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Antipsychotic Medication - What You Need To Know
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Medications used to treat psychotic disorders are called antipsychotics. They have also been referred to as neuroleptics and major tranquilizers. The first antipsychotic, Chlorpromazine (Thorazine) was discovered in 1952 by French psychiatrist Pierre Deniker. At the time, it was considered a miracle drug because it helped many people with schizophrenia be able to live outside the institution for the first time. Antipsychotic medication is the most important aspect of treatment for schizophrenia and quickly becoming a first choice for Bi-Polar 1 (not Bi-Polar 2) disorder. These drugs do not cure these illnesses but rather manage and control the symptoms just as medication and insulin can do for diabetes. There have been many questions lately about use of these medications "off label". This means using the medication for illnesses it is not yet approved by the FDA for. This is not as bad as it sounds. The FDA is very slow and potentially political and it could take years to get approval for other uses that clearly help patients. Clinicians are often on there own about how to best use these medications. Good clinicians keep up with the latest research and information from colleages. The other to me more serious concern is the overuse of these medications, especially in children and older adults. There has been lots of much needed discussion of these issues recently. How Antipsychotics Work. Antipsychotics are dopamine antagonists. Dopamine is a neurotransmitter that allows messages to pass between cells in the brain. It is believed that an excess of dopamine in the brain can cause too much stimulation between brain cells and that results in confusing messages and symptoms of psychosis. Dopamine antagonists block the reuptake of dopamine from the blood which results in decreased dopamine in the cells. Antipsychotic are classified as typical and atypical Typical Antipsychotics. These were the first drugs to treat psychosis and schizophrenia in the 1950s. They are also referred to as conventional ot first generation antipsychotics. Typical antipsychotics are very effective but have worrisome side effects especially tardive dyskinesia. The typical antipsychotics are relatively inexpensive and are still
used. Typical Antipsychotics include: - chlorpromazine (Thorazine)
- haloperidol ( Haldol)
- trifluopeazine (Stelazine)
- Thioridazine (Mellaril)
- fluphenazine (Prolixin)
- molidone (Moban)
- thiothixene (Navane)
- loxapine (Loxatane)
- perphenazine (Trilafon)
- mesoridazine (Serentil)
Atypical Antipsychotics These are the newer antipsychotic drugs that are equally effective but have fewer side effects then the typical antipsychotics. They are also referred to as second generation. Clozapine was the first atypical antipsychotic introduced in the US in 1990. The risk of TD is said to be ten times less with these new medications. Atypical antipsychotics are the drug of choice in the US. They are very effective but are also expensive. They are the drugs of choice in the US. As time goes on however, we are learning that the atypical antipsychotic drugs also have significant side effects. There continues to be growing concern about weight gain, metabolic syndrome and endocrine changes. Atypical Antipsychotics include: - ziprazodone (Geodon)
- risperdone (Risperdal)
- quetiapine (Seroquel)
- olanzepine (Zyprexa)
- aripiprazole (Abilify) is the latest antipsychotic medication to hit the market. It is said to be different from the others in that it balances dopamine levels in the brain rather then simply decreasing it.
References:
Torrey, E ( 2001). Surviving Schizophrenia. Quill, NY
Physicians Desk Reference (2008) American Psychiatric Association,
Stahl, S. Essential Psychopharmacology 2nd ed. (2004) Virginia J. Duffy PhD Psychiatric Nurse Practitioner
Author, Psychotherapist, Seminar leader, Educator, Consultant.
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