Schizophrenia Home > Antipsychotics

Antipsychotics are often prescribed for people with schizophrenia, psychotic depression, or other psychotic disorders. There are two basic types: older, "typical" drugs and newer, "atypical" drugs. While it was originally thought that the older antipsychotics were more likely to cause muscle stiffness and other side effects, research now suggests that the two types of medications are more similar than once thought.

What Are Antipsychotics?

Antipsychotics are prescription medications used to treat psychotic disorders, such as schizophrenia, schizoaffective disorder, or psychotic depression. While some feel that the term "antipsychotics" may be a little insensitive, it is a medical term that has been used for a long time and is unlikely to be changed.

Types of Antipsychotics

There are two basic types of antipsychotics: older, "typical" antipsychotics (also known as first-generation antipsychotics) and newer, "atypical" antipsychotics (also known as second-generation antipsychotics). While there are several important differences between the two, recent research suggests that they may be more similar than once thought.
Typical Medications
These are the original antipsychotic medications. Traditionally, it was thought that these medications were more likely than newer ones to cause extrapyramidal symptoms, such as:
  • Rigidity (muscle stiffness)
  • Unusual body or facial movements
  • Persistent muscle spasms
  • Shakiness (tremors)
  • Restlessness
  • A feeling of internal jitteriness.
However, recent research (particularly a study called the CATIE trial) suggests that these medications may be just as safe and can be tolerated just as well as newer medications, although much controversy still exists on this topic. In the past, these medications were often used at much higher doses than are used currently, which may explain why they appeared to cause more side effects.
Traditionally, it was also thought that these older medications were not very effective for "negative symptoms" of schizophrenia. Negative symptoms include:
  • Lack of speech
  • "Flat" facial expression or personality
  • Apathy (not caring about things)
  • Lack of pleasure in normally pleasurable activities.
Research seems to support the conclusion that newer medications are better for negative symptoms, although there is significant controversy surrounding this issue as well.
Typical antipsychotics are usually much less expensive than newer medications and may be less likely to cause weight gain and diabetes. These medications include:
Atypical Medications
These are the newer antipsychotic medications. They have largely replaced the older medications, due to the supposedly lower risk of side effects (particularly extrapyramidal side effects). These medications are rather expensive and carry a significant risk of weight gain (sometimes extreme weight gain) and diabetes. However, they may be more effective than older medications for symptoms of schizophrenia.
These medications include:
Of all the antipsychotic medications available, clozapine may be the most effective (especially for people who have not responded well to other medications). However, it can cause a dangerous condition called agranulocytosis, a loss of the white blood cells that fight infection. Therefore, people who take clozapine must have their white blood cell counts monitored every week or two. The inconvenience and cost of both the blood tests and the medication itself has made treatment with clozapine difficult for many people.
Written by/reviewed by:
Last reviewed by: Kristi Monson, PharmD;
Last updated/reviewed:
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