Treatment with atypical antipsychotics

Antipsychotic drugs are designed to treat serious mental illnesses called psychosis. Psychosis is characterized by distorted thoughts, during which a person loses contact with reality, usually manifested as hallucinations, delusions, or confusion.

Psychosis has long been treated with a class of drugs called classic antipsychotics. These were first developed in the 1950s and although effective, they are known to cause Parkinson-like side effects. Today, a new type of drug called atypical antipsychotic is commonly used. These drugs were introduced in the 1980s and have different side-effect profiles. Compared with older drugs, Parkinson-like and other exercise effects are much less. Atypical antipsychotics are often referred to as second-generation antipsychotics, while typical psychiatric drugs are called first-generation antipsychotics.

Atypical and typical antipsychotics

Typical and some atypical antipsychotics are dopamine antagonists, which means they block the chemical messenger called dopamine in the brain. In patients with psychosis, dopamine signaling is usually abnormal. Antipsychotic drugs will block this information. Atypical antipsychotics can also affect a chemical messenger called serotonin.

Atypical antipsychotics are most commonly used to treat schizophrenia and to strengthen the treatment of major depression (MDD), bipolar disorder, and schizoaffective disorder.

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Side effects of antipsychotics

The two types of drugs differ in the range and severity of side effects they may cause. In comparison:

  • Atypical antipsychotics: These drugs are much less likely to cause extrapyramidal side effects. Having said that, it is well known that they can cause weight gain, metabolic problems and sexual side effects.
  • Typical antipsychotics: These are more likely to cause extrapyramidal side effects, where motor control is sometimes severely impaired, leading to tremors, cramps, muscle stiffness, and loss of muscle movement control and coordination. In some cases, symptoms may become permanent even if treatment is stopped.

Black box warning

Due to the increased risk of death in elderly people with dementia-related psychosis, all antipsychotics (atypical and typical) carry a black box warning. The main reasons for the increase in mortality are cardiovascular events (heart failure, sudden death) and infections (pneumonia).

Types of atypical antipsychotics

There are many different atypical antipsychotics used to treat psychotic episodes of schizophrenia, bipolar disorder, and other mental illnesses. in:

  • Abilify (aripiprazole): used to treat schizophrenia and bipolar disorder, but can also be used to treat major depression (MDD). Side effects include weight gain, headache, agitation, anxiety, insomnia, nausea, constipation and dizziness.
  • Clozaril (clozapine): Clozaril is the drug of choice for refractory schizophrenia and can reduce suicidal behavior. Serious side effects may include agranulocytosis (decreased risk of white blood cells) and acute myocarditis (inflammation of the heart).
  • Geodon (ziprasidone): Used to treat mixed episodes of schizophrenia and mania or bipolar disorder. It is also used to treat post-traumatic stress disorder (PTSD). The drug is known to cause dizziness, arrhythmia (irregular heartbeat), and orthostatic hypotension (a decrease in blood pressure when standing).
  • Invega (paliperidone): This is used to treat schizophrenia, but it is also the only oral atypical antipsychotic with a formal FDA indication for the treatment of schizoaffective disorder. Invega may also cause irritability, weight gain, and sedation.
  • Risperdal (risperidone): used to treat schizophrenia, bipolar disorder and irritability associated with autism. Although compared with other atypical antipsychotics, Risperdal has a weaker sedative effect, but it tends to have more extrapyramidal side effects.
  • Seroquel (quetiapine): Used to treat schizophrenia, bipolar disorder and other mood disorders. Due to its powerful sedative effect, Seroquel is often used to treat insomnia. Compared with other antipsychotics, Seroquel has a lower incidence of side effects from exercise, but it may cause weight gain and orthostatic hypertension.
  • Zyprexa (olanzapine): used to treat schizophrenia and bipolar disorder. Zaipura can also cause significant weight gain and high blood sugar (increasing the risk of insulin resistance and diabetes). Having said that, the incidence of extrapyramidal effects of Zaipura is lower than most other atypical antipsychotics.

New atypical antipsychotics continue to enter the market for the treatment of psychosis and emotional disorders. These include:

  • Saphris (asenapine)
  • Fanapt (Imperidone)
  • Latuda (Lurasidone)
  • Rexulti (brexpiprazole)
  • Vraylar (Cariprazine)
  • Caplyta (lumateperone)

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