Atypical Antipsychotic Medication

Atypical antipsychotics are a type of medication that treats psychosis, which is a mental state characterized by a loss of contact with reality^[1]. Read on to learn more about what atypical antipsychotics are, how they’re used to treat mental health conditions, and the side effects associated with them.

What Are Atypical Antipsychotics?

There are two types of antipsychotics: typical antipsychotics and atypical antipsychotics. Typical antipsychotics, which are also known as first-generation psychotics, were introduced in the 1950s.

Typical antipsychotics target dopamine receptors to help block the symptoms of psychosis. However, one problem with these drugs is they reduce dopamine so much it can cause an imbalance in the brain. This can lead to serious movement side effects, including tremors, loss of coordination and control of muscle movement, and muscle rigidity^[2].

Atypical antipsychotics, or second-generation antipsychotics, were first introduced in the 1980s. One of the main advantages of these drugs is they have fewer and less severe side effects than first-generation antipsychotics. They don’t affect movement the way typical antipsychotics do.

Both typical and atypical antipsychotics block dopamine signals, which are often abnormal in people who experience psychosis. Both types of drugs also help balance out serotonin levels. However, typical antipsychotics more strongly block dopamine signals than atypical antipsychotics. Conversely, atypical antipsychotics have a stronger effect on serotonin levels^[3].

How Do Atypical Antipsychotics Work?

Atypical antipsychotics impact how dopamine and serotonin communicate between nerve cells in the brain. Dopamine is a chemical messenger that affects how we experience pleasure, feel motivated, and know that something is significant or interesting. Dopamine is also involved in the control of movement and muscle.

If portions of the dopamine system become overactive, it can lead to the hallucinations, thought disorders, and delusions associated with psychosis. To help with this, atypical antipsychotics block some of the receptors that typically react to dopamine^[4].

Atypical antipsychotic drugs also affect serotonin levels. Serotonin is a chemical that helps regulate mood. Because atypical antipsychotics have such a strong effect on serotonin, they’re able to help those with anxiety and mood disorders^[5].

It can take time to find the right medication. While these drugs all affect dopamine and serotonin, the specific effects they have on the chemicals are different. Patients may have to try a few different types of medicine before finding the one that’s the most effective and causes the least side effects for them.

What Are Atypical Antipsychotics Used to Treat?

Atypical antipsychotics are used to treat a range of mental health conditions, including schizophrenia, bipolar disorder, major depressive disorder, and more. Different types of antipsychotics are diagnosed depending on the mental health condition an individual has.

Psychosis is often associated with schizophrenia, which is a complex, chronic mental health condition. Schizophrenia can cause a variety of symptoms, including hallucinations, delusions, a lack of interest in what once brought them pleasure, feelings of disconnectedness, and disordered thinking and speaking. Some individuals also become suspicious of or confused by other people, particularly strangers or people in positions of authority. They may also feel worried or afraid of seeking help.

Schizophrenia can be difficult for mental health professionals to diagnose since there’s no straightforward test for it. Along with taking medication, the main type of therapy recommended for schizophrenia is cognitive behavioral therapy (CBT)^[6].

Bipolar disorder is another mental health condition that’s treated with atypical antipsychotics. Bipolar disorder affects an individual’s mood. Individuals with this condition will experience manic episodes, which means feeling high. They’ll also experience depressive episodes where they feel incredibly low. They may also experience some psychotic symptoms during episodes^[7].

Atypical antipsychotics are also used to treat major depressive disorder (MDD). Individuals with this condition will feel depressed and will often experience a loss of pleasure or interest in activities. Other symptoms include poor concentration, feelings of low self-worth, feelings of hopelessness, disrupted sleep, and low energy. This is a common disorder that affects 5% of adults worldwide^[8].

Atypical antipsychotics are also sometimes used to treat severe anxiety or agitation, dementia, post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). They’re also FDA-approved to treat irritability in children associated with Autistic disorder. In addition, they’re sometimes prescribed off-label to treat other conditions, such as Tourette’s Syndrome^[9].

Commonly Prescribed Atypical Antipsychotics

There are numerous atypical antipsychotics available, and each one treats different types of mental health conditions. The list of atypical antipsychotics often prescribed includes^[9]:

