What Are Antipsychotic Medications?
Antipsychotic medications are prescribed psychiatric drugs intended for treating psychosis. These medications are approved for addressing specific mental health disorders characterised by psychotic symptoms such as :
- Schizophrenia
- Schizoaffective disorder
- Select forms of bipolar disorder
- Acute depression
- featuring psychotic elements
Antipsychotics are also authorised for treating other conditions, such as :
Physical issues like chronic hiccups, balance problems, and nausea
Agitation and psychosis in dementia, but only when the individual poses a risk to themselves or others.
How Are They Taken?
Various administration methods are available for antipsychotics. While oral forms—tablets or liquid—are common, depot injections providing slow, sustained release are also an option.
In hospital settings, a specific inhaled form of antipsychotic, called loxapine adasuve, might be used but is not commonly prescribed otherwise.
Who Can Prescribe Antipsychotics?
Professionals qualified to prescribe antipsychotics include :
- Psychiatrists
- General Practitioners (GPs)
- Specialist nurse prescribers
- Specialist pharmacists
Initial prescriptions are typically from a psychiatrist, while GPs often handle renewals or ongoing prescriptions.
How They Work?
Antipsychotic medications don't cure psychosis; however, they help manage and control symptoms like :
- Delusional thinking and hallucinations
- Anxiety and severe agitation
- Confused speech and thoughts
- Disruptive behaviour
- Mania
Antipsychotics can alleviate these symptoms, either partially or completely, helping individuals lead more stable lives and reducing the likelihood of symptom recurrence.
The Science
The medications work by :
- Blocking dopamine receptors in the brain, potentially reducing psychotic symptoms
- Affecting other neurotransmitters such as serotonin, noradrenaline, and glutamate, which help regulate mood
- Inducing Parkinsonism-like symptoms in some cases, particularly with first-generation antipsychotics
- Antipsychotic medications can help manage symptoms, but underlying causes often involve complex life experiences and environmental factors.
Types of Antipsychotics
Antipsychotics are categorised into :
- First generation ('typical') antipsychotics
- Second generation ('atypical') antipsychotics
Both categories have their benefits and drawbacks, with first-generation options sometimes causing severe neuromuscular side effects.
Second-generation antipsychotics generally have less severe neuromuscular but can induce metabolic side effects like rapid weight gain.
Choosing the Right Antipsychotic: Factors to Consider
Determining which antipsychotic medication is best suited for you hinges on several variables :
Your Diagnosis and Specific Symptoms
For instance, with schizophrenia, all classes of antipsychotics can manage its 'positive' symptoms. However, second-generation antipsychotics are more effective for dealing with 'negative' symptoms.
Older, first-generation antipsychotics are often less helpful in this respect.
If you have tried multiple antipsychotics for schizophrenia without success, including a second-generation option, clozapine might be the next step.
For those diagnosed with bipolar disorder or major depression, second-generation antipsychotics are generally the go-to option.
Your Medication History
Consider previous experiences with medication, discussing their efficacy or lack thereof with your healthcare team. If you've had negative experiences with a specific antipsychotic, another may be better suited for you.
Your Health Background
Check out our guidelines on safely administering antipsychotics for information on when and how to cautiously proceed or when to completely abstain.
Your Treatment Goals
Optimal medication should be selected through dialogue between you, your doctor, and your psychiatrist. This should reflect your personal wishes and you may also invite someone you trust to join these discussions.
Timing and Effectiveness
How quickly antipsychotics act depends on the administration method :
Oral form : Effects can be felt within a few hours.
Depot injections : Slow-release, effect extends over several weeks.
Emergency injections : Effects are immediate, usually peaking within an hour.
Other influencing factors include your metabolism, liver function, and activity levels.
What Constitutes an Emergency?
In extreme situations, you might require rapid tranquilisation through an antipsychotic or another sedative.
Emergency Situations Are :
- Imminent risk to yourself or others.
- Failure of deescalation measures.
- Refusal or failure of oral medication to work.
Emergency Antipsychotic Options
Co-Existing Medications
You might also be offered additional medications, depending on your diagnosis, symptoms, and potential side effects of your primary antipsychotic. These could include antidepressants, mood stabilisers, or sleep aids.
Polypharmacy
Simultaneously prescribing multiple antipsychotics should be minimised unless under specific circumstances. This can happen during a transition between medications or when a single medication is ineffective.
What If I Refuse?
If you opt not to have the injections, the hospital team may use restraint techniques to administer the medication via a certified nurse.
This process can be extremely uncomfortable. It's important that anyone who partakes in the restraint should have received specific training to minimise the risk of harming you.
Going through a fast-acting sedation like this can be emotionally distressing. According to the guidelines set by the National Institute for Health and Care Excellence (NICE), you should be granted the chance to :
- Engage in a dialogue with the healthcare professionals overseeing your treatment to discuss your experience
- Document your personal account of the event, which should then be included in your hospital records.
- If you're dissatisfied with the treatment you've received, you have the right to lodge a complaint.