia, schizoaffective disorder, personality disorder and bipolar disorder. But some people can experience psychotic symptoms without having any of these conditions.

How can antipsychotics help manage symptoms of psychosis?

Antipsychotics can help manage your symptoms of psychosis. This can help you feel more in control of your life, particularly if you are finding the psychotic symptoms distressing.

Research suggests 4 out of 5 people with severe mental illness, who take antipsychotics, find they are successful in treating their symptoms. This is according to the Royal College of Psychiatrists.

It is not possible to predict which type of antipsychotics will work best for you. So, you may have to try different ones before you find the one that works best for you.

How long does it take for antipsychotics to work?

You may feel better quickly. But it can take a few weeks or months for antipsychotics to work. Everyone responds to antipsychotics differently.

It can take several days or weeks to reduce symptoms such as hallucinations or delusional thoughts.

How do antipsychotics work?

Your brain contains chemicals which help to carry messages from one part of the brain to another. One of these chemicals is called dopamine. It is thought that high levels of dopamine can make the brain work differently and cause the symptoms of psychosis.

Antipsychotics work by blocking the effect of dopamine. This helps reduce psychotic symptoms for many people.

The Royal College of Psychiatrists say that the evidence suggests that nothing works as well as antipsychotic medications to treat schizophrenia.

For more information see our webpages on the following:
What are the NICE guidelines?

NICE stands for the National Institute for Health and Care Excellence.

NICE produce guidelines for the assessment and treatment of mental illnesses, such as psychosis and schizophrenia, and bipolar disorder. NICE recommend the use of antipsychotics to treat these conditions.

You can find these NICE guidelines below:
- Psychosis and schizophrenia in adults: prevention and management
- Bipolar disorder: assessment and management

There are 2 broad types of antipsychotics.

New types – known as ‘atypical’ or ‘2nd generation’. These types of antipsychotics have been used since the 1990s.
Older types – known as ‘typical’ or ‘1st generation’. These antipsychotics were the first ones used, starting from the 1950s.

The main difference between these types is in their side effects.

Older types of antipsychotics may:

have more of an effect on your body movement, and
they may cause a treatable condition called hyperprolactinaemia.

Newer antipsychotics are less likely to affect your movement. They may affect your weight and glucose intolerance.

Side-effects for different antipsychotics can vary. See the following section for more information on side-effects.

Antipsychotics affect people in different ways. You may have to try different ones. Your psychiatrist should work with you to find which medication works best for you.

If after a few weeks you are still having problems with side affects you can speak to your healthcare professional.

Your psychiatrist may offer you a different type of antipsychotic. They can also offer you a medication to help with the side effects. You can read more about side effects in the following section.

See our webpage on Medication – Choice and managing problems for more information.

How are antipsychotics taken?

Antipsychotic medication can come as tablets, a syrup or as an injection.

The injections are called a depot. They are long acting, so you only need to have one between once a week and once every 6 months. It is most common to have an injection every 4 weeks. You may find a depot injection useful if you find it hard to remember to take your medication.

For more information on depot injection antipsychotics, you can read information from the Royal College of Psychiatrists click here.

Your doctor should take your views into account about the form of medication you would like.

What are the newer types of antipsychotics?

The following antipsychotics are the newer types known as ‘atypical’ or ‘2nd generation’.

The newer types of antipsychotics licensed for use in the UK are shown in the table below.

Antipsychotic name	Trade name or names
Amisulpride	Solian
Aripiprazole	Abilify, Abilify Maintena
Clozapine	Clozaril, Denzapine, Zaponex
Lurasidone	Latuda
Risperidone	Risperdal, Risperdal Consta, Okedi
Olanzapine	Zypadhera, Zyprexa
Quetiapine	Seroquel, Seroquel XL
Paliperidone	Invega, Xeplion, Trevicta, Byannli

What is Clozapine?
Clozapine works slightly differently to others. It is usually given to people who are treatment resistant. Treatment resistant means other medication has not helped reduce or control symptoms successfully.

The NHS say Clozapine is the most effective antipsychotic for treatment resistant schizophrenia.

