Do Antipsychotics Make You Look Different? A Closer Look at the Physical Side Effects

October 9, 2025 •

3 min read

Over half of all people taking antipsychotic medication experience weight gain, one of the most common and visible side effects. Do antipsychotics make you look different? The answer is complex, encompassing metabolic, neurological, and dermatological changes that can significantly alter a person's physical appearance and self-perception.

Quick Summary

Antipsychotic medications can cause physical appearance changes, including weight gain, metabolic shifts, and involuntary facial and body movements. These effects stem from hormonal and neurological impacts, affecting the patient's body image and overall health. Awareness and management are crucial for patient well-being.

Key Points

Significant Physical Changes: Antipsychotics can cause noticeable alterations in physical appearance through metabolic, neurological, and dermatological side effects.
Weight Gain is Common: Many patients experience substantial weight gain, especially with atypical antipsychotics like olanzapine and clozapine, which can lead to metabolic syndrome.
Tardive Dyskinesia (TD): Prolonged use can lead to involuntary, repetitive movements, primarily of the face, jaw, and tongue, known as tardive dyskinesia.
Other Movement Issues: Extrapyramidal symptoms like muscle stiffness, tremors, and restlessness (akathisia) can affect gait and overall body control.
Skin and Hair Effects: Side effects can include acne, increased hair growth (hirsutism), skin discoloration, and heightened sun sensitivity.
Management Strategies: Options for managing side effects include lifestyle changes, medication adjustment or switching, and adjunctive medications to counteract specific issues.
Variations Between Drug Generations: First-generation (typical) antipsychotics are more strongly linked to movement disorders, while second-generation (atypical) drugs carry a higher risk of metabolic issues and weight gain.
Importance of Dialogue: Open communication with a healthcare provider is vital for monitoring side effects and ensuring the best balance between symptom control and quality of life.

Understanding the Visible Side Effects of Antipsychotics

Antipsychotic medications, both typical (first-generation) and atypical (second-generation), are vital for managing conditions like schizophrenia and bipolar disorder. While effective, they are also associated with a range of side effects, some of which can cause noticeable and, for many, distressing changes to a person's physical appearance. These changes are not universal; the severity and specific side effects can vary greatly depending on the individual and the medication prescribed. However, key areas of concern include weight gain, involuntary movements, and hormonal effects that impact the skin and hair.

The Impact of Antipsychotic-Induced Weight Gain

Weight gain is a significant concern with many antipsychotics, particularly second-generation drugs like olanzapine and clozapine. This can result in substantial weight increases. Antipsychotics can affect metabolism by blocking certain brain receptors, leading to increased appetite, reduced satiety, and cravings for carbohydrates. Hormonal changes, such as increased leptin levels, may also contribute to weight gain and related metabolic issues. Furthermore, the sedative effects of some antipsychotics can decrease physical activity. Beyond physical appearance, this weight gain increases the risk of serious health problems like type 2 diabetes and cardiovascular disease. The emotional impact and stigma can also negatively affect self-esteem and medication adherence.

Movement Disorders and Facial Changes

Antipsychotics can cause involuntary movements, especially in the face, tongue, and jaw. Tardive dyskinesia (TD) is a common condition that can develop after long-term use, causing repetitive, uncontrollable movements like lip-smacking, tongue protrusion, and grimacing. Extrapyramidal symptoms (EPS) can also occur, including muscle stiffness (dystonia), restlessness (akathisia), and tremors (pseudoparkinsonism), affecting posture and movement. Pseudoparkinsonism may result in a stiff gait and reduced facial expression. These visible movement disorders can lead to social anxiety and stigma.

Hormonal and Dermatological Effects

Antipsychotics can also disrupt hormone levels, leading to visible changes in skin and hair. Elevated prolactin can cause acne and increased hair growth (hirsutism). Some medications increase sun sensitivity, making sunburn more likely, and prolonged use can occasionally cause a blue-grey skin discoloration. Allergic rashes are also possible, usually early in treatment, and often resolve after stopping the medication.

