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Antipsychotics

Disclaimer:

This publication is based on a Mind UK publication and the original version may be found here: https://www.mind.org.uk/information-support/a-z-mental-health/

Thank you to Mind UK for sharing their valuable content with us. Content included in Mental Health A-Z is made available free of charge and does not form part of any commercial activity. The adaptation has been done independently by Mind HK and is intended for general information purposes only.

Could antipsychotics help me? 

This page covers: 

  • Which antipsychotic might be right for me? 
  • How quickly will they work? 
  • What is an emergency injection? 
  • Might I need to take other medication as well? 
  • Might I need to take two antipsychotics at once? 
  • Could taking antipsychotics make me feel worse? 

“I decided to try antipsychotics because my hallucinations and lack of sleep were putting my safety at  risk. Before I was on my medication, I was exhausted.” 

Which antipsychotic might be right for me?

The best antipsychotic for you is likely to depend on a few different factors: 

Your diagnosis and symptoms 

For example: 

  • For schizophrenia – all antipsychotics may help control the ‘positive’ symptoms of  schizophrenia. But it is more likely that a second generation antipsychotic will be able to  help with the ‘negative’ symptoms of schizophrenia. First generation antipsychotics often  have little effect on the negative symptoms. Some of their side effects may even make your  negative symptoms worse. 
  • You may try different types of antipsychotic and find that they don’t control your symptoms  of schizophrenia. If you’ve tried two types of antipsychotic that haven’t worked, including a  second generation antipsychotic, you may be offered clozapine. 

Your past experiences of taking medication 

This includes discussing what has and hasn’t worked for you in the past. For example, if you’ve tried  one kind of antipsychotic and had lots of problems with it, you could try a different type instead.

Your medical situation 

This website from the Drug Office has more information on commonly used oral antipsychotic drugs in HK, their common side effects, and general health precautions and contraindications. 

What you want from your treatment 

Your medication should always be chosen after  a discussion between you and those involved in  your care, including your doctor and psychiatrist. This discussion should take your preferences into  account. You could ask a trusted friend, family member, or carer to join you in this  discussion, if you wish. 

“The antipsychotic softens me – I’d be sharper and more animated without it, but I’d be at a much  higher risk of spiralling high.” 

How quickly will they work? 

This partly depends on how you take them: 

  • By mouth. If you take them by mouth, in tablet or in syrup form, the drug’s sedative effect  usually takes a few hours to begin. The liquid form may act more quickly than the tablets. 
  • Depot injection. Some antipsychotics are available by deep injection into a muscle, known  as a ‘depot injection’. This is a slow-release version, which acts slowly and steadily over the  course of two to six weeks, or longer. 
  • Emergency injection. In an emergency, you may be given an injection into a muscle. In this  case the sedative effect is rapid, and usually reaches its peak within one hour. If you are given  the antipsychotic zuclopenthixol acetate (Clopixol) as an emergency injection, it  may take 36 hours to reach its peak. 

Other factors that can also affect how quickly any medication works for you include:

  • your rate of metabolism 
  • the activity of your liver enzymes 
  • how physically active you are. 

Whichever method you use to take antipsychotics drugs, they may work quite quickly to make you  feel calmer. But it may take days or weeks to reduce your psychotic symptoms.

What is an emergency injection? 

If doctors consider you to be in an ‘emergency situation’, you may be given an antipsychotic or other  sedative drug to quickly tranquillise you. 

Emergency medication should ideally be given to you by mouth. But if that’s not possible, you may  need to be given drugs as a fast-acting injection into a muscle. This is known as an emergency  injection. 

What is an emergency situation? 

You are in an emergency situation if: 

  • you are behaving in a way that puts yourself at immediate risk, or puts other people at  immediate risk 
  • you have not responded to measures to try and deescalate the situation, or 
  • you have refused to take oral medication that would calm you down, or you’ve taken that  medication but it has not worked. 

In a situation like this, doctors may decide that you need something to calm you down as quickly as  possible (this is called rapid tranquillisation). 

