The effects of all medication vary from person to person. Through their training and professional experience, doctors and other prescribers know what some people have found helpful in the past, but they cannot accurately predict which specific medication an individual will find useful, or how they will react to any particular drug.
Types of medication
People may be offered different types of medications to help them deal with the impact of hearing distressing or confusing voices. You can find out more about these in the table below.
|To improve mood.||Can help if the voices are related to someone’s mood (or someone’s mood makes it hard to cope with them or other stressful things).|
|To help someone feel calmer and/or sleep.||Short term use might help if the voices are triggered by fear (or if the voices trigger a fear reaction).|
Typical and atypical antipsychotics
Broadly speaking, there are two different types of antipsychotic medication. Older, typical or first-generation antipsychotics – for example, chlorpromazine and haloperidol – were first developed in the 1950s and were widely used to try and reduce the frequency and intensity of ‘psychotic experiences’, including visions, voices, paranoia and delusions. Newer, atypical or second-generation antipsychotics have been used since the 1990s. Examples include clozapine, risperidone, quetiapine and olanzapine.
Atypical antipsychotics were initially popular because it was thought that they were more effective than the older drugs, with fewer side effects. Most researchers and clinicians now agree that there is not much difference between the ‘old’ and ‘new’ types of medication in terms of how well they work. Second-generation antipsychotics have different side effects: they seem less likely to cause movement problems and sexual dysfunction than typical antipsychotics, but they can cause other negative effects, such as rapid weight gain. Some can also cause movement disorders if used at high doses.
You can see our section on Adverse effects to find out more about the negative effects of antipsychotic medications.
Antipsychotics can be administered in the form of tablets, a syrup, or as an injection or ‘depot’ injection. Depot injections are long-lasting. Some people find them useful if they have difficulty swallowing, struggle to remember to take medication, or would rather not take it on a daily basis. You can find out more about depot injections, and their pros and cons, here.
Finding the medication that works best for an individual can take time, and often involves some trial and error. We all have slightly different chemistries and different people can react differently to the same drug. For this reason, it is important that doctors and other mental health professionals adopt a collaborative approach to prescribing medication, talking through options and working together to help a person try different things to see what works for them.
How do antipsychotics work?
While it is clear that many people find antipsychotic medication helpful, there is little consensus (and some controversy) around how it works.
Antipsychotics are thought to change certain chemicals (called neurotransmitters) in the brain, including dopamine, serotonin, noradrenaline and acetylcholine. These chemicals influence behaviour, mood and emotions in lots of different ways. Dopamine is the main chemical that these medicines have an effect on.
Some psychiatrists think that the effect of antipsychotic medication tells us something about why and how psychosis occurs. Sometimes people think psychosis is linked to a ‘chemical imbalance’ in the brain, and that medication helps to alter or correct what is going on.
Other psychiatrists disagree – they suggest that medication might help to ‘damp down’ experiences like visions and voices for people when they are very distressed, but that this does not tell us much about why the experiences occur.