New Generation “Atypical” Antipsychotics

New Generation “Atypical” Antipsychotics

Starting in the early 1990s, a new group of medications for the treatment of schizophrenia began to hit the market. They quickly began to replace the older, “first generation” or “typical” antipsychotics. They supposedly had fewer side effects and thus were considered to be more easily tolerated by patients. This group of medications is commonly referred to as “atypical” antipsychotics. They are also sometimes called “second generation” antipsychotics.

This group of antipsychotic medications includes the following:

What they’re used to treat

The atypical antipsychotics are used to treat schizophrenia. Currently, they are usually the first choice of treatment for this disorder. They are not only effective in terms of controlling the positive symptoms of schizophrenia, such as hallucinations and delusions; they also impact the negative symptoms.

Many of these medications have also been approved to treat bipolar disorder. A few are approved to treat various other disorders, such as Tourette’s Syndrome and irritability associated with autism.

How they work

Although the exact processes are still not fully understood, these medications work to alleviate or reduce the symptoms of schizophrenia (as well as manic symptoms associated with bipolar disorder) by targeting certain chemicals in the brain. These chemicals, known as neurotransmitters, are believed to be out of balance in individuals with schizophrenia or bipolar disorder. Although each medication works differently to some degree, most of them work to block the receptors for serotonin and dopamine.

None of these medications cures schizophrenia. However, they have proven to be quite effective for many patients in terms of helping to control symptoms and preventing the symptoms from recurring. Their degree of effectiveness varies depending on the individual.

How they’re administered

For acute symptoms, atypical antipsychotics are usually given as an injection. Depending on the medication, most are available in tablet, capsule and oral liquid forms. Some, such as Risperdal Consta (one of the brand names for risperidone) are available as a long-acting injection.


While precautions may vary somewhat from one atypical antipsychotic to the next, there are some typical precautions which apply to most of them. You should tell your doctor if you (or a family member) have any history of heart or liver disease, seizures, phenylketonuria, kidney disease, high blood pressure, breast cancer, glaucoma, problems swallowing, prostrate or urination problems, elevated cholesterol, or a white blood cell count which has been low.

Also, if you are pregnant, thinking about becoming pregnant, or nursing, you need to let your doctor know.

These medications can also increase the chances of death for elderly individuals who have dementia.

Potential side effects

Side effects vary somewhat depending on the particular medication, but all have the potential to cause a long list of side effects. One of the most troubling side effects caused by some of the atypical antipsychotics is weight gain. Some of the other more common side effects include:

  • Drowsiness
  • Fatigue
  • Increase in appetite
  • Light-headedness
  • Feelings of restlessness
  • Dry mouth
  • Shakiness
  • Headache
  • Nausea and vomiting
  • Constipation
  • Unusual changes in behavior
  • Difficulties sleeping

Other more serious potential side effects may include seizures and diabetes.

Although much less common with atypical antipsychotics than with the conventional antipsychotics, tardive dyskinesia (TD) is a possible side effect. TD can become a permanent condition for some individuals. TD symptoms involve random movements which are uncontrollable and involuntary. These include lip smacking, blinking, unusual tongue or jaw movements, grimacing, and movements involving the limbs, fingers, toes, upper body or hips.

These medications may also cause the development of a very serious condition known as neuroleptic malignant syndrome (NMS). Although it is very rare with the atypical antipsychotics, NMS is a potentially fatal condition which requires immediate medical attention. Some of the symptoms include muscle stiffness, changes in one’s mental state, fluctuations in blood pressure or heartbeat, sudden renal failure, tremors, difficulty breathing, dehydration, rapid heartbeat, and extremely high temperature.

Atypical antipsychotics vs. conventional antipsychotics

Several recent studies are suggesting that the atypical antipsychotic medications are not more effective in treating schizophrenia than the conventional or “typical” antipsychotics 1 2 3. This has important treatment implications, particularly for those who do not have insurance and cannot afford the newer medications. Many of the atypical antipsychotics are several times more expensive than the older antipsychotics.

written by Dr. Cheryl Lane, PsyD