Which medications might be used for emergency injection? 

The antipsychotic drugs which may be given by emergency injection are: 

  • olanzapine 
  • aripiprazole 
  • haloperidol 

You may be given lorazepam or promethazine. These are different types of drug, but both can be  used as tranquillisers. Sometimes, doctors may use lorazepam at the same time as an antipsychotic,  if you are very agitated. 

In some cases, doctors may use zuclopenthixol acetate (Clopixol). This is given as an  injection and can sedate you for two to three days. They should only use this if medications which  last for a shorter period don’t work. 

What happens if I refuse the injections?

If you refuse these injections, you may be restrained by hospital staff while a qualified nurse gives  you the injection. This can be very unpleasant. Anyone involved in restraining you should have had  special training to avoid causing you injury. 

Experiencing rapid tranquillisation like this can be traumatic. The National Institute for Health and  Care Excellence (NICE) has guidelines on the use of rapid tranquillisation in this setting. These  guidelines state that afterwards you should be given the opportunity to: 

  • discuss the experience with the health professionals responsible for your care
  • write down your own record of what happened, to be kept in your hospital notes. 

Remember: if you are not happy with how you’ve been treated, you can complain. 

Might I need to take other medication as well? 

You may be offered a combination of an antipsychotic and another drug as the best way to manage  your symptoms. This is likely to depend on: 

  • your diagnosis and symptoms 
  • the kind of side effects your main antipsychotic can cause. 

The other kinds of medication that you may be offered as part of your treatment include: • antidepressants, if you are severely depressed 

  • mood stabilisers, if you have a diagnosis of bipolar disorder or schizoaffective disorder 
  • sleeping pills and minor tranquilisers, if you are extremely agitated or finding it difficult to sleep 
  • anti-Parkinson’s drugs. These aren’t psychiatric medication, but they are sometimes  prescribed alongside antipsychotics to help reduce their neuromuscular side effects. 
  • Drugs to control excess saliva. This is a possible side effect of the antipsychotic clozapine. 
Remember: you should always check with your doctor, psychiatrist or pharmacist before  taking different drugs at the same time, or close together in time. This is in case the drugs  might interact badly with each other. See our page on taking antipsychotics safely for more  information.

“It’s difficult to say [how antipsychotics are working for me] as I was prescribed strong  antidepressants and sleeping pills at the same time.”

Might I need to take two antipsychotics at once?

Prescribing more than one antipsychotic drug at the same time is called polypharmacy. In most cases  doctors should avoid doing this, except in specific short-term situations. For example, this may  happen while you are switching from one antipsychotic drug to another. 

But in some circumstances you may be prescribed more than one antipsychotic on a longer-term  basis. This may happen if: 

  • your regular medication doesn’t seem to be working well enough 
  • you and your doctor or psychiatrist have found that a careful combination of two drugs is  what controls your symptoms best. 

If you are detained in hospital, doctors may be able to prescribe you more than one antipsychotic at once. In some circumstances, they may be able to do  this without your consent.

Could taking antipsychotics make me feel worse? 

It’s important to remember that all drugs can affect different people in different ways. 

Not everyone finds antipsychotics helpful. Many people can experience negative side effects from  them. Lots of these people may find that the good effects of antipsychotics make up for the bad  effects. But not everybody does. 

Your experience of taking antipsychotics will be personal to you. You may need to try a few different  drugs before you find the one that suits you best. It may also take time to find the right dosage for you. 

It’s also important to be aware that it can be hard to come off antipsychotics. They may cause  withdrawal effects if you come off them too quickly. So if you decide to try coming off your  antipsychotics, it is important to come off them gradually. 

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What is iACT Service?

Improving Access to Community Therapies (iACT®) is one of the services from Mind HK. Trained Wellbeing Practitioners will offer initial assessment and early intervention for people dealing with mild to moderate symptoms of depression, anxiety, or other emotional difficulties.

 

The service includes 6-8 sessions of low-intensity psychological support, the flexibility of the service allows individuals to receive free and timely support when needed.

