Antipsychotics: What They Are, How They Work, and What Alternatives Exist

When someone hears voices, feels paranoid, or loses touch with reality, antipsychotics, a class of medications designed to reduce symptoms of psychosis like hallucinations and delusions. Also known as neuroleptics, they are often the first line of defense in conditions like schizophrenia and severe bipolar disorder. These drugs don’t cure the illness, but they help people think more clearly, feel less scared, and live more independently.

Antipsychotics work by adjusting brain chemicals—mostly dopamine. Too much dopamine in certain areas of the brain is linked to psychosis, and these medications block dopamine receptors to bring it back into balance. But they don’t all work the same way. First-generation antipsychotics like haloperidol are strong but often cause movement problems, like tremors or stiffness. Second-generation ones, like risperidone or olanzapine, are more common today because they’re less likely to cause those side effects, but they can lead to weight gain, high blood sugar, or fatigue. People often stop taking them because of how they feel, not because they don’t work. That’s why doctors sometimes try alternatives: lower doses, different drugs, or even combining them with therapy.

It’s not just about picking the right drug—it’s about matching it to the person. Genetics play a role. Some people process antipsychotics slowly because of their CYP2D6, a gene that affects how the liver breaks down many psychiatric medications, meaning they get too much drug in their system and feel worse. Others clear it too fast and get no benefit. That’s why some doctors now test for gene variants before prescribing. Mental health conditions like bipolar disorder, a condition involving extreme mood swings that can include psychotic episodes often need a mix of mood stabilizers and antipsychotics, not just one. And when side effects are too much, alternatives like cognitive behavioral therapy, social support, or even newer treatments like clozapine (for treatment-resistant cases) come into play.

You won’t find a one-size-fits-all antipsychotic. What helps one person might make another feel numb, heavy, or worse. That’s why the real goal isn’t just to suppress symptoms—it’s to find a balance where the person feels like themselves again, without being weighed down by the medicine. The posts below cover real comparisons: how domperidone and buspirone relate to psychiatric treatment, how genetic testing can prevent bad reactions, and what alternatives people actually use when standard drugs fail. You’ll see what works, what doesn’t, and why some people need to try three or four before finding the right fit.