Antipsychotic medications are essential in managing psychiatric conditions such as schizophrenia, bipolar disorder, and severe depression. They are categorized into two primary classes: typical (first-generation) and atypical (second-generation) antipsychotics. Each class has distinct characteristics, benefits, and potential side effects.

Typical Antipsychotics (First-Generation)

Typical antipsychotics, developed in the mid-20th century, primarily function by blocking dopamine receptors in the brain. This action helps alleviate symptoms like hallucinations and delusions. However, they are associated with a higher risk of extrapyramidal symptoms (EPS) — side effects that occur in response to some antipsychotic medications — which include:

• Tardive Dyskinesia: Involuntary, repetitive movements, often affecting the face and tongue.

• Parkinson’s-type symptoms: Symptoms resembling Parkinson's disease, such as tremors and rigidity.

• Akathisia: A feeling of inner restlessness and an urgent need to move.

• Dystonia: Muscle spasms and contractions leading to abnormal postures.

Atypical Antipsychotics (Second-Generation)

Atypical antipsychotics emerged to address the limitations of typical antipsychotics, particularly the risk of unpleasant side effects. They act on both dopamine and serotonin receptors, offering a broader spectrum of symptom relief. While they generally present a lower risk of EPS, atypical antipsychotics are associated with other side effects, including:

• Metabolic Changes: Weight gain, increased blood sugar, and lipid abnormalities.

• Fatigue: Drowsiness.

• Physical effects: Dry mouth, constipation, and blurred vision.

It's important to note that while atypical antipsychotics may offer advantages in reducing EPS, they can have other side effects that require careful monitoring.

Choosing Between Typical and Atypical Antipsychotics

The decision to prescribe a typical or atypical antipsychotic depends on various factors, including:

• Specific Symptoms: The nature and severity of the psychiatric condition.

• Side Effect Profile: The patient's tolerance and risk factors for potential side effects.

• Previous Treatment Responses: How the patient has responded to medications in the past.

• Comorbid Conditions: Presence of other health issues that may influence medication choice.

A collaborative approach between the patient and healthcare provider is essential to determine the most appropriate medication regimen.

Understanding the distinctions between typical and atypical antipsychotic medications is crucial for effective treatment planning. By carefully considering the benefits and potential side effects of each class, Dr. Doi can help plan your treatment and ensure quality care.  Book a free discovery call with Dr. Doi here.