If you’re aged between 18 – 65 and are facing some emotional challenges, we would like to invite you to take an online assessment for us to gain a better understanding of your current emotional struggle.

 

If you’re eligible, we’ll get you connected with a Wellbeing Practitioner within two weeks to sort out the next steps.

The service runs for about 3 months and includes 6-8 support sessions, tailored to your needs.

 

We encourage you to attend all sessions and actively practice the tips and exercises provided by your Wellbeing Practitioner.

We take your privacy seriously. Your chats with the Wellbeing Practitioner are confidential.

 

We won’t share any of your info unless you’ve provided consent or if there are risks detected.

This programme isn’t suitable for people facing emergencies, major setbacks, or those diagnosed with serious or complex mental health conditions.

 

If you’re having thoughts of suicide or self-harm, this programme might not meet your needs, so please seek help right away. You can check out Mind HK’s “Find Help Now” page for immediate information and services.

Most of our Wellbeing Practitioners have backgrounds in psychology or counselling and are passionate about mental health. They’ve gone through about 140 hours of intensive training and completed at least 120 hours of supervised clinical practice over 9 months to ensure the quality of service.

 

They’re trained by accredited local experts in the mental health field, including clinical psychologists, counselling psychologists, counsellors, and psychiatrists. Plus, we regularly check how effective our services are. All service outputs and performances are subject to consistent monitoring.

Who is suitable for participating in this programme?

This programme welcomes anyone between the ages of 18 and 65 who may be feeling lost or facing emotional difficulties. Please note that this programme is not suitable for individuals diagnosed with severe or complex mental health conditions.

This programme is not suitable for individuals diagnosed with severe or complex mental health conditions, but suitable for those who experience mild to severe moderate anxiety, mild to moderate depression, or other emotional challenges. If you are currently experiencing a major setback or even having thoughts of suicide or self-harm, please visit the “Find Help Now” page on our Mind HK’s website for immediate information and services.

After signing up, our Wellbeing Practitioner will contact you within two weeks to schedule a convenient time for a 45-minute conversation, either via video or phone call, according to your preference. During the conversation, the Wellbeing Practitioner will understand your current situation and help you gain a better understanding of your emotional state based on the questionnaire you filled out during application. Additionally, they will provide recommendations for appropriate community resources based on your needs, helping you take an important first step in taking care of your mental health.

Although the intervention procedure is mostly standardised, Wellbeing Practitioners will work flexibly with clients to address individual presenting problems and unique characteristics.

Our Wellbeing Practitioners are trained to support people who experience mild to moderate mental health difficulties primarily. This programme is not suitable for the situations mentioned above. If you are currently experiencing a major setback or even having thoughts of suicide or self-harm, please visit the “Find Help Now” page on our Mind HK’s website for immediate information and services.

Your conversations with the Wellbeing Practitioner are absolutely confidential. Any information about you will not be shared with anyone without your consent unless you or others are at immediate risk or the Wellbeing Practitioner has reason to believe that you may be in imminent danger.
Supervisors will monitor trainees’ development throughout the placement to ensure that they are meeting the required level of competency to pass the training course at the end of the placement.

Yes, it is necessary to book an appointment in advance by filling out the form. Additionally, you can select one of the five stores yourself. We will allocate clients to different Wellbeing Practitioners based on their chosen location.

Before having the conversation, we will ask you to fill out a basic questionnaire for preliminary screening assessment. This screening process aims to ensure that the training received by the Wellbeing Practitioners is sufficient to meet the needs of the individuals receiving the service. If it is determined after the screening assessment that the service is not suitable for you, Mind HK will provide alternative recommendations to ensure your safety and support.

For adults who are suitable for this service, all Wellbeing Practitioners have received training on how to identify and respond to safety and risk issues. If you have any concerns about the support process, the Wellbeing Practitioners have appropriate measures in place and will develop response plans based on the urgency of the situation. They can also access support from clinical practitioners from Mind HK or participating organisations.