Comparing Typical and Atypical Antipsychotic Side Effects

The table below outlines some differences in physical side effects between typical and atypical antipsychotics:


Side Effect	First-Generation (Typical) Antipsychotics	Second-Generation (Atypical) Antipsychotics
Tardive Dyskinesia	Higher risk, especially with long-term use.	Lower risk compared to typicals, though not absent. Varies by medication.
Extrapyramidal Symptoms	Higher incidence, including stiffness, tremors, and restlessness.	Lower incidence, but still possible, particularly with certain medications like risperidone.
Weight Gain	Generally considered to have a lower risk, but still possible.	Higher risk, particularly with clozapine and olanzapine, leading to significant metabolic concerns.
Sedation	Can be common, varying by medication.	Common, especially with clozapine, olanzapine, and quetiapine.
Hormonal Issues (e.g., Prolactin)	Possible, with varying degrees depending on the specific drug.	Also possible, with some like risperidone and amisulpride being more likely to increase prolactin.

Managing and Addressing Physical Side Effects

Managing these side effects effectively requires open communication with a healthcare provider. Strategies include adjusting medication dose or switching to a different drug. Lifestyle changes like diet and exercise can help combat weight gain, and behavioral interventions have been shown to be effective. Adjunctive medications like metformin may be used for severe weight gain, and VMAT2 inhibitors can help manage tardive dyskinesia symptoms. Sun protection is important for increased skin sensitivity. Additionally, therapy can help individuals cope with changes in appearance and self-esteem.

Conclusion

Antipsychotic medications, while crucial for managing severe mental health conditions, can cause visible physical changes. Weight gain, involuntary movements, and skin changes are potential side effects that can impact a person's life and self-image. As individual responses vary, continuous monitoring and open discussion with healthcare professionals are essential to balance treatment effectiveness with quality of life. Awareness and active management of these effects allow patients and clinicians to work towards the best outcomes.

To learn more about the specifics of antipsychotic side effects, the Royal College of Psychiatrists provides detailed information on their website.(https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/antipsychotics)

Frequently Asked Questions

Antipsychotics can cause weight gain by affecting metabolism and increasing appetite. They block certain receptors in the brain, like those for histamine and serotonin, which can lead to increased hunger and a preference for high-carbohydrate foods. This is also linked to changes in hormones like leptin.

Tardive dyskinesia is a movement disorder caused by long-term use of certain medications, including antipsychotics. It leads to involuntary, repetitive movements, often affecting the face and mouth. This can manifest as lip-smacking, tongue protrusion, chewing motions, and grimacing, which can significantly alter a person's facial expressions.

Yes, some antipsychotics can cause skin and hair changes. Possible side effects include acne, increased hair growth (hirsutism), heightened sensitivity to sunlight, and in rare cases, skin discoloration. Allergic rashes can also occur, usually shortly after starting the medication.

Both older ('typical') and newer ('atypical') antipsychotics can cause physical side effects, but the types often differ. Typical antipsychotics are more commonly associated with movement disorders like tardive dyskinesia, while atypical antipsychotics carry a higher risk of significant weight gain and metabolic problems.

Managing weight gain involves close collaboration with your doctor. Strategies include adjusting the medication dose, switching to a different drug with less risk of weight gain, and implementing lifestyle changes, such as a balanced diet and regular exercise. In some cases, add-on medications like metformin can be used.

Yes, a side effect called pseudoparkinsonism, which can occur with antipsychotic use, can cause muscle stiffness, tremors, and a reduction in facial expressions, sometimes referred to as a 'mask-like' face. This is one of several extrapyramidal symptoms that affect movement.

Many side effects, particularly those that appear early in treatment, may improve or disappear if the medication is stopped or the dose is changed. However, certain side effects, most notably tardive dyskinesia, can sometimes be permanent even after discontinuation. It is crucial to never stop medication without a doctor's guidance.