Recognizing the Side Effects

Some side effects of antipsychotic medications tend to show up soon after the medication is started and tend to get better with time as the person's body and brain adjust to the medication. While side effects vary from one medication to the next and from one individual to another, they may include blurred vision, dry mouth, restlessness, drowsiness, muscle spasms, and tremor. Adjusting the dosage, changing medications, or taking additional medication are the usual approaches to dealing with these side effects.

Other, often more serious side effects may show up later. Again, this depends on the medication and the individual.


Drowsiness or sedation can occur to a greater or lesser degree with all drugs used to treat psychosis. Among the first generation drugs, this side effect is more common in drugs with lower potency, that is, drugs that require higher doses to attain an antipsychotic effect. Drowsiness often fades with time as patients adapt or develop a tolerance to the drug.

Drowsiness can be a problem if it affects daytime functioning, but when treatment is first started it can be helpful. Sedation can control the agitation many patients feel after experiencing their first psychotic episodes.

A doctor has several options to try to free a patient from this unacceptable side effect. These include adjusting the dose, instructing the patient to take the drug before bed, or changing the medication.


More than 99 percent of people taking antipsychotic medication have no problem with seizures, which are the abnormal, uncontrolled firing of brain cells. The remaining few, including those who had seizures in the past, find that these medications can lower their seizure threshold. High doses of many antipsychotic medications increase the risk, as does the use of the atypical antipsychotic clo-zapine. If a patient's psychotic symptoms respond well to a drug that causes seizures, her doctor may prescribe an anticonvulsant drug to control them.

Anticholinergic Side Effects

Anticholinergic effects involve a neurotransmitter called acetyl-choline. This is the neurotransmitter that communicates between nerves and skeletal muscles. It also plays a key role in controlling other important functions in the brain and body. These side effects may occur with any antipsychotic, but they are more severe with some of the older, lower potency antipsychotics such as Thorazine.

Antipsychotic drugs interfere with acetylcholine's control of vision and excretion. Thus, anticholinergic side effects include blurry vision, constipation, and difficulty urinating; they may also cause rapid heartbeat.

Neuroleptic Malignant Syndrome

This rare side effect presents an urgent medical emergency. The patient becomes very rigid, so much so that she cannot move. The heart beats very fast, breathing becomes difficult, and the body heats up and develops a fever. The patient may become disoriented or incoherent. The patient should be taken to a hospital immediately if these symptoms appear. The doctors can administer drugs to help control the symptoms, and they will discontinue use of the antipsy-chotic drug that produced this potentially life-threatening side effect. All antipsychotics may cause this side effect, although it is important to stress that it is very rare. The second generation drugs are less likely to cause it than are the first generation drugs. It is important to note that Abilify may be an exception; to date, there have not been any reports of neuroleptic malignant syndrome caused by Abilify.

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