Antipsychotic side effects can be different depending on the medicine you take. You will learn about common and unique side effects for each antipsychotic and find simple tips to reduce them, helping you get better results from your treatment.

Introduction to Antipsychotic Medications

Antipsychotics are medicines that help you manage symptoms like hearing voices, seeing things that aren’t there, or having strong thoughts that don’t match reality. These symptoms are often called psychosis. Years ago, people used to call these medicines major tranquilizers or neuroleptics, but today we mostly call them antipsychotics.

These medications don’t cure mental illness, but they help reduce symptoms so you can feel more stable and think more clearly.

Conditions They Treat

You might take antipsychotics if you have:

• Schizophrenia – a condition where you might hear voices, see things, or believe things that others don’t.
  
• Bipolar disorder – antipsychotics can help during manic or depressive episodes, especially when mood stabilizers alone don’t work.
  
• Major depression – sometimes doctors add an antipsychotic if regular antidepressants aren’t helping enough.
  
• Other psychotic disorders – like schizoaffective disorder or psychosis caused by stress, trauma, or medical issues.

How They Work in the Brain

Antipsychotics work by changing the way certain brain chemicals (like dopamine and serotonin) send messages. If you have too much dopamine in some parts of your brain, it can cause problems like hallucinations or delusions. These medicines help balance those levels.

Your brain is a busy control center, and antipsychotics help calm down the parts that are “overactive” so your thoughts and senses don’t get overwhelmed.

Common Side Effects Across All Antipsychotics

When you take antipsychotic medication, it’s important to know what side effects might happen. These effects can vary depending on the drug, your dose, and how long you take it. Some side effects are common with most antipsychotics, while others are rare or specific to certain medications.

General Guidelines

• Don’t combine antipsychotics unless your doctor tells you to. Taking more than one can increase the risk of serious side effects.
  
• These drugs can change your brain over time. High doses or long-term use may reduce brain tissue, especially white matter. But combining second-generation antipsychotics with therapy may help protect your brain if you’re new to treatment.

Common Side Effects (Seen in 1% to 50% of People)

Physical and Mental Effects

• Tiredness or drowsiness (very common with clozapine, quetiapine, olanzapine)
  
• Dizziness
  
• Headaches
  
• Feeling flat or unmotivated (called dysphoria or apathy)
  
• Anxiety or restlessness

Movement Problems (Especially with Older Drugs)

• Akathisia – feeling like you can’t sit still
  
• Dystonia – painful muscle cramps or twisting
  
• Pseudoparkinsonism – shaky hands, stiff muscles, drooling
  
• Tardive dyskinesia – slow, uncontrollable face or body movements (usually after long-term use)

Hormonal and Sexual Issues

• Increased prolactin may cause:
  
  • Breast swelling (in both men and women)
    
  • Milk production
    
  • Irregular periods or sexual problems
    
  • Risk of weak bones (osteoporosis)

Weight and Metabolism

• Weight gain
  
• Higher blood sugar or diabetes risk
  
• Metabolic syndrome – includes weight gain, high cholesterol, and high blood pressure

Stomach and Digestive Issues

• Constipation can become serious if untreated
  
• Dry mouth or extra saliva
  
• Blurred vision
  
• Diarrhea

Heart and Blood Pressure

• Low blood pressure when standing up (called orthostatic hypotension)
  
• Changes in heart rhythm (QT prolongation)

Rare or Serious Side Effects (Seen in Less Than 1%)

Life-Threatening Conditions

• Neuroleptic Malignant Syndrome (NMS) – signs include:
  
  • High fever
    
  • Muscle stiffness
    
  • Confusion
    
  • Fast heart rate
    
  • Can be deadly, so seek help right away
    
• Seizures
  
• Stroke or heart attack
  
• Severe blood clots (thromboembolism) 

Blood and Organ Issues

• Agranulocytosis – a drop in white blood cells; needs regular blood tests
  
• Pancreatitis
  
• Liver or kidney changes

Brain and Nervous System

• Tardive psychosis – a rare condition where symptoms get worse over time
  
• Pisa Syndrome – a rare side effect where your body tilts to one side

Risk for Some Groups

• Women may be more sensitive to weight and hormonal side effects
  
• Black Americans may be more likely to develop diabetes from some antipsychotics
  
• Older adults – using antipsychotics increases the risk of dementia

Unique Side Effects by Drug Type

Antipsychotic drugs are grouped into different generations, and each group has some side effects.

First-generation (Typical) Antipsychotics

These older drugs often cause movement-related side effects (like tremors, stiffness, restlessness).

• Butyrophenones (e.g., Haloperidol): High risk of extrapyramidal symptoms (tremors, rigidity, restlessness). It can also cause agitation or sedation.
  
