Also termed anti-psychotics, these are drugs used in alleviating the symptoms of SCHIZOPHRENIA and bipolar disorder as well as severe anxiety and DEPRESSION They relieve the florid PSYCHOTIC symptoms such as hallucinations, delusions and thought-disorder and can relieve extreme mood swings.

Most of these drugs act by blocking DOPAMINE receptors. The first neuroleptics appeared in the 1950s and are often termed ‘typicals.’ The main ones are: (i) chlorpromazine (Largactil), haloperidol (Haldol), pinozide (Orap), trifuoperazine (Stelazine) and Sulpiride (Dolmatil). Newer neuroleptics have slightly different mechanisms of action, are of added value in depression and are termed ‘atypicals’. They include: olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal) and clozapine (Clozaril). The main aim of all these drugs is to reduce unpleasant symptoms while avoiding undue sleepiness or slowness. Patients vary greatly in their response so it can take some time to find the optimal regime. Compared to ‘typicals’ the newer agents appear to have a lower risk of side-effects such as weight gain, PARKINSONISM and TARDIVE DYSKINESIA. Many psychiatrists consider clozapine the most effective and it has the added advantage of reducing suicidal ideation in persons with schizophrenia but the disadvantage of requiring blood testing because of its uncommon side-effect of bone marrow depression, so is often recommended only after other drugs have been found wanting. Neuroleptics can also be given as ‘depot’ injections whose effects last between 2 and 4 weeks.