Generally, more than one<unk>  drug should not be used at a time because of increased adverse effects. Very rarely<unk> s may cause tardive psychosis. By rate Common (≥ 1% and up to 50% incidence for most<unk>  drugs) adverse effects of<unk> s include: * Sedation (particularly common with asenapine, clozapine, olanzapine, quetiapine, chlorpromazine and zotepine) * Headaches * Dizziness * Diarrhea * Anxiety * Extrapyramidal side effects (particularly common with first-generation<unk> s), which include: :- Akathisia, an often distressing sense of inner restlessness. :- Dystonia, an abnormal muscle contraction :- Pseudoparkinsonism, symptoms that are similar to what people with Parkinson's disease experience, including tremulousness and drooling * Hyperprolactinaemia (rare for those treated with clozapine, quetiapine and aripiprazole), which can cause: :- Galactorrhoea, the unusual secretion of breast milk. :- Gynaecomastia, abnormal growth of breast tissue :- Sexual dysfunction (in both sexes) :- Osteoporosis * Orthostatic hypotension * Weight gain (particularly prominent with clozapine, olanzapine, quetiapine and zotepine) * Anticholinergic side-effects (common for olanzapine, clozapine; less likely on risperidone) such as: :- Blurred vision :- Constipation :- Dry mouth (although hypersalivation may also occur) :- Reduced perspiration * Tardive dyskinesia<unk> pears to be more frequent with high-potency first-generation<unk> s, such as haloperidol, and tends to<unk> pear after chronic and not acute treatment. It is characterized by slow (hence the tardive) repetitive, involuntary and purposeless movements, most often of the face, lips, legs, or torso, which tend to resist treatment and are frequently irreversible. The rate of<unk> pearance of TD is about 5% per year of use of<unk>  drug (whatever the drug used). Rare/Uncommon (1 and serotonin 5-HT2Creceptors and perhaps by interacting with other neurochemical pathways in the central nervous system. * Neuroleptic malignant syndrome, a potentially fatal condition characterized by: :- Autonomic instability, which can manifest with tachycardia, nausea, vomiting, diaphoresis, etc. :- Hyperthermia — elevated body temperature. :- Mental status change (confusion, hallucinations, coma, etc.) :- Muscle rigidity :- Laboratory abnormalities (e.g., elevated creatine kinase, reduced iron plasma levels, electrolyte abnormalities, etc.) * Pancreatitis * QT interval prolongation — more prominent in those treated with amisulpride, pimozide, sertindole, thioridazine and ziprasidone. * Torsades de pointes * Seizures, particularly in people treated with chlorpromazine and clozapine. * Thromboembolism * Myocardial infarction * Stroke Long-term effects Some studies have found decreased life expectancy associated with the use of<unk> s, and argued that more studies are needed.<unk> s may also increase the risk of early death in individuals with dementia.<unk> s typically worsen symptoms in people who suffer from depersonalisation disorder.<unk>  polypharmacy (prescribing two or more<unk> s at the same time for an individual) is a common practice but not evidence-based or recommended, and there are initiatives to curtail it. Similarly, the use of excessively high doses (often the result of polypharmacy) continues despite clinical guidelines and evidence indicating that it is usually no more effective but is usually more harmful. Loss of grey matter and other brain structural changes over time are observed amongst people diagnosed with schizophrenia. Meta-analyses of the effects of<unk>  treatment on grey matter volume and the brain's structure have reached conflicting conclusions. A 2012 meta-analysis concluded that grey matter loss is greater in patients treated with first generation<unk> s relative to those treated with atypicals, and hypothesized a protective effect of atypicals as one possible explanation. A second meta-analysis suggested that treatment with<unk> s was associated with increased grey matter loss. Animal studies found that monkeys exposed to both first- and second-generation<unk> s experience significant reduction in brain volume, resulting in an 8-11% reduction in brain volume over a 17–27 month period. Subtle, long-lasting forms of akathisia are often overlooked or confused with post-psychotic depression, in particular when they lack the extrapyramidal aspect that psychiatrists have been taught to expect when looking for signs of akathisia. Adverse effect on cognitive function and increased risk of death in people with dementia along with worsening of symptoms has been describe in the literature. Discontinuation The British National Formulary recommends a gradual withdrawal when discontinuing<unk> s to avoid acute withdrawal syndrome or rapid relapse. Symptoms of withdrawal commonly include nausea, vomiting, and loss of<unk> petite. Other symptoms may include restlessness, increased sweating, and trouble sleeping. Less commonly there may be a feeling of the world spinning, numbness, or muscle pains. Symptoms generally resolve after a short period of time. There is tentative evidence that discontinuation of<unk> s can result in psychosis. It may also result in recurrence of the condition that is being treated. Rarely tardive dyskinesia can occur when the medication is stopped. Unexpected psychotic episodes have been observed in patients withdrawing from clozapine. This is referred to as supersensitivity psychosis, not to be equated with tardive dyskinesia. Tardive dyskinesia may abate during withdrawal from the<unk>  agent, or it may persist. Withdrawal effects may also occur when switching a person from one<unk>  to another, (it is presumed due to variations of potency and receptor activity). Such withdrawal effects can include cholinergic rebound, an activation syndrome, and motor syndromes including dyskinesias. These adverse effects are more likely during rapid changes between<unk>  agents, so making a gradual change between<unk> s minimises these withdrawal effects. The British National Formulary recommends a gradual withdrawal when discontinuing<unk>  treatment to avoid acute withdrawal syndrome or rapid relapse. The process of cross-titration involves gradually increasing the dose of the new medication while gradually decreasing the dose of the old medication. City and Hackney Clinical Commissioning Group found more than 1,000 patients in their area in July 2019 who had not had regular medication reviews or health checks because they were not registered as having serious mental illness. On average they had been taking these drugs for six years. If this is typical of practice in England more than 100,000 patients are probably in the same position.
Antipsychotic
Mood stabilizer
Antidepressant
Antimanic drugs
Appetite stimulant
Tricyclic antidepressant
Tetracyclic antidepressant
Atypical antidepressant