Akathisia is a feeling of intense restlessness that is often linked with involuntary movements (pacing, rocking from foot to foot, shifting weight whilst sitting) and a need to keep moving. In severe cases people may feel extremely distressed, have problems sleeping and feel overwhelmed with difficult thoughts and impulses. Akathisia can be acute (develops on starting a drug), tardive (develops months after starting the drug), withdrawal (happens when stopping a drug) or chronic (any type that lasts more than 6 months).

The risk of developing neutropenia is low, and mainly linked to ClozapinetAn ‘atypical’ antipsychotic drug used for managing psychosis symptoms. treatment, which is offered in the UK to people who have tried two different antipsychotic medications and found them ineffective. Roughly 3% of people taking Clozapine develop neutropenia, with about 1% developing the more severe agranulocytosis. Other antipsychotics are considered much less of a risk.

People taking Clozapine are required to have regular blood tests as part of a national management system that picks up early signs of neutropenia.

Some people report difficulties with concentration, memory and learning while taking antipsychotic medication. On the other hand, some research studies show that antipsychotics can improve cognition.

The overproduction of saliva can lead to drooling during the night and, in extreme cases, increase the risk of aspiration pneumonia. If drooling becomes a problem, people may be prescribed medications to help them manage the condition – for example, scopolamine, pirenzepine and atropine.

Whilst it can happen to anyone, especially when they feel stressed, a persistent dry mouth is associated with the use of antipsychotic drugs and can cause a range of problems. Lack of saliva can cause difficulties with chewing, swallowing and talking. It can also increase the risk of tooth decay and fungal infections because saliva helps keep the mouth clean. Some people find regular sips of water, sucking on ice cubes and sucking on sugar free (e.g. diabetic) sweets helps to counteract this side effect. The increased risk of tooth decay makes dental care very important while taking antipsychotic medication.

Neuroleptic medication can affect people’s digestive system in different ways, including constipation diarrhoea, nausea and vomiting. Clozapine, for example, is linked to slower transit through the bowels which causes constipation. If constipation is not addressed there is an increased risk of blockages and complications.

It’s important that people who take Clozapine mention issues with constipation to their healthcare professional because of the increased risk of complications. See the following resources for more information:

Constipation, NHS Choices

Feeling sick, NHS Choices

The IBS Network self-care programme

Although NMS is rare, awareness and early identification (amongst people taking antipsychotics, their supporters and medical professionals) is of crucial importance. If NMS is suspected, the NHS recommends seeking urgent medical care, telling practitioners the medications that are being taken and that there is a risk of this condition.

Sedation is a commonly reported in people taking antipsychotic medication, who often describe feeling sleepy or ‘knocked out’. If excessive, sedation can make it difficult to engage in everyday life. Taking medication in the evening or just before bed is useful when medications have a sedative effect.

Antipsychotics can cause loss of libido (sexual desire), difficulties getting or sustaining an erection, retrograde ejaculation (where semen is redirected to the bladder rather than out through the urethra), priapism (long-lasting, and often painful, erection) and inability to orgasm.

29–49% of women and 45–59% of men experience at least some symptoms of sexual dysfunction whilst taking antipsychotics. For women, the most common issues seem to be lack of menstruation/periods (39%) and low sexual interest (26%). For men, the most common issues seem to be low sexual interest (37%) and erectile dysfunction and ejaculation problems. Being prescribed more than one second-generation antipsychotic at the same time may increase risk, as can taking higher doses of certain drugs.

Reducing the dose or switching to a medication that is less likely to cause these difficulties can help to deal with these effects.

There is no clear evidence on an effective treatment for Tardive Dyskinesia as the quality of research is low. However, approaches include dose reduction, switching to another medication and adding extra treatments (including benzodiazepinestBenzodiazepines act as a sedative – slowing down the body’s functions – and are sometimes used for sleeping problems and anxiety., buspironetA medication that is used to treat or manage anxiety., ginkgo bilobatA popular supplement and herbal medicine which is derived from the Ginkgo biloba tree., relaxation and hypnosistA trance-like state that is induced by another person. When hypnotised, people may be susceptible to suggestion.).

You can find out more about Tardive Dyskinesia by following these links:

Understanding tardive dyskinesia, Mind.
How to cope with tardive dyskinesia, The Mighty.

‘Tardive psychosis’ is medical term used to describe a new set of unusual and disturbing experiences, including visions and voices, which arise after you have been taking antipsychotics for a period of time and which are directly caused by your medication.

Weight gain is usually worse at the beginning of treatment and is most often noticed when someone first starts medication. Although the reasons why people gain weight when taking antipsychotics are not very well understood, it is often linked to increased appetite and the effects of sedation. Taking regular exercise and a healthy diet can help to control this.