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Psychosis has long been treated with a class of drugs known astypical antipsychotics. These were first developed in the 1950s and, while effective, are known to cause Parkinson-like side effects. Today, a newer class of medication known as atypical antipsychotics are commonly used. These were introduced in the 1980s and boast a different side effect profile with far fewer of the Parkinson-like and other movement effects compared to the older agents. Atypical antipsychotics are commonly referred to as second-generation antipsychotics, while typical psychotics are called first-generation antipsychotics.

Atypical vs. Typical Antipsychotics

Typical and some atypical antipsychotics are dopamine antagonists, which means that they impede chemical messengers in the brain known asdopamine. In people with psychosis, dopamine signals are typically abnormal. Antipsychotics block those messages. Atypical antipsychotics also influence a chemical messenger known asserotonin.

Atypical antipsychotics are most typically prescribed to treatschizophreniaand to augment the treatment ofmajor depressive disorder (MDD), bipolar disorder, andschizoaffective disorder.

Side Effects of Antipsychotics

The two classes of drugs differ in the range and severity of side effects they can cause. Comparatively speaking:

Black Box WarningAll antipsychotics (atypical and typical) carry a black box warning due to an increased risk of death in older adults with dementia-related psychosis. The increased mortality is mostly due to cardiovascular events (heart failure, sudden death) and infections (pneumonia).

Black Box Warning

All antipsychotics (atypical and typical) carry a black box warning due to an increased risk of death in older adults with dementia-related psychosis. The increased mortality is mostly due to cardiovascular events (heart failure, sudden death) and infections (pneumonia).

Types of Atypical Antipsychotic

There are many different atypical antipsychotics used to treat psychotic episodes of schizophrenia, bipolar disorder, and other mental illnesses. Among them:

There continue to be new atypical antipsychotics reaching the market for the treatment of psychotic and mood disorders. These include:

SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fornaro M, Stubbs B, De Berardis D, et al.Atypical antipsychotics in the treatment of acute bipolar depression with mixed features: a systematic review and exploratory meta-analysis of placebo-controlled clinical trials.IJMS. 2016;17(2):241. doi:10.3390/ijms17020241Kishimoto T, Agarwal V, Kishi T, Leucht S, Kane JM, Correll CU.Relapse prevention in schizophrenia: a systematic review and meta-analysis of second-generation antipsychotics versus first-generation antipsychotics.Mol Psychiatry. 2013;18(1):53-66. doi:10.1038/mp.2011.143Rummel-Kluge C, Komossa K, Schwarz S, et al.Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: A systematic review and meta-analysis.Schizophrenia Research. 2010;123(2-3):225-233. doi:10.1016/j.schres.2010.07.012

Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Fornaro M, Stubbs B, De Berardis D, et al.Atypical antipsychotics in the treatment of acute bipolar depression with mixed features: a systematic review and exploratory meta-analysis of placebo-controlled clinical trials.IJMS. 2016;17(2):241. doi:10.3390/ijms17020241Kishimoto T, Agarwal V, Kishi T, Leucht S, Kane JM, Correll CU.Relapse prevention in schizophrenia: a systematic review and meta-analysis of second-generation antipsychotics versus first-generation antipsychotics.Mol Psychiatry. 2013;18(1):53-66. doi:10.1038/mp.2011.143Rummel-Kluge C, Komossa K, Schwarz S, et al.Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: A systematic review and meta-analysis.Schizophrenia Research. 2010;123(2-3):225-233. doi:10.1016/j.schres.2010.07.012

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Fornaro M, Stubbs B, De Berardis D, et al.Atypical antipsychotics in the treatment of acute bipolar depression with mixed features: a systematic review and exploratory meta-analysis of placebo-controlled clinical trials.IJMS. 2016;17(2):241. doi:10.3390/ijms17020241Kishimoto T, Agarwal V, Kishi T, Leucht S, Kane JM, Correll CU.Relapse prevention in schizophrenia: a systematic review and meta-analysis of second-generation antipsychotics versus first-generation antipsychotics.Mol Psychiatry. 2013;18(1):53-66. doi:10.1038/mp.2011.143Rummel-Kluge C, Komossa K, Schwarz S, et al.Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: A systematic review and meta-analysis.Schizophrenia Research. 2010;123(2-3):225-233. doi:10.1016/j.schres.2010.07.012

Fornaro M, Stubbs B, De Berardis D, et al.Atypical antipsychotics in the treatment of acute bipolar depression with mixed features: a systematic review and exploratory meta-analysis of placebo-controlled clinical trials.IJMS. 2016;17(2):241. doi:10.3390/ijms17020241

Kishimoto T, Agarwal V, Kishi T, Leucht S, Kane JM, Correll CU.Relapse prevention in schizophrenia: a systematic review and meta-analysis of second-generation antipsychotics versus first-generation antipsychotics.Mol Psychiatry. 2013;18(1):53-66. doi:10.1038/mp.2011.143

Rummel-Kluge C, Komossa K, Schwarz S, et al.Head-to-head comparisons of metabolic side effects of second generation antipsychotics in the treatment of schizophrenia: A systematic review and meta-analysis.Schizophrenia Research. 2010;123(2-3):225-233. doi:10.1016/j.schres.2010.07.012

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