Antipsychotic Medications

Antipsychotic Medications

The original set of antipsychotic medications, known as typical antipsychotics or first-generation antipsychotics, were introduced in the 1950s to treat schizophrenia and other psychotic disorders. These medications primarily affect dopamine (DA) receptors, specifically the D2 receptors, by blocking them. This helps reduce symptoms such as delusions and hallucinations, which are linked to overactive dopamine pathways in the brain. However, their strong dopamine-blocking action leads to significant side effects, particularly extrapyramidal symptoms (EPS) such as tremors, rigidity, and bradykinesia, which resemble symptoms of Parkinson’s disease. Other side effects include tardive dyskinesia, a severe and often irreversible movement disorder, as well as sedation and weight gain. APA.

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Antipsychotic Medications

In contrast, atypical antipsychotics, or second-generation antipsychotics, differ pharmacologically in that they target both dopamine (D2) and serotonin (5-HT2A) receptors. While they still block dopamine receptors, their effects on serotonin receptors help balance neurotransmitter activity, which reduces the likelihood of extrapyramidal symptoms. Atypical antipsychotics are generally better tolerated in terms of movement-related side effects, but they can still lead to metabolic issues such as weight gain, diabetes, and dyslipidemia. One valid reason a schizophrenic patient might ask for Haldol (haloperidol) over Clozapine is the potential for agranulocytosis with Clozapine. Agranulocytosis is a life-threatening condition where white blood cell levels drop dangerously low, severely compromising the immune system. Clozapine requires frequent blood monitoring to detect this rare but serious side effect, making it less appealing to some patients. Haldol, despite its risk for EPS, does not carry this life-threatening risk, making it a safer option for patients wary of Clozapine’s dangers.

Antipsychotic Medications

A newer antipsychotic on the market is Caplyta (lumateperone), approved for the treatment of schizophrenia. Caplyta works by modulating dopamine, serotonin, and glutamate systems in the brain. Unlike traditional antipsychotics, it selectively targets D1 and D2 receptors, acting as a partial agonist rather than a full antagonist. This balanced action helps to alleviate both positive and negative symptoms of schizophrenia while minimizing side effects like EPS and metabolic disturbances.

A newer medication for psychotic disorders released after 2017 is Vraylar (cariprazine), approved in 2019 for the treatment of schizophrenia and bipolar disorder. Vraylar affects dopamine (D3/D2) and serotonin (5-HT1A) receptors. It is a partial agonist at these receptors, which means it modulates dopamine levels without causing the excessive dopamine blockade seen in typical antipsychotics. This helps reduce both positive and negative symptoms of schizophrenia with fewer side effects related to movement or metabolism.