What Are Atypical Antipsychotics?

Atypical antipsychotics are also called second-generation antipsychotics (SGAs). They’re a newer class of medications that work differently in your body than previous (first-generation or typical) antipsychotics. Both help to regulate neurotransmitters, chemicals in your body that allow neurons to signal to each other.

Studies have found that the brains of people with schizophrenia are more sensitive to the neurotransmitters dopamine, serotonin, and glutamate. High or low dopamine levels can lead to hallucinations and disordered thinking.

While typical antipsychotics (FGAs) block dopamine in the brain, SGAs block both dopamine and serotonin. This results in some key differences.

The most significant difference is that SGAs are less likely to cause extrapyramidal symptoms. These are movement disorders that are common and serious side effects of FGAs. Some of these side effects can become permanent.

Both types of antipsychotics work to treat positive symptoms of schizophrenia, such as hallucinations and delusions. But SGAs may also help treat negative symptoms, like decreased pleasure or lack of motivation. However, there’s debate on how effective SGAs are at reducing negative symptoms.

Here’s a look at the key differences between typical and antipsychotics, and how they work in your body.

Each atypical antipsychotic medication has its own possible mild, moderate and serious side effects and contraindications, so it’s important to learn about your prescription before you begin taking it.

• Aripiprazole (Abilify) can be prescribed for adults and adolescents ages 13 and up. You can take it as an injectable solution available through a healthcare professional, or in one of four oral forms:
  • tablet
  • oral solution
  • Abilify Discmelt, an orally disintegrating tablet
  • Abilify MyCite, a tablet with a patch sensor that lets your doctor know you’ve taken the drug
• Aripiprazole lauroxil (Aristada) is a prodrug, which means it’s inactive until a chemical reaction in your body changes it into aripiprazole. It also requires a medical professional to administer an injection.
• Asenapine maleate (Saphris) is unique in that it’s available as both a tablet and a patch. Studies show that it’s particularly good at preventing relapse. The FDA has approved its use for children older than 10 to treat bipolar disorder, but not schizophrenia.
• Brexipiprazole (Rexulti) treats schizophrenia and depression. Doctors usually prescribe it as a once-daily tablet. A generic form is not yet available.
• Cariprazine (Vraylar) is FDA-approved to treat schizophrenia and bipolar I disorder. It can take a long time to build up in your body and to leave your system. If you stop taking it, you might still feel its effects for up to 4 weeks.
• Clozapine (Clozaril) is the oldest SGA and remains the “gold standard” for those with treatment-resistant schizophrenia. The FDA has approved its use for reducing suicidal behavior in people with schizophrenia. It’s available as a tablet, an orally disintegrating tablet (Fazaclo), and an oral suspension (Versacloz). Clozapine is not FDA-approved to treat schizophrenia in children or adolescents, but some doctors prescribe it off-label.
• Iloperidone (Fanapt) is a twice-daily tablet that can treat both positive and negative symptoms of schizophrenia. It can cause serious problems, such as stroke or even death, in older adults with dementia.
• Lumateperone (Caplyta) is approved to treat schizophrenia and depressive episodes of bipolar disorder. The FDA has not approved it for pediatric use.
• Lurasidone (Latuda) is a once-daily tablet that doctors can prescribe for people ages 13 and older. A 2020 study found that lurasidone continued to reduce schizophrenia symptoms in adolescents for the full 2 years of the study.
• Olanzapine (Zyprexa) is another drug used to treat schizophrenia or bipolar I disorder. It’s available as a tablet, orally disintegrating tablet, or long-acting injectable administered by a healthcare professional. This is one of the atypical antipsychotics that the FDA has approved for adolescents. It can cause serious side effects, such as drug reaction with eosinophilia and systemic symptoms (DRESS).
• Paliperidone (Invega) is derived from a different drug, risperidone. It comes in different forms, including extended-release tablets and long-acting injectables with different brand names. Paliperidone is approved to treat schizophrenia in children ages 12 and older, but it could have broader potential.
• Quetiapine (Seroquel) is available in an immediate-release tablet that you take two or three times a day, or an extended-release tablet that you take once daily. It’s the least likely of the SGAs to cause extrapyramidal symptoms. It’s also FDA-approved for treating schizophrenia in adolescents.
• Risperidone (Risperdal, Perseris) is one of the earliest SGAs and is the most commonly used SGA among children. Doctors prescribe it for children as young as 5 years to treat irritability associated with autism, but it’s only approved for treating schizophrenia in children 13 years and older. It comes in four forms:
  • regular tablet
  • orally disintegrating tablet
  • oral solution
  • injectable administered by a healthcare professional
• Ziprasidone (Geodon) is available as a twice-daily capsule, or you can have a healthcare professional give you an immediate-release injection.

All atypicals carry a risk of mild to severe side effects. These side effects differ from person to person and drug to drug.

Some common side effects include:

• sedation
• dizziness
• low blood pressure when standing up (orthostatic hypotension)
• significant weight gain
• metabolic syndrome
• diabetes
• hypertension
• abnormal cholesterol
• heart disease
• complications in the third trimester of pregnancy
• suicidal thoughts and behaviors

With some SGAs, extrapyramidal symptoms may still occur, especially at high doses.

It’s important that you take care of your physical health while using antipsychotics. SGAs can cause you to gain weight or worsen overweight or obesity if you already have it, leading to other chronic conditions.

You may also become resistant to your medication, so it’s important to stay in touch with your healthcare team and keep them updated if your medicine stops working.

Finally, be sure to continue your medication, even if you feel better. Suddenly stopping the medication can cause problems and may increase your risk of a relapse of symptoms.

Your treatment plan for schizophrenia may include a combination of the following:

• antipsychotic medication, with or without other medicines, to help with conditions like anxiety or depression
• counseling and therapy, such as cognitive behavioral therapy and family therapy
• educational services
• occupational therapy and job support
• alternative and natural treatments, including vitamin supplements and self-care
• electroconvulsive therapy in some cases, which can also help with depression

No one knows exactly what causes schizophrenia. It’s a chronic, incurable mental illness that requires lifelong care. While there’s no cure, there are many effective ways to manage symptoms and live a satisfying, productive life.

Management usually includes therapy, group support, and antipsychotic medication, including atypical antipsychotics.

Side effects can occur when you take antipsychotics, so it’s important to continue to monitor your reactions to medication.

Keeping up with your treatment schedule can help prevent health problems or a relapse of symptoms. Maintaining a moderate weight can also help you stay in good mental and physical health.