• Abilify (aripiprazole): Used to treat bipolar disorder and schizophrenia, but may also be used for MDD.
• Clozaril (clozapine): Used to treat schizophrenia if other treatment options have failed.
• Saphris (asenapine): Commonly used to treat schizophrenia in adults and bipolar I disorder in adults and children over 10.
• Rexulti (brexpiprazole): Used to treat MDD, schizophrenia in adults and children over 13, and agitation associated with dementia due to Alzheimer’s disease.
• Vraylar (cariprazine): Used to treat schizophrenia, MDD, and bipolar I disorder.
• Fanapt (iloperidone): Used to treat manic or mixed episodes of bipolar I disorder and schizophrenia in adults.
• Latuda (lurasidone): Used to treat episodes of depression associated with bipolar disorder and schizophrenia in adults and teenagers who are 13 or older.
• Zyprexa (olanzapine): Used to treat manic or mixed episodes of bipolar I disorder and schizophrenia.
• Invega (paliperidone): Used to treat schizophrenia in adults and children who are 12 years or older.
• Seroquel (quetiapine): Used to treat schizophrenia in adults and children who are at least 13 years old. It’s also used off-label to treat insomnia due to its sedative effects.
• Risperdal (risperidone): Used to treat schizophrenia in adults and children who are at least 13 years old. It’s also used to treat bipolar disorder in adults and children who are at least 10 years old.
• Geodon (ziprasidone): Used to treat schizophrenia and the manic symptoms of bipolar disorder in adults and children who are at least 10 years old. It’s also used off-label to treat post-traumatic stress disorder (PTSD).

Side Effects of Atypical Antipsychotics

Overall, atypical antipsychotic side effects are less severe than the ones from typical antipsychotics. However, there are still some side effects that are important to know about before starting to take one of these medicines. This includes metabolic changes, including high cholesterol and an increase in the risk for type 2 diabetes.

Some of the other common atypical antipsychotic side effects include^[9]:

• Weight gain
• Dry mouth
• Difficulty speaking and concentrating
• Drooling
• Mask-like face
• Sexual dysfunction
• Blurred or double vision
• Tremor
• Shuffling walk
• Constipation
• Trouble sleeping
• Changes in blood pressure
• Drowsiness

Atypical Antipsychotic Precautions

Some atypical antipsychotics may have drug interactions. For instance, some antipsychotics are known to interact with antibiotics. This means they decrease how effective antibiotics are. This can be problematic in the event it causes an infection to worsen. This includes fluoroquinolone antibiotics, like ciprofloxacin (Cipro). There are also some interactions with macrolide antibiotics, like azithromycin (Zithromax).

Atypical antipsychotics may also have interactions with some anti-seizure medications. This includes carbamazepine (Tegretol) and phenytoin (Dilantin, Phenytek)^[10]. It’s important to keep an updated list of all the supplements and medicines you take and make sure to share this list with your health provider so they can check for any interactions.

There are also some precautions you’ll want to take if you’re pregnant and taking atypical antipsychotics. The risk of congenital malformations in early pregnancy exposure to antipsychotics is low. However, there is a concern that risperidone specifically could slightly increase the risk of malformations. Because of that, risperidone isn’t recommended as a first-line agent during pregnancy.

Taking atypical antipsychotics can also increase a pregnant patient’s risk for gestational diabetes. If this occurs, dose adjustments may be necessary^[11].

There are also risks for elderly patients. Atypical antipsychotics are sometimes prescribed to elderly patients with dementia. However, studies have found there is an increased risk of stroke or transient ischemic attack (TIA), which is a temporary blockage of blood flow to the brain. Because of that, the FDA has issued a black box warning about prescribing atypical antipsychotics to elderly patients^[12].

Atypical antipsychotics can also cause tardive dyskinesia (TD), which is a potentially irreversible movement disorder characterized by involuntary and repetitive movements. While the risk of TD is lower with atypical antipsychotics compared to typical antipsychotics and other classes of medications, it can still happen, and it’s important for individuals to be aware of it.^[13]

Coming off antipsychotics too quickly can also be dangerous, particularly if you’ve been taking them for a long time. Stopping suddenly can lead to a relapse in psychosis symptoms. It can also lead to tardive psychosis, which is a term used to describe new psychotic symptoms that occur after going off antipsychotic medicine. It’s safest to go off atypical antipsychotics slowly and gradually by reducing the dose over a period of weeks or months^[14].

Because of the side effects of these medications, it’s important to regularly see a doctor while taking atypical antipsychotics. Make sure to inform your doctor of any changes in side effects or symptoms.

Atypical Antipsychotics vs Alternatives: Are They Worth It?

Overall, second-generation antipsychotics have less severe side effects than first-generation psychotics. Because of that, most medical professionals will try to prescribe second-generation antipsychotics.

Atypical antipsychotics also have a broader efficacy than typical antipsychotics. One study found that atypical antipsychotics are more effective at treating negative symptoms (such as lack of motivation, social impairments, and speech difficulties), mood symptoms, and cognitive impairment, as well as reducing the risk of suicide and decreasing aggression^[15].

There are still some adverse side effects with atypical antipsychotics, including metabolic concerns. The cost of the medication can also be a concern for patients, particularly for those who don’t have health insurance.

Overall, though, atypical antipsychotics have proven to be helpful for many individuals affected by a variety of mental health conditions. If you have any questions or concerns about taking atypical antipsychotics, reach out to your healthcare professional for guidance.