Antipsychotics AO3

• +Evidence for their effectiveness. Thornley reviewed data from 13 trials (1121 participants) and found that chlorpromazine was associated with better functioning and reduced symptom severity compared with placebo. There is also support for the benefits of atypical antipsychotics. Meltzer concluded that clozapine is more effective than typical antipsychotics, and that it is effective in 30-50% of treatment-resistant cases. This means that, as far as we can tell, antipsychotics work.
• +-Most studies are of short-term effects only and some data sets have been published several times, exaggerating the size of the evidence base (Healy). Also benefits may be due to calming effects of drugs rather than real effects on symptoms. This means the evidence of effectiveness is less impressive than it seems.
• -Side effects. Typical antipsychotics are associated with dizziness, agitation, sleepiness, weight gain, etc. Long-term use can lead to lip-smacking and grimacing due to dopamine super-sensitivity (tardive dyskinesia). The most serious side effect is neuroleptic malignant syndrome (NMS) caused by blocking dopamine action in the hypothalamus (can be fatal due to disrupted regulation of several body systems). This means that antipsychotics can do harm as well as good and individuals may avoid them (reducing effectiveness).
• -We don’t know how they work. The use of most of these drugs is strongly tied up with the dopamine hypothesis and the idea that there are higher-than-usual levels of dopamine in the subcortex of people with schizophrenia. But there is evidence that this may not be correct and that dopamine levels in other parts of the brain are too low rather than too high. If so, most antipsychotics shouldn't work. This means that antipsychotics may not be the best treatment to opt for - perhaps some other factor is involved in their apparent success.
• Chemical Cosh

  It is believed that antipsychotics are used in hospital situations to calm people with schizophrenia and make them easier for staff to work with. However, calming people distressed by hallucinations and delusions probably makes them feel better, and allows them to engage with other treatments (e.g. CBT) and services. On balance then there are clear benefits to using antipsychotics to calm people with schizophrenia and in the absence of a better alternative they should probably be prescribed.