NICE says that people with schizophrenia should only be offered Clozapine after having tried 2 other antipsychotics. NICE stands for the National Institute for Health and Care Excellence.

Why will I need regular blood tests if I take Clozapine?
Clozapine can cause your white blood cell numbers to drop. Drops in white blood cells can lead to infections. You will need regular blood tests to make sure your white blood cell count is healthy.

Your healthcare professional should invite you to have blood tests during Clozapine treatment. You will need weekly blood tests for the first 18 weeks. For the next year, you will need blood tests every 2-weeks. Then, blood test should be done once a month.

You will be asked to stop taking the Clozapine if your white blood cell numbers start dropping. You will have another blood test after you have stopped clozapine to make sure they are back to normal.

Your healthcare professional might decide to change your dose of clozapine or offer you another type of medication.

What should I do if I have missed a dose of Clozapine?
If you have missed any doses of your Clozapine, contact a healthcare professional as soon as possible.

What is Wim’s protocol

Wim’s protocol is a guide to help doctors prescribe clozapine safely and reduce the risk of serious health problems. If you take clozapine, it is useful for you and your carers and relatives.

It explains:

the health checks if you should have if you take clozapine, and
what warning signs to look out for that might mean clozapine is affecting your health.

The guide helps carers and relatives spot problems early and know when to get help.

Its aim is to make clozapine treatment safer and prevent avoidable deaths.

What are the older types of antipsychotics?

The following antipsychotics are the older types known as ‘typical’ or ‘1st generation’.

Most are not usually used for treating psychosis anymore.

The older types of antipsychotics licensed for use in the UK are.

chlorpromazine
flupentixol
haloperidol
levomepromazine
pericyazine
perphenazine
pimozide
prochlorperazine
promazine
sulpiride
trifluperazine
zuclopenthixol

Different antipsychotics can have different side effects. So, in this section we only give a general overview of some of the side effects of antipsychotics.

How can I find out about side effects for my medication?

If you want to know more about the side effects off your antipsychotic medication you can.
- Talk to your psychiatrist, GP, or pharmacist. You can ask them any questions you have. If you are unsure about anything you can ask them to explain it. Most pharmacies have a private room where you can discuss things confidentially.
- Read the patient information leaflet for the medication. There should be one in the box the medication comes in. It says what the side effects are and explains what to do if you are experiencing any side effects. You can find the patient information leaflet for your medication on this website.
- Look up your medication on this NHS website. Each medication has a section on side effects.
What side effects can be included?

Below is a list of possible side effects of antipsychotics. But it is important to remember:
- people who take the same medication can get different side effects,
- people who take the same medication might get the same side effect. But one person might be affected more than the other,
- The risk of a side effect can depend on the type of antipsychotic you take.
Before you start to take antipsychotics, it is important to weigh up:
- the benefit the medication will have, and
- the possible side effects of it.
You can discuss this with your psychiatrist, GP, or pharmacist.

The National Institute of care excellence (NICE) recommend treatment to the NHS. NICE say side effects of antipsychotics include:
- Extrapyramidal symptoms. They include:
  - abnormal movements of the face and body
  - tremor
  - slowness of movement and speed
  - being rigid
  - restlessness
  - irregular movements which you cannot control
- Weight gain.
- Raised levels of cholesterol in the blood.
- Hyperprolactinaemia. This is higher-than-normal levels of prolactin in your blood. It can lead to:
  - a milky nipple discharge
  - missed periods
  - men’s breasts getting larger than normal
  - the body not producing enough testosterone, sperm, or both
  - sexual dysfunction
  - an increased risk of osteoporosis, a health condition that weakens bones.
- Sedation. Feeling sleepy and relaxed.
- Sleep apnoea syndrome. A condition in which your breathing stops and restarts many times while you sleep.
- Anticholinergic effects. Such as dry mouth, blurred vision, urinary retention, constipation, skin flushing and problems emptying all the urine from your bladder.
- Postural hypotension. A form of low blood pressure that happens when standing after sitting or lying down.
- High blood pressure.
- Seizures.
- Less glucose tolerance.
- Issues with your heart or blood vessels.
- Stroke risk.
- Blood clots in the veins.
- Neuroleptic malignant syndrome (NMS). This is a rare but potentially fatal adverse effect of all antipsychotics. Signs and symptoms of NMS include:
  - fever
  - increased sweating
  - rigidity
  - confusion
  - fluctuating consciousness
  - fluctuating blood pressure
  - fast heartbeat
  - an increased white blood cell count
  - raised creatine kinase, a type of protein in the blood.
- Pneumonia.
- Neutropenia. A condition where you have a low number of white blood cells called neutrophils in your blood.
- Effects on liver function.
- Photosensitivity. Heightened skin sensitivity.
- Skin disorders.
- Double vision.
- Increase in drug or alcohol use.
- Restless legs syndrome. An overwhelming urge to move your legs.
This NHS chart explains side effects of antipsychotics. It helps you to see some of your options for antipsychotics. This could also help you to make choices about your treatment. A healthcare professional can help explain what the following chart means.

