This is the fourth post in a series in which I’m aiming to demystify some of the very basics of psychotropic medications. Make sure you read the first post to get some of the background before reading this post about antipsychotic medications. And remember that I’m not a physician and in no way claim to be an expert on medications, so this educational information should not be interpreted in any way as clinical advice of any kind whatsoever. Talk to your prescriber about medications before making any changes — it can be very dangerous to change or stop your medications on your own.
Background
Antipsychotic medications are FDA-approved to treat schizophrenia and other psychotic illnesses, but they’re commonly used “off-label” these days to treat depression and anxiety. “Off-label” means research has shown antipsychotic medications to be effective in managing the symptoms of schizophrenia, but physicians are able to prescribe them for other conditions based on their knowledge and experience.
Antipsychotic medications were developed to decrease hallucinations, delusional thinking, and paranoia and to increase the quality of life of people living with psychotic illnesses. Like other psychotropic medications, they affect neurotransmitters. Dopamine, in particular, is thought to be important in many of the stereotypical symptoms of schizophrenia (like hallucinations and delusions).
First-Generation/Typical Antipsychotics
The first-generation antipsychotics (or “typical antipsychotics”) include
- Haloperidol (Haldol)
- Fluphenazine (Prolixin)
- Trifluoperazine (Stelazine)
- Chlorpromazine (Thorazine)
These medications work well at decreasing the frequency, intensity, and severity of auditory hallucinations and can greatly improve the daily life of a person with these debilitating symptoms. But they have some pretty nasty side effects, including
- Restlessness
- Muscle stiffness
- Tremor
- Abnormal movements
Tardive dyskinesia is a condition caused by using these medications that involves involuntary muscle movements (like facial tics and grimacing) that are disfiguring and usually permanent.
“Antipsychotic medications are FDA-approved to treat schizophrenia and other psychotic illnesses, but they’re commonly used “off-label” these days to treat depression.”
Second-Generation/Atypical Antipsychotics
Because the side effects of typical antipsychotics were so bad, a second generation of drugs was developed, including clozapine (Clozaril). Drugs in this category have fewer side effects and they treat a wider range of symptoms — not just hallucinations and delusions, but also some of the emotional symptoms and lack of motivation that can come along with psychotic illnesses. And the risk for tardive dyskinesia is less. But people who take Clozaril are at increased risk for a condition called agranulocytosis, which is a blood disorder resulting in a decrease in white blood cells in your blood, which help you fight infections. So people who take Clozaril get their blood drawn regularly to make sure they’re okay in that regard.
Because Clozaril was so effective, attempts were made to replicate its effectiveness, with fewer side effects, resulting in the development of medications like
- Risperidone (Risperdal)
- Olanzapine (Zyprexa)
- Quetiapine (Seroquel)
- Ziprasidone(Geodon)
- Aripiprazole (Abilify)
- Paliperidone (Invega)
- Asenapine (Saphris)
- Iloperidone (Fanapt)
- Lurasidone (Latuda)
- Brexpiprazole (Rexulti)
- Cariprazine (Vraylar)
There are still side effects, but they’re less severe than with the earlier drugs and include
- Resting tremor, gait changes
- Dry mouth
- Weight gain
- Increased cholesterol
- Increaed risk of diabetes
- Drowsiness
- Increased heart rate
- Dizziness, lightheadedness
- Increased appetite
- Restlessness
- Decreased libido
- Menstruation irregularity
- Skin rash
- Increased sensitivity to the sun
- Muscle stiffness (especially risperidone), thickening of the tongue, twisting of the neck, arching of the back, rolling up of the eyes
The atypical antipsychotics also have FDA approval for use as a mood stabilizer and these days are being used as adjuncts (meaning they’re being added to other medications) in treating severe depression and agitation.
I’ve got one more post in this series, with some final thoughts about psychotropic medications. Make sure you subscribe so you don’t miss it.
Other posts in this series:
Source: Patzer, D. Overview of Psychopharmacology. Magellan Health.
Source: Scheifler, P. Bipolar and Related Disorders. Magellan HealthSource: Patzer, D. Overview of Psychopharmacology. Magellan Health.
Hayden C. Finch, PhD, is a practicing psychologist in Des Moines, Iowa, focused on helping you master your mental health.
