Antipsychotics

Antipsychotics are a family of drugs normally associated with treating disorders like schizophrenia, but they have been found to be useful for treating bipolar disorder as well.

There are older “typical antipsychotics” and newer “atypical antipsychotics.” The classifications stem from the extent to which the drug causes a set of side effects that affect motor control.

Where it fits in

Antipsychotics can control manic episodes and are also useful in treating hallucinations or delusions that can occur in patients with bipolar disorder. Antipsychotics are also prescribed when mood stabilizers like lithium are not effective.

These drugs can have a wide range of side effects that vary depending on whether they are part of the older “typical” family or the newer “atypical” family.

HOW DO THEY WORK

Antipsychotics can help manage bipolar episodes and can also treat the psychosis that some people with bipolar may experience. The psychosis can include hallucinations and delusions.

WHO THEY ARE FOR

Many patients with bipolar disorder will be prescribed antipsychotics at one point or another during their treatment. These drugs are not only useful in treating psychosis, but also act as a back up when mood stabilizers like lithium are not proving adequate.

Available Types

There are a number of both types of antipsychotics available.

This is the federal Food and Drug Administration's list of Typical Antipsychotics:

   • Compazine (prochlorperazine)
   • Haldol (haloperidol)
   • Loxitane (loxapine)
   • Mellaril (thioridazine)
   • Moban (molindone)
   • Navane (thithixene)
   • Orap (pimozide)
   • Prolixin (fluphenazine)
   • Stelazine (trifluoperazine)
   • Thorazine (chlorpromazine)
   • Trilafon (perphenazine)

Add
Note: these drugs can also be known as conventional or first-generation antipsychotics.

This is the federal Food and Drug Administration's list of Atypical Antipsychotics:

   • aripiprazole (Abilify)
   • asenapine Maleate (Saphris)
   • clozapine (Clozaril)
   • iloperidone (Fanapt)
   • lurasidone (Latuda)
   • olanzapine (Zyprexa)
   • olanzapine/Fluoxetine (Symbyax)
   • paliperidone (Invega)
   • quetiapine (Seroquel)
   • risperidone (Risperdal)
   • ziprasidone (Geodon)
Note: these drugs are also known as second-generation antipsychotics.

What the Expert Says

Dr. Soroya Bacchus, who practices in California, said she mostly prescribes the new atypical antipsychotics.

“They are mood stabilizers. They bring down mania rapidly and often can lift modestly a depressed mood. The newer drugs have fewer side effects of movement and weight gain side effects.”

SIDE EFFECTS

The older “typical”antipsychotics cause extrapyramidal side effects – also known as EPS or movement disorder side effects, while the newer “atypicals” are less likely to cause these side effects.

A potentially dangerous but rare form of EPS is neuroleptic malignant syndrome or NMS. It requires stopping the antipsychotic treatment and getting swift medical treatment.

NMS can cause unstable breathing, heart rate and blood pressure. It can also cause an elevated white blood cell count, fever, confusion, rigidity of the muscles and confusion.

In other cases, EPS mimics the symptoms of Parkinson's disease: tremors, stiffness, and slowed speech and movement. This is known as Parkinsonian EPS.

Other EPS side effects associated with the use of older antipsychotics include Tardive dyskinesia, acute dystonic reactions and akethisia.

Tardive dyskinesia, or TD, can appear when someone has been taking older antipsychotics for some time. It exhibits itself as involuntary movements of the body, including the face, limbs and torso. When TD involves the face, it can include blinking, chewing and movements of the lips and tongue.

Acute dystonic reactions are involuntary spasms of the facial muscles that usually occur in younger males who are taking antipsychotics. They tend to be less severe than those associated with TD.

Akethisia is a sensation of restlessness. In this case it tends to be focused on the legs.

The people experiencing this side effect feel an urge to walk or pace.

There are other side effects associated with typical antipsychotics, including increased appetite, weight gain, seizures and heart abnormalities.

The newer drugs tend to be used more because they are less likely to cause EPS, but atypicals are noted for a variety of their own side effects.

The more serious is a link to heart arrhythmia and the possibility of a drop in the number of white blood cells.

The most common is weight gain. The amount of weight a person gains due to these drugs can be significant and people using new antipsychotics can have an increased risk for diabetes.

Other side effects include:

   • heightened cholesterol and triglycerides
   • increased appetite
   • dizziness
   • sleepiness
   • prolonged and painful erection
   • nausea
   • light-headedness