Can aripiprazole increase the risk of gambling addiction?

The Medicines and Healthcare products Regulatory Agency is responsible for making sure that medicines are safe in the UK. They say up to December 2023, there have been 63 reports that aripiprazole has been linked to gambling issues.

Aripiprazole is a frequently prescribed antipsychotic medication. In July 2024 alone, 150,000 items of it were prescribed.

Do not stop taking aripiprazole without first talking about it with your doctor.

Tell your doctor as quickly as you can if you take aripiprazole and:
- you have a history of excessive gambling behaviour or impulse control disorders, or
- you or your loved ones notice that you are getting urges to behave in ways that are unusual for you. This includes behaviours such as addictive gambling, excessive eating or spending, or an abnormally high sex drive.
How might antipsychotics effect my physical health?

Some antipsychotic medications can affect your heart.

Doctors might scan your heart at check-ups, if:
- you have a heart condition, or
- you are at risk of having difficulties with your heart.
They might want to do this once every year, or more regularly. This is done by having an electrocardiogram gram (ECG). This is a painless scan.

GP surgeries have a register of people with severe mental illness, such as schizophrenia. If you are on the register your GP should offer you an annual physical health check. They might check your heart in these appointments.

You can speak to your GP or psychiatrist if:
- you want a heart check-up before you start taking antipsychotics, or
- if you have any concerns about your heart or blood vessels.
If you live with psychosis or schizophrenia your doctor should offer to check your heart before you start antipsychotics if:
- the manufacturers of your medication say you should,
- a physical health check has found you have a higher risk of heart or blood vessel problems,
- you have heart or blood vessel problems or someone in your family has had them, or
- you have to go into hospital.
For more information see our webpage on Severe mental illness and physical health checks

What can I do if I have issues with side effects?

You might get side effects that are unpleasant or distressing.

Side effects might go away after a few weeks or months of taking medication. Some side effects might last longer.

It is important that you find the right balance between medication that helps your symptoms and has the least side effects.

You can talk to your psychiatrist or GP if you have issues with side effects. They might change your dose or suggest a different medication. They may also be able to give you other drugs to help with the side effects.

You can use a scale like the Glasgow antipsychotic side effects scale to monitor your side effects. It is a questionnaire with 22 questions about different side effects. You can take this to your doctor to help you decide how to manage the side effects.

You can download the GASS here.

What is the yellow card system?
The Medicines and Healthcare Products Regulatory Agency (MHRA) make sure medicines, and medical devices work and are safe.

The MHRA runs the yellow card system. You can use the system to report bad side effects. By doing this you can help the MHRA to make sure medicines are safe.

You can report bad side effects online by clicking on the following link.

You may also find the following website helpful to learn more about antipsychotics:
- British National Formulary (BNF).
See our webpage on Medication – choice and managing problems for more information.
What if I want to stop taking antipsychotics?

You should talk to your doctor if you want to stop taking antipsychotics.