What private training does Mind HK provide?

Mind HK provides 4 themes of mental health training, including: Supporting Self, Supporting Others, Family Wellbeing and DEI (Diversity, Equity and Inclusion).

 

Check out the brochure here for more information.

Mind HK provides a wide range of standardised mental health training, which can be tailored to different circumstances. Chat with our team to explore more! 

Our trainers come from a diverse, accredited pool of clinically experienced professionals. Check out our trainers’ biographies here.

Yes, the Mental Health First Aid class of Mind HK is internationally accredited by the MHFA International. The content and certification is delivered by trainers certified from the Mental Health Association of Hong Kong. You can find out our trainers accreditation here.

We are here to support your mental health education journey! Reach out to us and chat with our team.

Could antipsychotics help me? 

Could antipsychotics help me? 

This page covers: 

  • Which antipsychotic might be right for me? 
  • How quickly will they work? 
  • What is an emergency injection? 
  • Might I need to take other medication as well? 
  • Might I need to take two antipsychotics at once? 
  • Could taking antipsychotics make me feel worse? 

"I decided to try antipsychotics because my hallucinations and lack of sleep were putting my safety at  risk. Before I was on my medication, I was exhausted." 

Which antipsychotic might be right for me?

The best antipsychotic for you is likely to depend on a few different factors: 

Your diagnosis and symptoms 

For example: 

  • For schizophrenia – all antipsychotics may help control the 'positive' symptoms of  schizophrenia. But it is more likely that a second generation antipsychotic will be able to  help with the 'negative' symptoms of schizophrenia. First generation antipsychotics often  have little effect on the negative symptoms. Some of their side effects may even make your  negative symptoms worse. 
  • You may try different types of antipsychotic and find that they don’t control your symptoms  of schizophrenia. If you’ve tried two types of antipsychotic that haven’t worked, including a  second generation antipsychotic, you may be offered clozapine. 

Your past experiences of taking medication 

This includes discussing what has and hasn’t worked for you in the past. For example, if you've tried  one kind of antipsychotic and had lots of problems with it, you could try a different type instead.

Your medical situation 

This website from the Drug Office has more information on commonly used oral antipsychotic drugs in HK, their common side effects, and general health precautions and contraindications. 

What you want from your treatment 

Your medication should always be chosen after  a discussion between you and those involved in  your care, including your doctor and psychiatrist. This discussion should take your preferences into  account. You could ask a trusted friend, family member, or carer to join you in this  discussion, if you wish. 

"The antipsychotic softens me – I’d be sharper and more animated without it, but I’d be at a much  higher risk of spiralling high." 

How quickly will they work? 

This partly depends on how you take them: 

  • By mouth. If you take them by mouth, in tablet or in syrup form, the drug's sedative effect  usually takes a few hours to begin. The liquid form may act more quickly than the tablets. 
  • Depot injection. Some antipsychotics are available by deep injection into a muscle, known  as a 'depot injection'. This is a slow-release version, which acts slowly and steadily over the  course of two to six weeks, or longer. 
  • Emergency injection. In an emergency, you may be given an injection into a muscle. In this  case the sedative effect is rapid, and usually reaches its peak within one hour. If you are given  the antipsychotic zuclopenthixol acetate (Clopixol) as an emergency injection, it  may take 36 hours to reach its peak. 

Other factors that can also affect how quickly any medication works for you include:

  • your rate of metabolism 
  • the activity of your liver enzymes 
  • how physically active you are. 

Whichever method you use to take antipsychotics drugs, they may work quite quickly to make you  feel calmer. But it may take days or weeks to reduce your psychotic symptoms.

What is an emergency injection? 

If doctors consider you to be in an ‘emergency situation’, you may be given an antipsychotic or other  sedative drug to quickly tranquillise you. 

Emergency medication should ideally be given to you by mouth. But if that's not possible, you may  need to be given drugs as a fast-acting injection into a muscle. This is known as an emergency  injection. 

What is an emergency situation? 

