The introduction of antipsychotics in the 1950s was a milestone in the management of schizophrenia, but since the development of groundbreaking medications such as chlorpromazine and, later, clozapine, the pharmacotherapeutic landscape has remained disappointingly static. In this issue of The Lancet, we publish a phase 3 trial of KarXT, a muscarinic receptor agonist, which significantly reduced acute psychotic symptoms in people with schizophrenia. Although there is much enthusiasm over a positive trial of a novel antipsychotic, does it herald a new era in the treatment of people with schizophrenia?