Your doctor should tell you how stopping antipsychotics may affect you. You can ask them about these things. Before you stop taking antipsychotics it is important to understand:
- the benefits of continuing to take them, and
- what might happen if you stop.
Your doctor will help you come off the medication if you decide to stop taking antipsychotics. Your doctor can do this by gradually reducing the dose over a period of time.

Stopping antipsychotic medication suddenly may mean that your symptoms return, and you become unwell again. , This is also known as ‘relapse’.

If you or your family or friends think you are becoming unwell again, you should speak to your doctor.

You may find that stopping your medication can lead to your symptoms returning.

Your doctor may suggest that you keep taking the medication because it is keeping you well. If this is the case, you could ask about trying another type of medication.

If you want to stop taking antipsychotics, it is important to consider what happened during previous episodes of illness.

The risks of relapsing need to be weighed up against the side effects you may be having. This includes other things that are important to you. Your doctor can help you talk about these things and help you make the best decision.

Can I experience withdrawal symptoms from stopping antipsychotics?

Antipsychotics are not addictive, but your body may get used to them. This is why you may experience withdrawal symptoms.

The withdrawal symptoms you may experience depends on each individual antipsychotic.

You can talk to your GP or psychiatrist if you get withdrawal symptoms. They can advise you on how to manage them.

Do I have to take antipsychotics?

It is your choice whether you take antipsychotics.

If you are detained in hospital under the Mental Health Act medical professionals should still involve you in decisions about your treatment. But they might be able to treat you if you:
- refuse the treatment, or
- do not have the mental capacity to give your consent.
For more information see our webpages on the following:
- Mental Health Act
- Mental capacity and mental illness - The Mental Capacity Act 2005
Antipsychotics can interact with many different medications. This means if you take an antipsychotic and another medication, they can affect each other.

For example, some antipsychotics can interact with tricyclic antidepressants. In some cases, this means they should not be prescribed together.

You should tell your doctor about all the medicines you are taking. This includes any supplements. This will allow your doctor to prescribe the right antipsychotic.

Health supplements, including natural health products, can interact with antipsychotics. If you are taking a supplement, always get the same brand. Switching brands can have an effect your antipsychotics. Even if it is the same supplement.

You might already take antipsychotics. Get advice from your doctor before you:
- start any new prescription medication, or
- try a new health supplement.
You may benefit from keeping an up-to-date medication list. This should include all the medication you are currently taking so you can give it to healthcare professionals.

It is also very important to not stop or start any medication without checking with a healthcare professional. This could be a doctor or a pharmacist.

You can find out more from Mind about interaction risks between antipsychotics and different medications here.

Your doctor may prescribe you different medications with antipsychotics, which is common. Your doctor should carefully monitor this to ensure your safety.
Alcohol can affect antipsychotics. So, you should:
- discuss with your doctor how alcohol use can affect you if you take antipsychotics, and
- carefully read your medication patient information leaflet to see what it says about alcohol use. The box your medication comes in should include the patient information leaflet.
Drinking alcohol can make it harder for your body to absorb medication. This could increase the effects alcohol has on you. Drinking alcohol with antipsychotics might increase the sedative effects. This means you might feel very tired.

How can I get a copy of the patient information leaflet for my medication?
You can get a copy of the patient information leaflet for you medication online.

You can do best by visiting the Medicines and Healthcare Products Regulatory Agency (MHRA) website here.

Be sure to search for exactly the right type of medication. There might be several different types of the same medication.

What about alcohol use and clozapine?

If you take clozapine drinking alcohol can be very dangerous.

There are risks when drinking alcohol while taking clozapine. It can cause central nervous system depression. This is when the brain and nervous system slows down. If it slows down too much, it can be life-threatening.

It is very important you:
- discuss alcohol use with your doctor, and
- carefully read your medication patient information leaflet to see what it says about alcohol use. The box your medication comes in should include the patient information leaflet.
The symptoms of central nervous system depression are shown below.