You are in an emergency situation if: 

  • you are behaving in a way that puts yourself at immediate risk, or puts other people at  immediate risk 
  • you have not responded to measures to try and deescalate the situation, or 
  • you have refused to take oral medication that would calm you down, or you’ve taken that  medication but it has not worked. 

In a situation like this, doctors may decide that you need something to calm you down as quickly as  possible (this is called rapid tranquillisation). 

Which medications might be used for emergency injection? 

The antipsychotic drugs which may be given by emergency injection are: 

  • olanzapine 
  • aripiprazole 
  • haloperidol 

You may be given lorazepam or promethazine. These are different types of drug, but both can be  used as tranquillisers. Sometimes, doctors may use lorazepam at the same time as an antipsychotic,  if you are very agitated. 

In some cases, doctors may use zuclopenthixol acetate (Clopixol). This is given as an  injection and can sedate you for two to three days. They should only use this if medications which  last for a shorter period don’t work. 

What happens if I refuse the injections?

If you refuse these injections, you may be restrained by hospital staff while a qualified nurse gives  you the injection. This can be very unpleasant. Anyone involved in restraining you should have had  special training to avoid causing you injury. 

Experiencing rapid tranquillisation like this can be traumatic. The National Institute for Health and  Care Excellence (NICE) has guidelines on the use of rapid tranquillisation in this setting. These  guidelines state that afterwards you should be given the opportunity to: 

  • discuss the experience with the health professionals responsible for your care
  • write down your own record of what happened, to be kept in your hospital notes. 

Remember: if you are not happy with how you've been treated, you can complain. 

Might I need to take other medication as well? 

You may be offered a combination of an antipsychotic and another drug as the best way to manage  your symptoms. This is likely to depend on: 

  • your diagnosis and symptoms 
  • the kind of side effects your main antipsychotic can cause. 

The other kinds of medication that you may be offered as part of your treatment include: • antidepressants, if you are severely depressed 

  • mood stabilisers, if you have a diagnosis of bipolar disorder or schizoaffective disorder 
  • sleeping pills and minor tranquilisers, if you are extremely agitated or finding it difficult to sleep 
  • anti-Parkinson's drugs. These aren't psychiatric medication, but they are sometimes  prescribed alongside antipsychotics to help reduce their neuromuscular side effects. 
  • Drugs to control excess saliva. This is a possible side effect of the antipsychotic clozapine. 
Remember: you should always check with your doctor, psychiatrist or pharmacist before  taking different drugs at the same time, or close together in time. This is in case the drugs  might interact badly with each other. See our page on taking antipsychotics safely for more  information.

"It's difficult to say [how antipsychotics are working for me] as I was prescribed strong  antidepressants and sleeping pills at the same time."

Might I need to take two antipsychotics at once?

Prescribing more than one antipsychotic drug at the same time is called polypharmacy. In most cases  doctors should avoid doing this, except in specific short-term situations. For example, this may  happen while you are switching from one antipsychotic drug to another. 

But in some circumstances you may be prescribed more than one antipsychotic on a longer-term  basis. This may happen if: 

  • your regular medication doesn’t seem to be working well enough 
  • you and your doctor or psychiatrist have found that a careful combination of two drugs is  what controls your symptoms best. 

If you are detained in hospital, doctors may be able to prescribe you more than one antipsychotic at once. In some circumstances, they may be able to do  this without your consent.

Could taking antipsychotics make me feel worse? 

It's important to remember that all drugs can affect different people in different ways. 

Not everyone finds antipsychotics helpful. Many people can experience negative side effects from  them. Lots of these people may find that the good effects of antipsychotics make up for the bad  effects. But not everybody does. 

Your experience of taking antipsychotics will be personal to you. You may need to try a few different  drugs before you find the one that suits you best. It may also take time to find the right dosage for you. 

It's also important to be aware that it can be hard to come off antipsychotics. They may cause  withdrawal effects if you come off them too quickly. So if you decide to try coming off your  antipsychotics, it is important to come off them gradually.