Antipsychotics work by balancing brain chemistry, primarily by blocking dopamine receptors and affecting serotonin, to reduce psychotic symptoms like hallucinations and delusions, helping to stabilize mood and thinking. While effective, they can also cause structural changes, such as temporary grey matter reduction or shrinkage in some areas, and long-term use might be associated with broader brain volume changes, impacting cognitive function and motor control.
List of potential long-term side effects
These block the way your brain uses several neurotransmitters, especially dopamine. They also block acetylcholine, histamine and norepinephrine from latching onto various receptors. These medications block receptors like serotonin and dopamine. And they activate other serotonin and dopamine receptors.
Agitation and sedation: Some people feel “wired” and unable to stop moving when taking antipsychotics. This effect may be mistaken for a worsening of illness rather than a side-effect of the medication. These same drugs can also have the opposite effect, making people feel tired.
Antipsychotics cause reversible structural brain changes within one week. Neuropsychopharmacology. 2025 Jul;50(8):1275-1283.
The short-term administration of typical antipsychotic drugs has been reported to induce impairments in sustained attention 32, 33 and immediate memory span, 17 but these effects decrease with chronic treatment. Verbal memory can be improved by the administration of typical antipsychotic drugs.
An episode of psychosis is treatable, and it is possible to recover. It is widely accepted that the earlier people get help the better the outcome. 25% of people who develop psychosis will never have another episode, another 50% may have more than one episode but will be able to live normal lives.
Side effects of antipsychotic medications
Sedation, or sleepiness, is a common side effect of many antipsychotics. It is more common with certain antipsychotics than others, such as chlorpromazine and olanzapine. Sedation can happen during the day as well as at night. So if you experience this you might find it very hard to get up in the morning.
Results: Antipsychotics, as a group, increase weight and may lead to dry mouth and bad breath, cataracts, hirsutism, acne, and voice changes; they may disturb symmetry of gait and heighten the risk for tics and spasms and incontinence, potentially undermining a person's attractiveness.
Will my psychotic symptoms come back? Medication can help to stabilise your symptoms, so it's possible that your psychotic symptoms may return if you stop taking it. But it's not certain that this will happen. There are several factors that can affect whether you will become ill again.
Tardive dyskinesia (TD) is a neurological syndrome that involves involuntary (out of your control) movements. Taking antipsychotic (neuroleptic) medications is the main cause of this condition. But other medications can cause it as well.
A review of such studies shows that the long-term use of antipsychotics had no major effect on the density of the dopamine terminals in individuals who had no tardive dyskinesia, but had reduced the density in those patients with tardive dyskinesia.
The information below shows the main interaction risks between antipsychotics and:
The adverse effects of antipsychotic medications range from relatively minor tolerability issues (e.g., mild sedation or dry mouth) to very unpleasant (e.g., constipation, akathisia, sexual dysfunction) to painful (e.g., acute dystonias) to disfiguring (e.g., weight gain, tardive dyskinesia) to life threatening (e.g., ...
While not a certainty, long‐term antipsychotic treatment is a very common outcome for people with schizophrenia.
First-generation antipsychotics
All FGAs possess prominent dopamine D2 receptor antagonism effects. In addition to producing adverse motor system effects, D2 blockade can have adverse effects on higher level cognitive skills. Such adverse effects on working memory are well established in animal models [12–14].
Conclusion. Quetiapine abuse is relatively common, and is abused far more often than any other second-generation antipsychotic.
Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. People with psychoses lose touch with reality. Two of the main symptoms are delusions and hallucinations.
Antipsychotic medications are generally used to treat the symptoms of schizophrenia and other psychotic disorders. They can also be used to treat bipolar disorder. Antipsychotics affect people differently. It can take time to find the right antipsychotic that works for you.
You can tell if someone is going through psychosis by observing significant changes in their thoughts, perceptions, and behavior, such as hearing voices or seeing things (hallucinations), having strong false beliefs (delusions), experiencing confused thinking, withdrawing socially, showing poor hygiene, or having sleep disturbances, all indicating a break from reality where they struggle to distinguish what's real from what isn't. Early signs often include increased anxiety, suspicion, unusual ideas, or difficulty with concentration and daily tasks, leading to sudden drops in performance at work or school.
Antipsychotic drugs are harmful if you do not need them. For someone with dementia, antipsychotic drugs can make everyday activities more difficult. They also have dangerous side effects such as more anxiety, restlessness, loss of hunger or thirst, excessive sleeping and even death.
Life is different for a while after psychosis. You won't feel like yourself and there might be rifts in your life. It might feel empty or depressing. It doesn't end, though.
Eat More: Clams
A number of reports have shown low levels of vitamin B12 in those with psychosis -- a set of mental disorders that schizophrenia is one of. Other research says a bit more B12 can ease symptoms. Clams are a big source of B12. It's found in liver, trout, and in some breads, too.
The impacts of untreated psychosis
First-episode psychosis (FEP) can result in a loss of up to 1% of total brain volume and up to 3% of cortical gray matter.