You should get help straight away by calling NHS 111 if you show signs of them. Or in an emergency by going to A&E or calling 999.
- Over sedated or inappropriately sleepy.
- Unusually confused or forgetful.
- Un-coordinated, with slurred speech, slow reflexes or difficulty moving.
- Breathing unusually slowly or have other breathing difficulties.
- A slow pulse or heart rate.
- A dry mouth.
- Blue lips.
- Clammy, cold skin.
Smoking can interact with the way medication is absorbed in your body. So, it is best to tell your doctor if you smoke.

If you are thinking of quitting smoking, you should discuss this with your doctor. If you stop smoking suddenly, this can affect the levels of medication in your body. This can cause serious side effects.

You can find more information on our webpage Smoking and mental health
Antipsychotics can affect your concentration and make you feel drowsy. This could affect how well you are able to drive. Especially when you first start taking the medication. You should consider stopping driving during this time if you are affected.

You must tell the DVLA if you live with certain mental health conditions. Including psychosis, paranoid schizophrenia and bipolar disorder.

See our webpage on Driving and mental illness for more information.
There could be a very small increased risk of complications if you take antipsychotic drugs during pregnancy.

You should speak to your doctor if you:
- become pregnant, or
- planning on having a baby
You should not stop taking your antipsychotics without speaking to your doctor first.

You can also talk to your midwife or health visitor.

You are at a higher risk of becoming unwell after birth. You can talk to your doctor about this as you may need specialist care.

This will usually come from an NHS perinatal mental health service. An NHS community mental health team might also support you. These services will talk to you about your care and treatment options during your pregnancy.

You can find more information on our webpage New parents, pregnancy, and mental health

Can I breastfeed if I take antipsychotics?
All antipsychotics can be passed to your baby from your breast milk. So, if you take antipsychotics, you should speak to your doctor before breastfeeding your baby.

Guidelines say that you should not breastfeed if you take Clozapine. This is because of the risk of:
- agranulocytocis, which is a problem affecting white blood cells, and
- seizures.
Breastfeeding can benefit your baby, but it might affect your sleep. This could increase your risk of a relapse. If you do breastfeed after advice from your doctor, others could help with bottle feeding at night to help you to sleep.

Drug manufacturers might advise that you should stop breastfeeding while taking an antipsychotic. When you are prescribed an antipsychotic, to see if you are safe to breastfeed, please:
- read the patient information leaflet. The box your medication comes in comes in should include the patient information leaflet, and
- ask your doctor or pharmacist about it.
The Royal College of Psychiatrists have more information on ‘Antipsychotics in pregnancy and breastfeeding’ here.
Mood Swings Network
This organisation provides a range of services for people affected by a mood disorder, including their family and friends.

Phone: 0161 832 37 36
Address: 36 New Mount St, Manchester, M4 4DE.
Email: info@moodswings.org.uk
Website: www.moodswings.org.uk

Bipolar UK
This is a user led charity working to enable people affected by bipolar disorder to take control of their lives

Address: Bipolar UK, 32 Cubitt Street, London, WC1X 0LR11
Phone: 0333 323 3880
Email: info@bipolaruk.org.uk
Website: www.bipolaruk.org

The Hearing Voices Network
This organisation provides support and understanding for those who hear voices or experience other types of hallucination.

Address: National Hearing Voices Network (HVN), 86-90 Paul Street, London, EC2A 4NE
Email: info@hearing-voices.org
Website: www.hearing-voices.org

Action on Postpartum Psychosis
A national charity for women and families affected by postpartum psychosis. They run a peer support service, provide information, training to health professionals, do research and promote awareness.

Phone: 020 3322 9900
Address: Action on Postpartum Psychosis, PO Box 137, Swansea, SA3 9BT
Email: app@app-network.org
Website: www.app-network.org
- There is an accessibility function on this webpage called Recite.
- On the desktop site, click on the icon in the top right-hand corner next to ‘Donate.’
- On the mobile site, scroll right and click on the ‘Turn on accessibility’ icon.
- You can watch a short video about Recite here.

Did this help?

We would love to know if this information helped you or if you found any issues with this page. You can email us at feedback@rethink.org

Last updated September 2024
Next update September 2027, subject to any changes

Version number 10.1

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