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Psychopharmacology
Does Antipsychotic Medication Work?
Antipsychotic medication can help a lot, but we should use it wisely.
Posted July 14, 2024 Reviewed by Lybi Ma
Key points
- Antipsychotic medications are commonly prescribed for schizophrenia and severe depression.
- There is strong evidence that antipsychotic medications are effective in reducing symptoms.
- Antipsychotic medication can have side effects, including weight gain.
- Antipsychotics are associated with reduced risk of early death among people with schizophrenia.
Antipsychotic medication is used in schizophrenia, severe depression, elation (in bipolar disorder), and other conditions. These medications offer many benefits provided they are used with care and consideration.
The first effective antipsychotic, chlorpromazine, was developed in the 1950s. It was soon apparent that these medications could have side effects, including movement problems (restlessness), dry mouth, constipation, sedation, effects on the heart, and various other concerns (dizziness, sexual dysfunction).
Several strategies were introduced to manage these issues. The research focused on developing new treatments that would combine good clinical effects with fewer side effects. A series of ‘second-generation’ or ‘atypical’ antipsychotics was duly developed and introduced to clinical practice. These are widely used today.
What are the common antipsychotic medications?
There is now a broad range of antipsychotic medications available. ‘Atypical’ antipsychotics include risperidone, olanzapine, quetiapine, aripiprazole, amisulpride, ziprasidone, and paliperidone. These medications are effective but some have concerning side-effects, such as weight gain and other effects on body function.
Overall, each antipsychotic has its combination of benefits and side effects. Each has a different role in the treatment of various mental illnesses.
But, given that some of the antipsychotics can have significant side effects, what is the evidence that they work? Are the potential negative effects justified by the positive ones?
Evidence of the benefits of antipsychotic medication
In 2013, The Lancet medical journal published an overall analysis of the comparative effectiveness and tolerability of 15 antipsychotics in schizophrenia. This study looked at 212 clinical trials with data from 43,049 participants. All 15 antipsychotics were better than placebo. The medications differed substantially in side effects, but there were only small differences in effectiveness.
But what about side-effects? In particular, some ‘second-generation’ antipsychotics are associated with weight gain. Might this lead to poor physical health, heart disease, and increased risk of early death?
Many people with schizophrenia are on antipsychotic medication for years or even decades, so might side effects have a cumulative impact over time? Are these medications worth it?
Do the benefits of antipsychotics outweigh the side effects?
In 2020, the journal World Psychiatry published a study of rates of illness and death among 62,250 patients with schizophrenia in Finland. After following up with these patients for 14 years, this research group found that being on antipsychotic medication was associated with a reduced risk of early death, rather than an increased risk.
When patients were followed up for 14 years, 46 percent of people with schizophrenia who were not taking an antipsychotic medication died, but this fell to 26 percent among those taking any antipsychotic, and 16 percent among those taking clozapine (an antipsychotic medication for difficult-to-treat schizophrenia).
These dramatic benefits persist even after taking into account the patient’s gender, age, time since diagnosis, previous hospitalisations, other medications, previous suicide attempts, substance abuse, physical illnesses, and various other factors.
Everyone is different
Antipsychotic medication reduces symptoms of severe mental illness and is associated with a substantially reduced risk of early death among people with schizophrenia.
As with all medications, any side effects must be considered in each individual case, not least because some people find certain side effects so disturbing that they would prefer a different treatment, despite the benefits.
Communication and flexibility are vital to manage these issues and to realise the substantial benefits of antipsychotic medication in the long-term.
References
Kelly BD. The Modern Psychiatrist’s Guide to Contemporary Practice: Discussion, Dissent, and Debate in Mental Health Care. New York and London: Routledge, 2024 (Open access: https://www.taylorfrancis.com/books/oa-mono/10.4324/9781003378495/modern-psychiatrist-guide-contemporary-practice-brendan-kelly).
Leucht S, Cipriani A, Spineli L, Mavridis D, Örey D, Richter F, Samara M, Barbui C, Engel RR, Geddes JR, Kissling W, Stapf MP, Lässig B, Salanti G, Davis JM. Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis. Lancet 2013; 382: 951-62.
Taipale H, Tanskanen A, Mehtälä J, Vattulainen P, Correll CU, Tiihonen J. 20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20). World Psychiatry 2020; 19: 61-8.
Taylor DM, Barnes TRE, Young AH. The Maudsley Prescribing Guidelines in Psychiatry (14th Edition). Hoboken, NJ and Chichester: Wiley Blackwell/John Wiley & Sons, Inc., 2021.