• Diphenylbutylpiperidines (e.g., Pimozide): Risk of heart rhythm problems (QT prolongation). Used in Tourette’s.
  
• Phenothiazines (e.g., Chlorpromazine): Can cause sedation, low blood pressure, sun sensitivity, and jaundice (liver issues).
  
• Thioxanthenes (e.g., Flupentixol): Similar to other typicals, they can cause movement problems and mood changes like agitation or depression.

Second-generation (Atypical) Antipsychotics

These are newer and usually have fewer movement side effects, but a higher risk of weight gain, diabetes, and heart issues.

• Benzamides (e.g., Amisulpride): Dose-dependent effects with low doses boost dopamine and help mood; high doses reduce psychosis. It can also raise prolactin.
  
• Benzisoxazoles/Benzisothiazoles (e.g., Risperidone, Ziprasidone): Weight gain, sedation, hormonal changes (like lactation), and in some cases, heart rhythm problems.
  
• Tricyclics (e.g., Clozapine, Olanzapine):
  
  • Clozapine: Risk of agranulocytosis (dangerously low white blood cells), seizures, and drooling.
    
  • Olanzapine: Major weight gain, diabetes risk, and sedation.
    
• Others (e.g., Pimavanserin): Target specific conditions like Parkinson’s psychosis; fewer movement effects, but may affect mood or cause hallucinations.

Third-generation Antipsychotics

These drugs balance dopamine levels better by partially activating dopamine receptors.

• Aripiprazole (Abilify): Can cause restlessness (akathisia), insomnia, and sometimes compulsive behaviors (gambling, overeating).
  
• Brexpiprazole (Rexulti): Similar to Abilify, but with milder side effects.
  
• Cariprazine (Vraylar): Can cause insomnia, nausea, and movement problems like tremors.
  
• Lumateperone (Caplyta): Lower risk of weight gain and movement problems, but may cause sleepiness or dizziness.
  
• Xanomeline/trospium (Cobenfy): Unique among antipsychotics, this targets muscarinic receptors instead of dopamine. It can cause dry mouth, constipation, and urinary problems.

Tips to Manage and Reduce Side Effects

Here’s how you can manage and reduce antipsychotic side effects using simple steps:

1. Eat a Balanced Diet

Eat more fruits, vegetables, lean protein, and whole grains. Avoid too much sugar, fried food, or junk food to help with weight gain and low energy. 

Tip: Ask your doctor or pharmacist whether you should take your medication with food or on an empty stomach. Some medicines work better or cause fewer side effects when taken with meals, while others need to be taken on an empty stomach.

2. Stay Hydrated

Many antipsychotic medications can cause dry mouth, which can lead to bad breath, tooth problems, and discomfort. Water helps keep your mouth moist, supports healthy digestion, and can reduce constipation.

3. Move Your Body Regularly

Try walking, stretching, or any light activity you enjoy, like swimming, dancing, or gentle yoga. Moving your body regularly helps you burn extra calories, which can control weight gain caused by some medications. Exercise also releases chemicals in your brain that improve your mood and reduce feelings of stress or anxiety. 

4. Follow a Sleep Routine

A steady sleep schedule helps your body know when it’s time to rest, which can improve sleep quality over time. Make your bedroom a calm and quiet space: keep it dark, cool, and free from noise or distractions.

5. Talk to Your Doctor

If side effects don’t improve, your doctor might change your dose, switch your medicine, or recommend taking it at a different time. They may also suggest lifestyle changes. 

In some cases, your doctor might prescribe other medicines to ease side effects:¹

• Anticholinergic medicines can help with muscle stiffness or spasms.
  
• Beta-blockers or anticholinergic medicines may help with restlessness or akathisia (feeling like you have to move).
  
• Metformin can help with weight loss.
  
• Anticholinergic drops under your tongue can reduce too much saliva (drooling).
  
• Usual medicines can help with constipation or high cholesterol.

6. Try Therapy

Behavioral therapies like Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT) can help you cope with stress, improve your thinking patterns, and manage emotions. This can make it easier to stick with your medication and handle side effects like anxiety or mood swings.

You don’t have to manage side effects on your own. Always ask your doctor before making changes.

When to Get Help

Call your doctor right away if you notice any serious symptoms mentioned above. These can be signs that something is wrong and needs medical help.

If you’re struggling with side effects or challenges from antipsychotic medications, OceanRock Health is here to support you. Our intensive outpatient programs combine expert medical care with therapy options like CBT and DBT to help you manage symptoms and improve your quality of life. 

It’s important to speak up. Getting help quickly can keep things from getting worse.

Source:

1. Stroup, T. S., & Gray, N. (2018). Management of common adverse effects of antipsychotic medications. World Psychiatry, 17(3), 341–356. https://doi.org/10.1002/wps.20567