What Are Atypical Antipsychotics?

Atypical antipsychotics tend to be more effect with less side effects

Photo of a pile of atypical antipsychotic pills
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All antipsychotic medications—regardless of whether they're considered typical or the atypical—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 that can result in psychosis.

Psychotic symptoms may occur with disorders such as schizophrenia or bipolar disorder, or medical conditions such as traumatic brain injury.

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 Versus Atypical Antipsychotics

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 as compared to the older typical antipsychotics. Both typical and atypical antipsychotics are dopamine antagonists, meaning they block dopamine in the brain, though this action is more transient with the atypical antidepressants. Atypical antidepressants also block serotonin.

In general, atypical antipsychotics are much more effective and have fewer side effects, especially when it comes to muscular rigidity (Parkinsonism) and involuntary movements (tardive dyskinesia) that are common with typical antipsychotics.

Common Atypical Antipsychotics

There are many different atypical antipsychotics.

Some common 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 those 10 years and older, and schizophrenia in those above the age of 13. When prescribed for bipolar disorder, Abilify is typically used during manic episodes and is often prescribed with another mood stabilizing drug. Abilify can also be used to treat several other conditions, such as agitation in children with autism spectrum disorder. There are two black box warnings with Abilify as it 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 children on the autism spectrum. 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 antidepressants). It's sometimes used in other conditions, such as insomnia, but is considered an "off label" use of the drug. Seroquel is more likely to cause sleepiness, as compared to other atypical antipsychotics.

Symbyax: Symbyax is a combination of olanzapine (Zyprexa), an atypical antipsychotic, and fluoxetine (Prozac), an antidepressant. Symbyax is used to treat depression caused by bipolar disorder as well as treatment-resistant 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 with bipolar disorder and schizophrenia, who are 13 years or older. It also can be used for treatment-resistant depression. Weight gain is a common side effect of Zyprexa, especially in teenagers.

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