Anti-Psychotics

What Are They?

They are medicinal drugs mainly prescribed by psychiatrists for severe mental illness.

How Do They Work?

The main method of action is to alter the amount of a brain chemical called dopamine.   Dopamine is found in several sites in the brain. Imbalances in dopamine are closely connected with the symptoms that people with psychotic illnesses suffer. 

They do work on other chemicals as well and this is one of the causes of any side-effects.

What Do I Need to Know?

• They are very useful and can be literally life saving, however they can have lots of side effects. They are therefore usually kept for serious situations where there are few or no alternatives.
• They are sometimes known as major tranquilisers because they are good at calming people down. They are used for emergency situations where it’s essential to calm someone down quickly. For example, if someone is about to kill themselves or someone else and cannot be persuaded out of it.
• If you have a psychotic illness (such as schizophrenia) then you may need to stay on these drugs for a long time.
• In most people they will reduce or stop hallucinations, muddled thinking and delusions.
• They will help you get back to a calmer state.

There are two main groups of these drugs; the older ones known as Typical and the newer ones known as Atypical. The differences between them are mainly to do with the side-effects. It used to be thought that the Atypicals (newer ones) were better at treating the negative symptoms of schizophrenia but this is no longer thought to be the case. 

Side-Effects

There are some side-effects that are individual to each drug. Side-effects do not occur for everyone and not everyone gets the same ones. So it is vital to discus with your doctor the use of these drugs in detail (except in emergencies).

Please remember that the following is a broad classification:

Movement Problems: These are more common with the older drugs but can occur with the newer ones at higher doses, there are three groups of side-effects here:

Short Term: They can occur after a few doses or one large dose if you are unlucky.

• Muscle spasms: can be painful and if they affect you badly, Fortunately they are very easy to treat.
• Restlessness: especially of the legs but which can also be experienced as an inability to keep still. This usually gets better with reduction of the dose but can be difficult to detect.

Medium Term: After weeks to  months of regular use.

• Trembling, especially of the hands. Rigidity of the limbs and slowness of movement, and jerky movements of limbs and tongue.

Longer Term:  Usually after several years.

• Repeated movements of the tongue, lips and jaw.
• May extend to the arms, legs and body and also to the eyes causing rapid eye blinking.

These symptoms can be extremely unpleasant but not life threatening. There are various ways of dealing with them including dose reduction and use of other medication to reduce symptoms. The short to medium term symptoms can be easy to sort out.  The longer term ones can be difficult.

The other thing you need to know about movement problems is that for some people they can be present before any treatment is started so you should have someone look for them before drugs are started.

Neuroleptic Malignant Syndrome (NMS): Your temperature goes up, your muscles get rigid and blood pressure and pulse go up and down rapidly. You sweat a lot. This is a serious but rare side-effect and can occasionally cause death. It is said to occur in its serious form between 0.1 and 0.2% of people taking anti-psychotics but the estimates are very variable. Of those who do develop the side-effect it is said that about 10% die.

Usually if you are going to get this side-effect it happens within a week or two of starting the anti-psychotic. It can however occur at any time.

Direct Heart Effects  

A few people get abnormal heart rhythms. These can start off in subtle ways so it’s important that you have an ECG prior to starting anti-psychotics and when doses are increased.

Other consequences on the body’s biochemistry include difficulties with handling glucose and increases in levels of blood fats. These matter because they contribute in later life to whether or not you get heart disease and diabetes. This means you should have these things checked on a regular basis and before starting therapy.

Having read all these side effects you may wonder why anyone would take these drugs. The answer is that for people with serious psychiatric illnesses the risks of not taking them and thus not improving/getting better are much higher than the risks of taking the medication.