Antipsychotics can be life-changing for anyone experiencing psychosis, including people with schizophrenia . But they can also come with challenging side effects.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294da2de8a-627d-4195-a820-dfce5c5b1ce9 Older, first-generation antipsychotics, like chlorpromazine (Thorazine) and haloperidol (Haldol), usually cause movement-related side effects, such as tremors, says Randall Turner, DO , a psychiatrist based in Southern California. Newer, second-generation antipsychotics like aripiprazole (Abilify) and olanzapine (Zyprexa) have a lower risk of movement-related side effects. But they can lead to weight gain and high blood sugar more often than first-generation antipsychotics, says Dr. Turner. A new class of antipsychotics called muscarinic agonists emerged in 2024 for the treatment of schizophrenia. Unlike other antipsychotics, muscarinic agonists don’t cause weight gain as a side effect, but they can cause side effects like nausea, constipation, high blood pressure, rapid heart rate, and acid reflux.e60dc2a1-f33c-4a05-9b50-8e3e8e59762993d006db-cee1-455d-97a3-2d9ec65f39f2e60dc2a1-f33c-4a05-9b50-8e3e8e5976295ca80924-b89e-459c-ae81-7d9635fc8045 Antipsychotic side effects can be so bothersome that they may prompt some people to skip doses or give up on the medications altogether. “When patients experience significant side effects, they may stop taking their medication abruptly, increasing the risk of relapse, hospitalization, or worsening symptoms,” says Zishan Khan, MD , a psychiatrist based in Frisco, Texas. If you’re experiencing side effects, it’s important to let your provider know so you can find ways to manage them. Here are five of the most common side effects of antipsychotics and tips on how to cope with them.
1. Fatigue Fatigue Sleep problems like daytime fatigue are common among people with schizophrenia, and one reason is antipsychotic medication.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a046f02e-fa59-4475-b6ba-7429055690ff One of the most common side effects of antipsychotics is fatigue or sedation. Certain drugs, like olanzapine (Zyprexa) and chlorpromazine (Thorazine), are more likely to cause fatigue than others.e60dc2a1-f33c-4a05-9b50-8e3e8e59762945991598-0799-41f0-9cec-ba2c4a2ecdaa Fatigue and drowsiness can make it hard to function effectively at work, school, or other aspects of daily life, says Dr. Khan. To help you feel more alert while on antipsychotics, Turner recommends taking the medication at night instead of the morning if your provider approves. And if possible, work with your provider to avoid other medications that could cause drowsiness during waking hours and worsen fatigue.e60dc2a1-f33c-4a05-9b50-8e3e8e59762963305a7f-102b-407e-8b48-11cb61a7c35a In addition, following healthy sleep habits each night — such as going to bed and waking up at the same times each day and avoiding long naps during the day, which can impede your ability to fall asleep at night — can also help you manage daytime fatigue.e60dc2a1-f33c-4a05-9b50-8e3e8e597629210929fd-305a-43af-a898-fac427c5d28f Know that fatigue may improve as your body gets used to the medication.e60dc2a1-f33c-4a05-9b50-8e3e8e59762963305a7f-102b-407e-8b48-11cb61a7c35a If it doesn’t, your healthcare provider may be able to lower the dose or switch to a less sedating antipsychotic, says Turner.
2. Weight Gain Weight Gain As mentioned, second-generation antipsychotics are more likely than others to cause weight gain. They do this by making you hungrier and changing the way your body processes sugar. This side effect comes along with high blood sugar levels, increased risk of diabetes , and higher cholesterol, which can cause problems for your physical health, says Yalda Safai, MD , a psychiatrist based in New York City.e60dc2a1-f33c-4a05-9b50-8e3e8e597629c4650f4b-9e7f-49b0-a87f-b15a90beddd9 “For weight gain and metabolic concerns, I recommend making small, sustainable lifestyle changes like eating more protein and fiber, cutting back on sugary drinks, and getting regular movement — even if it’s just a daily walk,” says Turner. Lifestyle changes like these can fight weight gain in the long run. If you’re having trouble making dietary changes for weight management, it could also help to meet with a registered dietitian-nutritionist (RDN), who could help you create a nutrition plan that meets your needs. You could also ask your provider about switching to another antipsychotic that causes less weight gain, says Khan. For some, adding metformin — a medication often used to treat diabetes — can slow weight gain, research suggests.e60dc2a1-f33c-4a05-9b50-8e3e8e5976293f0fb2b4-e0e1-4bb6-8020-1cdca5456a1c
