What are the 10 most effective antipsychotic tablets?

What are the 10 most effective antipsychotic tablets?

In this article, we will describe what are the 10 best antipsychotic tablets.

What are antipsychotics used for?

Antipsychotics may be prescribed to reduce the symptoms of:

• Psychosis
• Schizophrenia
• Schizoaffective disorder
• Severe anxiety, in some cases
• Bipolar disorder – to help control hypomania and mania.
• Depression – as an additional medication.

How antipsychotics work

They work by increasing or reducing the effects of natural chemicals (called neurotransmitters) in the brain, including:

• Dopamine
• Serotonin
• Noradrenaline
• Acetylcholine.

These neurotransmitters regulate numerous aspects of behaviour including:

• Thoughts
• Mood and emotions
• Control of sleeping and wakefulness
• Motivation.

What are the types of antipsychotic?

Typical (first generation) antipsychotic drugs

The typical, or conventional, antipsychotics were first developed in the 1950s. Haloperidol and chlorpromazine are the best known typical antipsychotics.

They continue to be useful in the treatment of severe psychosis and behavioural problems when newer medications are ineffective. However, these medications do have a high risk of side effects including difficulties with movement, shaking and sedation.

Common ones include: aloperidol, zuclopenthixol, flupentixol, chlorpromazine and trifluoperazine. Others include: loxapine, levomepromazine, fluphenazine, penfluridol, pimozide, sulpiride and prochlorperazine.

Atypical (second generation) antipsychotic drugs

These medications were introduced later with many approved for use in the 1980s. These medications are less likely to produce extrapyramidal effects (physical symptoms such as tremors, stiffness and abnormal movements) than typical (first generation) antipsychotics.

They include: aripiprazole, olanzapine, risperidone, quetiapine, clozapine. Others include: paliperidone, cariprazine, lurasidone, ziprasidone and amisulpride.

So. What are the 10 most effective antipsychotic tablets (available in the UK)?

1. Clozapine – the most effective antipsychotic medication. It is saved for those who do not respond to other treatments, as people can experience a wide range of side effects and regular blood tests are required.
2. Amisulpride – a great medication for ‘Positive Symptoms’ (hallucinations and delusions). This is a second generation antipsychotic that works like a first generation one. It is important to speak with your doctor if you experience tremors or stiffness in your movement
3. Olanzapine – this medication works on several transmitters in the brain, so it can be helpful with a range of symptoms including sleep and agitation. Olanzapine can however lead to a higher risk of weight gain and drowsiness  if you are experiencing these you will be able to discuss with your team the techniques to counter this, including changing the time of the dose and the interventions available
4. Risperidone ­– a widely prescribed medication with a large body of research. Not only is this prescribed in Psychotic disorders, it is also used in mood disorders and to reduce distress and agitation in those with autism and learning disabilities
5. Zuclopenthixol – an typical antipsychotic often given as a depot injection
6. Paliperidone – ametabolite (breakdown product) of Risperidone that can be given as a depot injection. Although usually given every month, if you are tolerating the medication well, this injection could be considered every 3 or even every 6 months
7. Haloperidol – a typical antipsychotic which can be taken as a tablet or depot injection
8. Sulpiride ­- atypical antipsychotic which is prescribed less often than it used to be due to similar, often more suitable options
9. Loxapine – although available in the UK this is rarely prescribed due to comparative efficacy of other similar medications
10. Chlorpromazine – the first antipsychotic. Discovered in the 1950s. Less often prescribed in recent years due to the tolerability and efficacy of newer medications

My antipsychotic isn’t on the list! Should I ask to change?

Do not fear if your antipsychotic is not included in the above list. Other than Clozapine, there are not huge differences in how effective different antipsychotics are.

Everyone does not react in the same way to antipsychotics, and a treatment that works well for one person, may not be beneficial for the next. Your doctor will have considered your circumstances and the side effects of each medication in order to tailor your treatment to your symptoms and needs.

If your medication is controlling your symptoms well and you are not experiencing distressing side-effects there is no need to speak to your doctor about switching antipsychotics.

Here is some information on commonly prescribed antipsychotics not listed above.

Aripiprazole – a medication often prescribed first line. Although it is not as effective as some other medications for some individuals, aripiprazole has a much lower side-effect profile. Individuals taking this are less likely to experience sedation, weight gain, rigidity and tremor.

Quetiapine – an antipsychotic that works on several transmitters in the brain and is often prescribed for low mood, anxiety and mania as well as psychosis. As it affects many transmitters however it can cause a range of side effects if given at a high a dose.

Flupentixol – a typical antipsychotic often given as a depot injection

Penfluridol – this is a once weekly tablet that can be helpful for those who struggle to remember to take a tablet everyday, however do not wish to take regular injections.

Lurasidone – a newer atypical antipsychotic which is starting to be prescribed more frequently due to a smaller side effect profile.

How are antipsychotics given?

Antipsychotics are available as tablets, capsules, liquids and depot injections (long-acting, e.g once a month).

Withdrawal from antipsychotics 

Please note withdrawal from antipsychotics should be slow and gradual – after discussion with your doctor. Please do not adjust the dose (or stop them) yourself. Psychotic symptoms and sleep disturbance may come back if sudden discontinuation of therapy occurs.

Summary

We have described what are the 10 most effective commonly used antipsychotic tablets. We hope it has been helpful.

Other resources

Here are other related articles.
What drugs are used to treat mental illness?
10 schizophrenia facts
10 most common antidepressants

This article was reviewed by Dr Brad Neal, Registrar in Psychiatry

This is a good video by Stephen Fry.