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What is the best medication for psychosis?

Psychosis is a mental health condition characterized by a disconnect from reality. The main symptoms of psychosis include hallucinations, delusions, confused thinking, and irregular behavior. Psychosis can occur as a result of mental illnesses like schizophrenia, bipolar disorder, or major depression. It can also be caused by drug use or medical conditions.

Medications are often used to treat psychosis. The goals of medication are to reduce symptoms, prevent relapse, and improve overall functioning. Finding the right medication can take some trial and error, as people respond differently to various drugs. However, there are medications that are commonly used as first-line treatments for psychosis.

What Causes Psychosis?

Psychosis itself is not an illness, but rather a set of symptoms. It occurs when a person loses contact with reality. This can be caused by:

– Mental illnesses like schizophrenia, schizoaffective disorder, bipolar disorder, or severe depression
– Drug use, especially stimulants like methamphetamines or psychedelics like LSD
– Medical conditions like brain tumors, strokes, HIV/AIDS, Parkinson’s, or Alzheimer’s
– Sleep deprivation
– Stress
– Postpartum psychosis after giving birth

Mental illnesses are the most common cause of psychosis. Schizophrenia in particular is marked by psychotic episodes. Other factors like drug use or lack of sleep can trigger psychotic symptoms as well.

Signs and Symptoms

The main signs of psychosis include:

  • Hallucinations – seeing, hearing, smelling, tasting or feeling things that aren’t there
  • Delusions – false beliefs that don’t match reality
  • Disorganized thinking and speech
  • Abnormal behavior and motor function
  • Lack of insight or self-awareness

Hallucinations related to psychosis often involve hearing voices. The voices might have a conversation with the person or comment on the person’s behavior.

Delusions frequently have themes of paranoia or grandeur. A person may believe they are in danger when they are not, or that they have special powers. Other psychotic delusions include thinking outside forces are controlling thoughts or behaviors.

Confused thinking and speech patterns are also characteristic of psychotic episodes. A person might jump between topics or speak in a way that does not make sense. They can have trouble organizing their thoughts and expressing them clearly.

Psychosis often leads to changes in behavior as well. A person may act bizarre or have difficulties with normal activities. They may become agitated or withdrawn. Movement and coordination can also become impaired.

Lack of insight is common too. The person does not recognize that the psychotic symptoms are abnormal. They believe the hallucinations and delusions are real.

When to Seek Help

Psychosis requires professional treatment. Early intervention leads to better long-term outcomes. It is important to seek medical help if psychotic symptoms persist beyond a couple days.

Signs that evaluation is needed include:

– Hearing, seeing, or sensing things others do not
– Believing things that are not plausible
– Dissorganized and incoherent speech
– Dramatic changes in behavior and appearance
– Decline in work or school performance
– Decline in self-care or hygiene
– Social withdrawal and isolation

Loved ones and family members can help identify when psychotic symptoms arise. Most people cannot recognize their own delusions or hallucinations. Having a trusted friend or relative provide feedback is crucial.

Do not wait and hope psychotic symptoms go away on their own. Seeking help quickly minimizes damage to the individual’s mental health, relationships, and quality of life.

Diagnosing Psychosis

A mental health professional will diagnose psychosis based on a clinical evaluation. They will assess symptoms and rule out potential medical causes.

A diagnosis is made when two or more active psychotic symptoms persist for at least one month. Brief psychotic episodes brought on by a specific trigger usually resolve in under a month. Diagnoses associated with psychosis include:

  • Schizophrenia – marked by delusions, hallucinations, disorganized speech and behavior, “negative” symptoms like apathy
  • Schizoaffective disorder – schizophrenia symptoms along with mood disorder symptoms
  • Bipolar disorder – episodes of mania as well as depression and psychosis
  • Major depressive disorder – severe depression with psychotic features
  • Schizophreniform disorder – schizophrenia symptoms lasting more than a month but less than 6 months
  • Substance/Medication-induced psychotic disorder – psychosis triggered by intoxication or drug withdrawal
  • Psychosis due to medical condition – psychotic symptoms caused by a health issue

Lab tests, medical history, and observations from family members help distinguish between these diagnoses. The treatment plan depends on the specific cause and diagnosis.

Medication Options for Psychosis

Medications for psychosis aim to reduce symptoms, prevent recurrence, and improve daily functioning. The main drug classes used are antipsychotics, antidepressants, and mood stabilizers. Medications are carefully chosen based on the individual’s symptoms, diagnosis, medical history, and drug tolerance.

Antipsychotic Medications

Antipsychotics are the primary medications used for psychosis. They work by blocking dopamine receptors in the brain. Dopamine is the neurotransmitter linked to psychotic symptoms. There are two main types of antipsychotics:

Typical Antipsychotics

These older antipsychotics are also called first-generation antipsychotics. They are effective at reducing positive symptoms like hallucinations, delusions, and disorganized thinking. Examples include:

  • Chlorpromazine (Thorazine)
  • Haloperidol (Haldol)
  • Perphenazine (Trilafon)
  • Fluphenazine (Prolixin)

Potential side effects of typical antipsychotics include:

  • Sedation
  • Muscle stiffness
  • Tremors
  • Restlessness
  • Weight gain

Atypical Antipsychotics

Also known as second-generation antipsychotics, these are newer medications. Atypical antipsychotics are effective for positive symptoms. They may also help relieve negative symptoms like apathy, social withdrawal, and lack of motivation. Common atypical antipsychotics include:

  • Aripiprazole (Abilify)
  • Olanzapine (Zyprexa)
  • Risperidone (Risperdal)
  • Quetiapine (Seroquel)
  • Ziprasidone (Geodon)

Possible side effects of atypical antipsychotics include:

  • Weight gain
  • Drowsiness
  • Dizziness
  • Blurred vision
  • Constipation
  • Dry mouth

Doctors may try more than one antipsychotic to find the most effective one with the fewest side effects. Most people need to keep taking antipsychotics long-term to prevent new psychotic episodes.


