Antipsychotics are broken down into two categories: first generation (typical) antipsychotics and second generation (atypical) antipsychotics. The first-generation antipsychotic agents were the first class of medications used to treat schizophrenia and related psychoses. The atypical agents have replaced the older, typical antipsychotics as first-line treatment of psychotic disorders. Compared with typical agents, atypical have fewer side effects. Typical antipsychotics have a high incidence of high levels of prolactin (stimulates breast milk production in pregnancy), QTc-prolongation (causes heart problems), and extrapyramidal symptoms (EPS), a collection of drug-induced movement disorders that can have a profound negative impact on daily functioning and quality of life. Atypical antipsychotics can cause weight gain, high cholesterol, and increased glucose.
These medications come as oral and injectable medications. For some people, injections can be scary. Many times, people prefer injections as they are normally given every 1-3 months. This is preferable to some over taking a tablet daily.

What are some common first generation (typical) antipsychotics?

Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Fluphenazine deconate, Haloperidol (Haldol), haloperidol deconate, Loxapine (Loxitane), Mesoridazine besylate (Serentil), Molindone (Moban), Perphenazine (Trilafon), Thioridazine (Mellaril), Thiothixene (Navane), and Trifluoperazine (Stelazine)

What are some common second generation (atypical) antipsychotics?

Aripiprazole (Abilify), Clozapine (Clozaril), Iloperidone (Fanapt), Olanzapine (Zyprexa), Paliperione (Invega), Paliperidone palmitate (Invega Sustenna), Quetiapine (Seroquel), Risperidone (Risperdal Consta), and Ziprasidone (Geodon)

Which antipsychotic is right for me?

These drugs affect the brain chemical called dopamine and dopamine levels differ in each patient. Each drugs effect on dopamine varies with some effecting dopamine levels more than the other, which also has an effect on the severity of their side effects. Talk to your doctor to find out which antipsychotic is the best option for you.

Are the side effects reversible?

For the most part all of the side effects seen with antipsychotics are reversible once discontinued. An exception is in the case of extrapyramidal symptoms (EPS), an example of this being tardive dyskinesia. Tardive dyskinesia is the involuntary movement involving lips, mouth, tongue, face, arms and legs. This is rare and is in the case where the patient has used the medication for a significant length of time. A doctor should be closely monitoring a patient that has been on an antipsychotic for an extended period in order to avoid this side effect. Once tardive dyskinesia develops, some effects may be permanent or take a long time to go away. However, many patients require long term use of antipsychotic medication to treat ongoing mental illness. If tardive dyskenesia develops, the first step is to notify the doctor so the medication can be safely adjusted, stopped or switched. The doctor may choose to switch the patient to a different antipsychotic that may lessen tardive dyskenesia.

Written by:
Kalu Kalu
PharmD Candidate 2021
Temple University School of Pharmacy