There are two types of antipsychotic drugs: typical and atypical. Atypical antipsychotics usually have fewer and less severe side effects, so doctors often prescribe them over typical antipsychotics.
Doctors prescribe atypical antipsychotics to treat a range of mental health conditions, including schizophrenia, obsessive-compulsive disorder (OCD), and treatment-resistant mania. They may also prescribe atypical antipsychotics off-label for other conditions, such as Tourette’s syndrome.
One example of a typical antipsychotic drug is prochlorperazine (Procomp). An example of an atypical antipsychotic drug is risperidone (Risperdal).
Keep reading to learn about the differences between typical and atypical antipsychotics, their uses, side effects, and more.
Typical antipsychotics were the first in their drug class and are sometimes called first-generation antipsychotics. They act on dopamine receptors in the brain.
Drug manufacturers later developed second-generation antipsychotics, which are also called atypical antipsychotics. They act on both dopamine and serotonin receptors.
Atypical antipsychotics also have some antidepressant effects when used alone or with an antidepressant.
The most significant difference between typical and atypical antipsychotics is their side effects.
Typical antipsychotics have significant
- Dystonia: uncontrolled muscle contractions that cause repetitive movements and abnormal posture
- Akathisia: a state of restlessness
- Parkinsonism: a disorder causing tremors, slow movements, and rigidity
- Tardive dyskinesia: a chronic condition causing repetitive muscle movements in the face, neck, arms, and legs
- Tardive akathisia: a delayed start of akathisia after starting an antipsychotic drug
Extrapyramidal symptoms can be debilitating.
Other possible side effects of antipsychotics include:
- dry mouth
- urinary retention
- allergic reactions
Severe side effects of antipsychotics may affect heart function.
Because antipsychotics act on dopamine receptors, they may increase a person’s level of prolactin. This is a hormone released in the pituitary gland.
High prolactin levels in the blood can cause:
- abnormal breast milk production
- breast enlargement
- loss of menstrual periods
- impotence in males
- loss of orgasm in females
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
Although atypical antipsychotics have less significant side effects, they can cause:
- weight gain
- high cholesterol
One atypical antipsychotic called clozapine
Antipsychotics have a boxed warning issued by the Food and Drug Administration (FDA). This is the most severe warning for a drug.
The following table lists examples of
|Typical antipsychotics||Atypical antipsychotics|
|acetophenazine (Tindal)||aripiprazole (Abilify)|
|haloperidol (Haldol)||asenapine (Saphris)|
|loxapine (Adasuve)||brexpiprazole (Rexulti)|
|prochlorperazine (Procomp)||lurasidone (Latuda)|
The FDA has approved antipsychotics for various psychiatric conditions.
Different types of antipsychotics and the conditions they treat are listed below:
|Typical antipsychotics||Typical or atypical antipsychotics (except clozapine)||Clozapine|
|delusional disorders||schizophrenia||childhood schizophrenia|
|Tourette’s syndrome||schizoaffective disorder||tardive dyskinesia|
|major depressive disorder (with psychotic characteristics)||treatment-resistant mania|
|borderline personality disorder (BPD)||obsessive-compulsive disorder (OCD)|
|substance-induced psychotic disorder||Parkinson’s disease|
|sudden manic episode||Huntington’s disease|
|schizophrenia or schizoaffective disorder (with suicidal thoughts)|
|severe psychotic symptoms|
Sometimes, doctors may prescribe atypical antipsychotics for conditions the FDA has not approved them for. This is called off-label prescribing.
For example, atypical antipsychotics may help people with Tourette’s syndrome, but this is an off-label use.
However, doctors can sometimes incorrectly prescribe antipsychotics. A concerning practice seen in some care homes is doctors overprescribing antipsychotic medications to older adults.
Off-label uses of antipsychotics in older adults in nursing homes include dementia-related behaviors, such as aggression and agitation. Antipsychotics are not safe when prescribed inappropriately to a vulnerable group of people.
National programs in the United States have worked to reduce the unsuitable prescribing of antipsychotics in nursing homes. While
When taking antipsychotic medications, people should report any side effects to a doctor. Sometimes, changing antipsychotics can help improve the medical condition while minimizing side effects.
If a person is taking atypical antipsychotics, doctors will review their body weight and order blood tests to check for increased cholesterol and blood sugar. Follow-up appointments may also include having an electrocardiogram to evaluate heart function.
For people taking clozapine, doctors will check neutrophil levels. This is a type of white blood cell that helps the body protect itself from infections. Clozapine can drop neutrophil levels and increase a person’s risk of illnesses.
Doctors can prescribe a range of types of antipsychotics. Each type has different side effects. While some health conditions require a typical antipsychotic medication, atypical antipsychotics are often preferred.
Atypical antipsychotic medications usually have fewer and less severe side effects than typical antipsychotic medications.
Weight gain, diabetes, and high cholesterol are side effects that can occur with atypical antipsychotics. When taking antipsychotics, follow-up appointments with a doctor are crucial to a person’s care.