Antipsychotic Medication
Prescription medicines used in schizophrenia and bipolar disorder, and sometimes added to an antidepressant when that alone is not enough.
- Type of medicine
- Taken by mouth, usually once daily. Not controlled substances.
- Monitoring
- Weight, blood sugar and cholesterol before starting and periodically after.
- Long-acting injectables
- Not offered here. Where one is the right option we will say so and refer you.
What Antipsychotics Are
Antipsychotics act on dopamine and, for most newer ones, serotonin signaling. The name is narrower than the use: they are prescribed at least as often in bipolar disorder as in psychosis.1
They are also added to an antidepressant when depression has not responded adequately, at doses well below those used for psychosis. That is a well-evidenced use, though it surprises people when it is suggested.
Conditions Treated
Schizophrenia
The original indication, and the one the class is named after. Also schizoaffective disorder.
Bipolar disorder
Both for acute mania and, for several of them, specifically for bipolar depression, where the options are narrower.
Depression that has not responded
Added alongside an antidepressant rather than replacing it, at lower doses. See antidepressants.
Severe agitation
Sometimes used short term where agitation is severe, alongside treatment of whatever is causing it.
Common Medication Types
Most second-generation antipsychotics work comparably. What separates them is what they do to weight, alertness and movement, so the choice is usually about side effects rather than effectiveness.2
Lower metabolic effect
Aripiprazole (Abilify), lurasidone (Latuda), ziprasidone (Geodon), cariprazine (Vraylar). Generally less effect on weight and blood sugar. Aripiprazole can cause restlessness.
Higher metabolic effect
Olanzapine (Zyprexa) and clozapine carry the most weight gain and diabetes risk of the group.2 Effective, but the trade needs weighing before starting.
More sedating
Quetiapine (Seroquel) is markedly sedating, which makes it useful at night and difficult during the day.
Older, first-generation
Haloperidol and similar. Prescribed less often now because they carry a higher risk of movement side effects.3
Benefits and Expectations
Sleep and agitation often improve within days. The fuller effect takes weeks, so a judgment made in the first week is being made early.
A poor response to one antipsychotic does not predict a poor response to another. Switching is routine, and so is adjusting the dose where there has been a partial response.
Common Side Effects
Some settle in the first weeks. Others accumulate over years, which is why they are measured rather than waited on:
- Drowsiness, often easing but persisting with the more sedating medicines
- Weight gain, building over months and varying a great deal between medicines
- Changes in blood sugar and cholesterol, which develop without symptoms
- Inner restlessness, which is genuinely distressing and easy to mistake for anxiety
- Stiffness or tremor, more common with the older medicines
- Dizziness on standing, usually early
- Sexual side effects, which often persist rather than fading
A side effect you can live with is not the same as no side effect. There are enough options that enduring one is rarely necessary, and a switch is a conversation rather than a gamble.
Important Safety Information
Movement effects and tardive dyskinesia
Tardive dyskinesia is a movement disorder that can follow long-term use of medicines that block dopamine, usually appearing as involuntary movements of the face, mouth or tongue.3 The risk is lower with newer antipsychotics than with older ones, but it is not zero. Report any new involuntary movement at the first sign rather than waiting for a review, because caught early it is far more manageable.
Metabolic monitoring
Weight, blood sugar and a lipid panel are checked before starting and monitored after, particularly with the medicines more likely to affect them.2 These changes are silent, so measurement is the only way to catch them. We send lab orders to a facility near you rather than asking you to come to the office.
Do not stop suddenly
Abrupt discontinuation is a common trigger for relapse and can produce physical effects of its own, including nausea, sleeplessness and restlessness, which are easy to mistake for the illness returning. Any reduction should be planned with your prescriber.
Tell your prescriber about
- Any heart condition, diabetes or high cholesterol, and any family history of them
- All other medicines and supplements
- Pregnancy, planned pregnancy or breastfeeding
- How much alcohol you drink. See alcohol use treatment
If you need help now. Seek urgent medical care for a high fever with muscle rigidity, confusion or a racing heart. Contact your prescriber the same day for new involuntary movements, restlessness you cannot sit with, or if thoughts of self-harm begin or worsen. Our office is open Monday to Friday, 9am to 6pm.
Ridge Way is not an emergency service. If someone is in immediate danger, call 911. For a mental health or suicide crisis, call or text 988, any time, or call the Georgia Crisis and Access Line at 1-800-715-4225. Crisis resources.
Frequently Asked Questions
Do I have psychosis if I am offered one of these?
No. They are used in bipolar disorder and as an addition in depression that has not responded, both at lower doses than in psychosis. The name is a historical artifact rather than a description of who takes them.
Will I need blood tests?
Usually. Weight, blood sugar and a lipid panel are checked before starting and then monitored.2 We send the order to a lab near you, so telehealth patients are not disadvantaged.
Do you prescribe long-acting injectables?
Not currently. Where one is the right option we will say so and refer you to a practice that administers them. See our full scope of care.
Can I stop once I feel well?
Not without discussing it. Stopping abruptly is a common trigger for relapse and can produce effects that look like the illness returning. If you want to come off, that is a legitimate conversation and it is done gradually.
Will I gain weight?
It varies a great deal by medicine. Olanzapine and clozapine carry the most risk; several others considerably less.2 If this matters to you, say so before starting rather than after, because it can be factored into the original choice.
References
- National Institute of Mental Health. Schizophrenia. Accessed September 2026.
- Willner K, Vasan S, Patel P, Abdijadid S. Atypical Antipsychotic Agents. StatPearls, National Library of Medicine.
- StatPearls, National Library of Medicine. Tardive Dyskinesia. Accessed September 2026.
- StatPearls, National Library of Medicine. Antipsychotic Medications. Accessed September 2026.
Support for the Whole Course of Treatment
Antipsychotic medication works best with careful monitoring and a team that knows your history. We’ll manage the dose, the side effects and the follow-up with you. Book an appointment today.