Antipsychotic medications are typically used to treat psychosis, a condition that involves some loss of contact with reality. People experiencing a psychotic episode often experience delusions (false beliefs) or hallucinations (hearing or seeing things others do not see or hear). Psychosis can be related to drug use or a mental disorder such as schizophrenia, bipolar disorder, or severe depression (also known as “psychotic depression”).
Health care providers may also prescribe antipsychotic medications in combination with other medications to relieve symptoms associated with delirium, dementia, or other mental health conditions. Antipsychotic treatment for older adults necessitates additional care and consideration. The FDA requires that all antipsychotic medication labels include a black-box warning stating that antipsychotics are associated with increased rates of stroke and death in older adults with dementia.
Older, first-generation antipsychotic medications are sometimes called “typical” antipsychotics or “neuroleptics.” Long-term use of typical antipsychotic medications may lead to a condition involving uncontrollable muscle movements called tardive dyskinesia (TD). TD can range from mild to severe. People who think they might have TD should check with their health care provider before stopping their medication.
Newer, second-generation medications are sometimes called “atypical” antipsychotics. Several atypical antipsychotics may be used to treat a broader range of symptoms compared with older medications. For example, these medications are sometimes used to treat bipolar depression or depression that has not responded to antidepressant medication alone. Health care providers may ask people taking atypical antipsychotic medications to participate in regular monitoring to check weight, glucose levels, and lipid levels.
Some symptoms, such as feeling agitated and having hallucinations, typically go away within days of starting antipsychotic medication. Other symptoms, such as delusions, usually go away within a few weeks of starting antipsychotic medication. However, people may not experience the full effects of antipsychotic medication for up to 6 weeks.
If a person’s symptoms do not improve with usual antipsychotic medications, they may be prescribed an atypical antipsychotic called clozapine . People who take clozapine must have regular blood tests to check for a potentially dangerous side effect that occurs in 1% to 2% of people.
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