Antipsychotic medications are frontline treatments for the symptoms of schizophrenia. It’s been estimated that up to 70 percent of patients will respond to one drug or another, though not every drug will work for every patient. A trial-and-error process may be required to identify the appropriate medication to stabilize the patient.

Typical Antipsychotics

First developed in the 1950s, older “typical” antipsychotics, such as chlorpromazine (Thorazine) and haloperidol (Haldol), transformed the treatment of this serious disease. These drugs arguably helped the disorder to shed its age-old stigma, to some extent, and paved the way for the humane treatment and reintegration of patients who had formerly been marginalized and/or permanently institutionalized.

Atypical Antipychotics

Some of typical medications are still in use today, but since the 1990s, newer second-generation “atypical” antipsychotics have further improved the clinical management of the disease. These include clozapine (Clozaril), a newer medication that effectively reduces or eliminates hallucinations and psychotic episodes. Unfortunately, clozapine use is associated with the risk of a condition called agranulocytosis—a potentially dangerous decline in the production of white blood cells. This decline may severely impact a patient’s ability to fight off infections, so patients taking the drug must be closely monitored for this side effect.

Other atypical drugs include:

  • aripiprazole (Abilify)
  • olanzapine (Zyprexa)
  • paliperidone (Invega)
  • quetiapine (Seroquel)
  • risperidone (Risperdal)
  • ziprasidone (Geodon)

These drugs do not cause agranulocytosis, though most of these medications are associated with other potentially problematic side effects, such as weight gain and an increased risk of developing type 2 diabetes or high cholesterol. Accordingly, it is important for patients taking these medications to have their blood monitored regularly for changes in glucose and lipid levels. These antipsychotic medications are also associated with potentially troubling initial side effects, such as blurry vision, drowsiness, sun sensitivity, rashes, etc., but many of these side effects may eventually subside. 

Long-term Use Complications

Long-term use of antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD is characterized by involuntary muscle spasms, especially around the mouth. The spasms may be mild or severe and may or may not disappear after discontinuation of the drug.

Atypical antipsychotics are somewhat less likely to cause this side effect than older medications. It’s important to note that the potential for dangerous drug interactions is high when using antipsychotic medications. Patients should never take any drugs or supplements without consulting with their psychiatrist first; even supplemental vitamins and minerals may interfere with effective drug therapy. Patients should also never stop taking a prescribed medication abruptly.

Emerging Medications

A number of new medications for the potential treatment of schizophrenia symptoms are presently undergoing clinical trials. At least eight new drugs are in the Phase III stage; nearly as many are in Phase II trials. Statistically speaking, about 25 to 30 percent of drugs undergoing final testing (Phase III clinical trials) may be expected to receive final approval by the Food and Drug Administration.