What Are Atypical Antipsychotics? What Do They Treat?

How Atypical Antipscyhotics Differ in Effects and Side Effects

Photo of a pile of atypical antipsychotic pills
What are the different antipsychotic medications, when are they used, and what are their side effects?. Nenov/Moment/Getty Images

What are atypical antipsychotic medications? What do they treat? And what kind of side effects do they have?

What is Psychosis?

All antipsychotic medications—regardless of whether they're in the typical or the atypical group—are designed to treat psychosis. Psychosis refers to psychiatric symptoms in which thoughts are severely distorted in a way that a person loses touch with reality. These symptoms may include hallucinations (such as hearing voices), paranoid thoughts, and delusions (false beliefs.)

There are several medical conditions as well as psychiatric disorders which can result in psychosis. Psychotic symptoms may occur with disorders such as schizophrenia or bipolar disorder, or medical conditions such as traumatic brain injury.

In contrast, the symptoms of conditions such as depression and anxiety are considered "neurotic symptoms." People with these conditions do not usually hear or see things that aren't there, or lose touch with reality. There is some overlap, however, such as with psychotic depression.

What are Antipsychotics and What Do They Treat?

Medications used to treat psychosis—which occurs in conditions such as bipolar disorder and schizophrenia — are called antipsychotics. Antipsychotics are divided into two groups: "typical antipsychotics" and "atypical antipsychotics."

Typical vs Atypical Antipscyhotics

The names "typical" and "atypical" regarding antipsychotics are misleading, since it's really a matter of which group of drugs was invented first.

The older, first generation antipsychotic drugs are considered "typical antipsychotics" and the newer, second generation drugs, which have a different chemical structure, are considered "atypical."

Atypical antipsychotics also have some different side effects when compared with the older typical antipsychotics.

In addition to being older and newer medications, there are several differences between typical antipsychotics and atypical antipscyhotic medications.

Both typical and atypical antipscyhotics both block dopamine in the brain (they are dopamine antagonists) though this action is more transient with the atypical antidepressants. Atypical antidepressants also block serotonin. In general, atypical antipscyhotics are much more effective and have fewer side effects, especially the muscular rigidity (Parkinsonism) and involuntary movements (tardive dyskinesia) so common with typical antipsychotics.

List of Atypical Antipsychotics

There are many different atypical antipsychotics. Not all are approved for the same conditions.

The atypical antipsychotics include:

  • Abilify (generic name: aripiprazole). Abilify has been approved by the U.S. Food and Drug Administration to treat bipolar I disorder in people 10 years of age and older, and schizophrenia in those age 13 and older. with bipolar disorder, it is used specifically for manic episodes, and is often prescribed with another mood stabilizing drug. It is also approved for several other conditions, such as agitation in children with autism. There are two black box warnings with Abilify. The medication is associated with an increased rate of death among older people with dementia-related psychosis, and when combined with antidepressants, may increase the risk of suicidal thoughts in young adults and children.
  • Clozaril (generic name: clozapine).Clozaril is used to treat severe, treatment-resistant schizophrenia. It's not approved to treat bipolar disorder, but some studies show it's effective in bipolar mania. It has five potentially serious black box warnings, including a risk of low white blood cell counts, seizures, heart inflammation and fainting (due to low blood pressure when rising) and an increased risk of death in elderly patients.
  • Geodon (generic name: ziprasidone). Geodon is approved for schizophrenia and bipolar disorder, and can be used both for acute symptoms and chronic management. The drug may offer less risk of weight gain than some other atypical antipsychotics, while still working effectively to control symptoms. Roughly 1 in 4000 people can develop a heart arrhythmia on the medication and it should not be used by those with long QT syndrome, who have heart failure or a recent heart attack, or for those with abnormal heart rhythms.
  • Invega (generic name: paliperidone). Invega is FDA-approved to treat schizophrenia in adults and adolescents and schizoaffective disorder in adults. It's the only oral atypical antipsychotic approved to treat schizoaffective disorder. The medication is also available as injections in one-month and three-month doses. This medication also carries the black box warning regarding an increased risk of death in elderly patients.
  • Risperdal (generic name: risperidone). Risperdal is approved to treat bipolar disorder, schizophrenia and irritability in autistic children. It's available in oral and in injectable form. The injectable form lasts two weeks.
  • Seroquel (generic name: quetiapine). Seroquel is approved to treat bipolar disorder, schizophrenia, and depression (in combination with an antidepressant medication). It's sometimes used in other conditions, such as insomnia, although it doesn't hold FDA approval for those conditions. It's more likely than other atypical antipsychotics to cause sleepiness.
  • Symbyax. This is a combination of the atypical antipsychotic olanzapine (Zyprexa) plus the antidepressant fluoxetine (Prozac). Symbyax is used to treat depression caused by bipolar disorder, plus difficult-to-treat depression. As with other antidepressant medications, Symbyax may increase the risk of suicidal thoughts and acts in children, adolescents and young adults.
  • Zyprexa (generic name: olanzapine). Zyprexa is approved for those 13 and older who have bipolar disorder and schizophrenia. It also can be used for hard-to-treat depression. Weight gain is very common in people who take Zyprexa, especially teenagers.

Bottom Line on Atypical Antidepressants

As noted in the descriptions of individual drugs, while the atypical antidepressants are all designed to treat psychosis, they act in different ways and have different strengths, weaknesses, methods of delivery, and side effects. Yet, just as antipsychotics differ from one another in many ways, people with either medical or mental health conditions exhibiting psychosis differ widely as well.

All of these drugs carry a black box warning stating that they may raise the risk of death in elderly patients with dementia-related psychosis, and all carry the risk of neuroleptic malignant syndrome. Neuroleptic malignant syndrome is a rare and dangerous side effect characterized by a high fever, muscle rigidity, unstable blood pressure, and an altered mental status.

It's important to work closely with your psychiatrist to find a medication which offers the greatest benefits to you with the fewest side effects.

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