Atypical antipsychotics usually have fewer and less severe side effects than 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.

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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 main advantage of atypical antipsychotics is that they have fewer and less severe side effects than typical antipsychotics.

The most significant difference between typical and atypical antipsychotics is their side effects.

Typical antipsychotics have significant extrapyramidal symptoms. These are drug-induced movement disorders. They may include:

  • 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. Some people report the symptoms interfere with activities of daily living, social functioning, and speaking.

Other possible side effects of antipsychotics include:

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.

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Although atypical antipsychotics have less significant side effects, they can cause:

One atypical antipsychotic called clozapine carries a risk of myocarditis, which is inflammation of the heart muscle. However, the risk of dying from myocarditis from taking clozapine is low.

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 and atypical antipsychotics:

Typical antipsychotics Atypical antipsychotics
acetophenazine (Tindal)aripiprazole (Abilify)
haloperidol (Haldol)asenapine (Saphris)
loxapine (Adasuve)brexpiprazole (Rexulti)
molindonecariprazine (Vraylar)
perphenazineclozapine (Clozaril)
pimozideiloperidone (Fanapt)
prochlorperazine (Procomp)lurasidone (Latuda)
thiothixeneolanzapine (Zyprexa)
trifluoperazinepaliperidone (Invega)
quetiapine (Seroquel)
risperidone (Risperdal)
ziprasidone (Geodon)

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 disordersschizophreniachildhood schizophrenia
Tourette’s syndromeschizoaffective disordertardive dyskinesia
major depressive disorder (with psychotic characteristics)treatment-resistant mania
borderline personality disorder (BPD)obsessive-compulsive disorder (OCD)
dementiachildhood autism
substance-induced psychotic disorderParkinson’s disease
sudden manic episodeHuntington’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 researchers note a decline in this practice, more work is needed to further reduce the improper prescribing of antipsychotics in nursing homes.

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.