Antidepressants can supplement antipsychotic medications, especially for depressive symptoms. Some commonly used options include:

  • Fluoxetine (Prozac)
  • Paroxetine (Paxil)
  • Sertraline (Zoloft)
  • Citalopram (Celexa)
  • Escitalopram (Lexapro)

Potential side effects of antidepressants include:

  • Nausea
  • Weight changes
  • Diarrhea
  • Sleep problems
  • Sexual dysfunction

Mood Stabilizing Medications

People with bipolar or schizoaffective disorder may receive mood stabilizers. These medications even out mood highs and lows. Lithium is the most common mood stabilizer. Others include:

  • Lamotrigine (Lamictal)
  • Valproic acid (Depakote)
  • Carbamazepine (Tegretol)

Potential side effects of mood stabilizers include:

  • Nausea
  • Tremors
  • Weight gain
  • Cognitive problems
  • Loss of coordination

Doctors monitor blood levels of mood stabilizers to avoid toxicity. Mood stabilizers require a slow tapering off to safely discontinue use.

Non-Medication Treatments

While medications help manage psychotic symptoms, additional therapies support recovery. Common non-medication approaches include:

  • Psychotherapy – talking therapies like cognitive-behavioral therapy (CBT) help patients cope with symptoms.
  • Social skills training – improves communication and relationship abilities.
  • Family therapy – provides education and support for relatives.
  • Case management – assists with healthcare coordination, housing, and employment.
  • Peer support groups – facilitates bonding with others facing similar challenges.

Non-medication treatments give patients important life skills and a support network. This aids functioning during periods of remission between psychotic episodes.


People in the midst of severe, unstable psychosis may require hospitalization. This provides intensive care to stabilize symptoms when outpatient treatment is not enough. Indications for hospitalization include:

  • Suicidal or homicidal thoughts
  • Inability to care for oneself
  • Dangerous or erratic behavior
  • Needing medication adjustments in a supervised setting
  • Safety concerns due to hallucinations or delusions

Hospitalization allows medical professionals to monitor patients on a 24/7 basis. New medications can be tested under strict observation. Hospitals also provide structure and support during times of crisis.

The goal is to transition patients to outpatient care once symptoms improve. After leaving the hospital, less intensive services like partial hospitalization, intensive outpatient therapy, and medication management maintain stability.

Choosing the Best Medication

Selecting the right medication for psychosis involves:

  • Considering the diagnosis – Schizophrenia treatment differs from bipolar treatment, for instance.
  • Reviewing symptoms – Medications target specific symptoms like hallucinations, insomnia, or depressed mood.
  • Considering side effects – Balancing effectiveness with tolerability.
  • Considering past response – What has worked or not worked before?
  • Starting with lower doses – To minimize side effects and improve compliance.
  • Monitoring closely – To assess medication effectiveness and side effects.
  • Making adjustments – Changing medications or doses until finding the optimal regimen.

It often takes trial and error to find the right medication plan for an individual. Having patience with the process and good communication with the treatment team leads to better outcomes. The most effective antipsychotic with minimal side effects can help someone regain stability.

Newer Medications

Researchers are developing and testing new medications for psychosis. The latest treatments aim to be more effective and have fewer adverse effects.

Some newer antipsychotic drugs include:

  • Lumateperone (Caplyta) – Approved in 2019 for schizophrenia.
  • Cariprazine (Vraylar) – Approved in 2015 for schizophrenia and bipolar disorder.
  • Brexpiprazole (Rexulti) – Approved in 2015 as an adjunct for major depression.

Other experimental drugs target different brain receptors associated with psychosis. Examples include:

  • Bitopertin – Modulates glycine receptors.
  • ITI-007 – Acts on serotonin receptors.
  • N-acetyl cysteine – Amino acid that modulates glutamate.

While research continues, most psychiatrists view antipsychotics as the foundation of psychosis treatment. Newer antipsychotics may offer benefits, but more study is needed. Patients still need access to psychosocial therapies and community support.

Treatment Challenges

Finding effective psychosis treatment can be difficult. Some key challenges include:

  • Medication side effects – Sedation, weight gain, and movement disorders are common.
  • Lack of insight – Impairs willingness to seek care or take medication as prescribed.
  • Social stigma – Prevents people from getting treatment due to embarrassment.
  • Cost of care – Medications and therapy may be too expensive.
  • Access to providers – Psychiatrists and therapists have limited availability.
  • Noncompliance – Some stop treatment due to side effects or lack of awareness.

Treatment teams must balance psychosis management with a patient’s overall quality of life. Side effects should be minimized and psychosocial functioning maximized. This requires an understanding of each patient’s needs and values.

Early intervention, patient education, and integrated care improve outcomes. Access to care remains a systemic challenge needing improvement. Support from family helps patients stick with the treatment plan.


Psychotic disorders require long-term medication management. Antipsychotic drugs form the basis of treatment. Additional medications like antidepressants and mood stabilizers target specific symptoms.

Non-medication approaches such as psychotherapy and community support are also key. Finding the optimal medication regimen takes time and careful monitoring. Newer antipsychotic drugs offer hope but require more research.

Treatment success depends on consistent access to medical care and social services. With the right treatment plan tailored to individual needs, many people with psychosis can manage symptoms successfully. This allows them to function well and lead fulfilling lives.