3. Extrapyramidal Symptoms Extrapyramidal Symptoms Extrapyramidal symptoms (EPS) refer to a range of movement-related issues. These can include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629c867af95-7984-4050-9d1f-9d8495159120e60dc2a1-f33c-4a05-9b50-8e3e8e597629b398c96a-dfde-4b2d-9e1d-9ae1f005ceec Involuntary muscle contractions (dystonia) Restlessness Tremors, stiffness, or slowed movements (Parkinsonism) Tardive dyskinesia , a condition involving repetitive, uncontrolled movements that can stick around even after you stop taking the medication.e60dc2a1-f33c-4a05-9b50-8e3e8e597629efd5c606-1c60-44a8-adc3-e3a42f762d0b These side effects are most common with long-term use of antipsychotics, often at high doses, says Khan. You can lessen your risk of EPS by avoiding substance use, quitting smoking , and ensuring you’re managing diabetes well if you have it. Smoking, substance use, and unmanaged diabetes are all factors that can raise your risk for EPS.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299ff382a2-f569-4afb-b058-eb64f875de28 If you already have EPS, you may need additional medication to manage it. Deutetrabenazine (Austedo) and valbenazine (Ingrezza) are standard-of-care medications that can help manage tardive dyskinesia and other EPS.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296d6427c7-21d7-408f-a28b-0b66b66e6b00 These medications work by altering levels of dopamine in the brain, which are thought to play a key role in involuntary movements.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292f6999ff-2a65-441b-ac2f-3203a61c6360 “Lowering the dose [of antipsychotics] or switching to a different medication may also be necessary,” Khan adds. Your provider needs to monitor you carefully for movement-related side effects, which makes consistent follow-up very important, Khan adds. But not all healthcare providers are familiar with EPS or how to manage it. If you feel these side effects aren’t being properly addressed, it could help to get a second opinion from another provider or ask for a referral to a movement disorder specialist.e60dc2a1-f33c-4a05-9b50-8e3e8e59762912a8e03a-d029-40e3-9f3f-0628030dcfe3
4. High Prolactin Levels High Prolactin Levels Prolactin , a hormone that develops breast tissue and triggers milk production, can increase with antipsychotics.e60dc2a1-f33c-4a05-9b50-8e3e8e59762993b04ec7-62b3-4954-a255-7267679c2a10 This rise is most common with risperidone (Risperdal), says Khan. High prolactin levels can cause enlarged breast tissue in men or women, irregular periods , and sexual dysfunction, says Khan.e60dc2a1-f33c-4a05-9b50-8e3e8e59762993b04ec7-62b3-4954-a255-7267679c2a10 For these symptoms, Khan recommends switching to a medication that doesn’t cause as much prolactin release, such as newer, second-generation antipsychotics. These side effects can feel isolating and discouraging, and it’s important to discuss them with your provider if you’re experiencing them, says Turner. “In some cases, lowering the dose or switching medications can help. It is a sensitive topic that’s absolutely worth bringing up,” he adds.
5. Anticholinergic Effects Anticholinergic Effects Antipsychotic medications cause anticholinergic effects, meaning they block cholinergic receptors that help control a wide range of body functions.e60dc2a1-f33c-4a05-9b50-8e3e8e59762908f350a4-762d-4baf-8862-40b5077a6c88 These effects can include:e60dc2a1-f33c-4a05-9b50-8e3e8e597629f6459ff1-017f-4e1f-b41c-4a458e15c005 Dry mouth Constipation Urinary retention Blurred vision e60dc2a1-f33c-4a05-9b50-8e3e8e597629394ed1b7-a9f0-4515-9a94-bdfcdeddac8b Some people also get very dizzy when their blood pressure plummets after standing up. This is known as orthostatic hypotension. These effects are most often seen with clozapine (Clozaril) and chlorpromazine (Thorazine), says Khan. “For dry mouth and dizziness, simple changes like staying hydrated , chewing gum, and standing up slowly from a seated position can help manage symptoms,” says Turner. If these effects don’t fade or become difficult, let your provider know, and they can adjust your medication to help lessen these effects, Turner adds.
When to Call Your Doctor When to Call Your Doctor Antipsychotics help many with schizophrenia live well, and it’s important to take them as prescribed. Because side effects can feel uncomfortable, you may feel tempted to stop taking them or skip doses.e60dc2a1-f33c-4a05-9b50-8e3e8e597629a029aae1-8bfa-4ba7-bde6-d096c0aba41a But doing this can make your schizophrenia symptoms much worse, says Dr. Safai. Not everyone stops their medications because of side effects, but, regardless, it’s important to let your provider know if they’re happening. Khan agrees, adding, “Many side effects can be managed or minimized with the right approach and so reaching out to the provider is essential.” The key is finding a balance between symptom control and side effects, says Turner. “If something does not feel right, do not just stop taking your medication — talk to your doctor first,” he adds. “There are almost always adjustments that can be made to help you feel better while staying on track with your mental health treatment. Your comfort and well-being matter, and you deserve a treatment plan that works for you.”
The Takeaway Antipsychotics can vastly improve symptoms of health conditions involving psychosis, like schizophrenia, but they can come with side effects that may make it difficult to stick to them. Common side effects of antipsychotics include weight gain, fatigue, uncontrollable movements, sexual dysfunction, and dizziness. If you experience side effects like these, let your doctor know right away. Together you can make a plan for maximum symptom management with the fewest possible side effects.
Resources We Trust Mayo Clinic: Schizophrenia: Diagnosis and TreatmentCleveland Clinic: Antipsychotic MedicationsNational Alliance on Mental Illness: How I Manage the Side Effects of AntipsychoticsMental Health America: What Are the Side-Effects of Antipsychotic Meds?Centre for Addiction and Mental Health (CAMH): Antipsychotic Medications
