Psychosis occurs when a person’s mental health condition causes them to lose touch with reality. Doctors prescribe antipsychotic medications to treat this.

Statistics from the National Institute of Mental Health suggest that 3 in every 100 people in the United States experience psychosis at some point. Psychosis can cause hallucinations, delusions, inappropriate behavior, and more.

Schizophrenia and bipolar disorder are two of the mental health conditions that can cause psychosis.

Read on to learn about the best medication for psychosis, as well as short- versus long-term treatments, risks, and side effects.

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People experiencing psychosis perceive or experience situations differently than others around them.

This can cause:

  • Hallucinations: experiences of seeing, hearing, and potentially smelling, feeling, or tasting things that do not exist — for example, a person may hear voices
  • Delusions: experiences of firmly believing something is true despite evidence to the contrary — for example, a person may think that someone wants to harm them

When a person experiences these hallucinations and delusions, it’s called a psychotic episode. It can be very distressing for the person and lead to a change in their behavior.

Other potential signs of psychosis include:

  • confusing speech
  • inappropriate behavior
  • depression
  • anxiety
  • trouble sleeping
  • social withdrawal
  • lack of motivation
  • general difficulty functioning

It is important to note that psychosis is a symptom rather than a condition itself. In some people, a mental health condition such as schizophrenia or bipolar disorder can cause psychosis.

In others, psychosis can be a result of:

  • sleep deprivation
  • a medical condition
  • a prescription medication
  • drug or alcohol misuse

People with schizophrenia or bipolar disorder may benefit from taking antipsychotics. These medications may also help people with depression or anxiety that is difficult to treat.

Antipsychotics can help reduce:

  • auditory hallucinations (such as hearing voices)
  • delusions
  • disordered or confused thinking
  • mood changes associated with bipolar disorder

Antipsychotic drugs come in two main subclasses: first-generation (older types) and second-generation (newer types).

The type a doctor prescribes will depend on a person’s individual biological makeup and mental health condition.

First-generation — also known as “typical” or “conventional” — antipsychotics include:

  • Chlorpromazine (Thorazine): Doctors prescribe this to treat schizophrenia and other psychotic disorders, as well as mania in bipolar disorder, severe behavior problems in children, nausea and vomiting, hiccups lasting at least a month, pre-surgery nerves, acute intermittent porphyria, and tetanus.
  • Fluphenazine (Prolixin): This drug treats schizophrenia and psychotic symptoms such as hallucinations, delusions, and hostility.
  • Haloperidol (Haldol): Doctors prescribe this drug to treat psychotic disorders, tics associated with Tourette’s syndrome, and severe behavioral problems in children.
  • Perphenazine (Trilafon): This treats schizophrenia or severe nausea and vomiting in adults.
  • Thioridazine (Mellaril): Doctors may prescribe this to treat schizophrenia in people who have already tried at least two other medications without success.

Second-generation, or “atypical,” antipsychotics include:

  • Aripiprazole (Abilify): Doctors prescribe this to treat schizophrenia in people at least 13 years old, mania and combination mania and depression in people with bipolar disorder at least 10 years old, treatment-resistant depression, irritable behavior in autistic children, and Tourette’s syndrome in children.
  • Asenapine (Saphris): This treats the symptoms of schizophrenia. Doctors may also prescribe it alone or along with other medications to treat or prevent mania and combination mania and depression in adults and children with bipolar disorder.
  • Brexpiprazole (Rexulti): Doctors prescribe this to treat the symptoms of schizophrenia. They may also use it along with antidepressants when antidepressants alone do not manage a person’s symptoms of depression.
  • Cariprazine (Vraylar): This treats schizophrenia and depression in people with bipolar I disorder.

Read more about antipsychotic drugs.

Antipsychotics help people manage the symptoms of mental health conditions that can often be serious.

However, these drugs come with side effects, so it is important for doctors to work out the risk-versus-benefit ratio of prescribing antipsychotics for each individual. This assessment must also take into account how long the person should take the medication.

A 2018 review published in World Psychiatry concluded that the available scientific evidence supports the long-term use of antipsychotics. The authors considered the long-term effects of the medications, including their impacts on the brain, metabolic health, and life expectancy.

However, the authors acknowledged that a minority of people with schizophrenia do not seem to relapse even though they do not take antipsychotics long-term. They said more research was needed to explore this phenomenon.

Since the publication of that review, a clinical trial has begun.

It will assess the effects of continuing antipsychotic medication compared with reducing or discontinuing the medication once the first episode of psychosis has stopped affecting:

  • personal and social functioning
  • the severity of psychotic symptoms
  • health-related quality of life

The exact list of possible side effects of antipsychotics varies from medication to medication. Some people do not experience side effects, while others experience them to varying degrees.

Another 2018 review published in World Psychiatry provides a list of the most common side effects of antipsychotic medicines. They include:

  • dystonias (uncontrolled muscle movements)
  • Parkinsonism (tremor, rigidity, slowness of movement)
  • akathisia (inability to stay still)
  • tardive dyskinesia (unusual, involuntary movements)
  • sialorrhea (overproduction of saliva)
  • sedation
  • elevated prolactin (the hormone needed for lactation)
  • sexual side effects
  • orthostatic hypotension (lightheadedness/dizziness upon standing, due to low blood pressure)
  • QT prolongation (when the heart takes longer to contract and relax than usual)
  • neuroleptic malignant syndrome (fever, rigidity, altered mental state, and nervous system dysfunction)
  • neutropenia/agranulocytosis (low white blood cell levels)
  • impulse control disorders and behavioral addictions
  • myocarditis (heart inflammation)
  • weight gain and imbalance of blood lipids, including cholesterol
  • anticholinergic effects (dry mouth, blurry vision, abnormally fast heart rate, constipation)

The authors report that groups of side effects do not neatly apply to first-generation and second-generation antipsychotics. Rather, each individual medication has its own list of potential side effects.

Additionally, the Food and Drug Administration (FDA) considers older adults with dementia to be at a higher risk of negative effects from antipsychotics. The FDA requires that all antipsychotic medication labels warn people about the increased risk of stroke and death among this population group.

Doctors also do not typically prescribe risperidone or paliperidone as a first-line treatment during pregnancy, as these medications may present a slightly increased risk of fetal development abnormalities.

It is important for anyone who is considering taking antipsychotic medication to discuss their individual risks and benefits with their doctor.

Psychosis is a symptom rather than a condition. People with psychosis experience hallucinations and delusions and essentially lose touch with reality.

Each individual antipsychotic medication comes with its own list of benefits and side effects. The best medication for psychosis always depends on the individual and their unique condition.