Medication Management of Psychotic Disorders
The information provided below is not comprehensive, but rather provides a general overview of the most common associated features.
It can be said that there are 3-types of antipsychotics now on the market. There is a clear distinction between first and second generation antipsychotics, but the category of third generation antipsychotics is not fully developed and it has not been officially determined which medications fit into this category.
First Generation or Typical Antipsychotics
*These medications are strong D2 antagonists. This means that they drastically decrease the level of dopamine in the brain. These medications best treat the positive symptoms of Schizophrenia. Many of these medications have been discontinued in the United States. The ones listed below are the most common still in use.
Second Generation or Atypical Antipsychotics
*These medications are also full D2 antagonists (decrease dopamine), but work on other receptors to try and treat the negative symptoms as well as the positive symptoms.
Third Generation Antipsychotics
*These medications are partial D2 agonists, which means they don’t deplete dopamine in the brain as much as other medications. They more regulate it. This helps to minimize side effects and also make them well tolerated in treating Bipolar or augmenting antidepressants.
Long-Acting Injectables (LAI)
Long acting injections are a newer delivery system for antipsychotic medications. Haloperidol, Fluphenazine, Abilify, Risperdal, Zyprexa and Invega all have versions of their medication that come as an intramuscular injection (like a flu shot). Depending on the medication it can stay in your system anywhere between 2 weeks and 6 months. These medications stay in the muscle and slowly defuse into the bloodstream overtime, the same way as Depo-Provera does (the birth control). The allows for a more even distribution of medication, often resulting in fewer side effects.
If you don't think an injection is for you...here are some pretty convincing statistics
Side Effects
*All antipsychotics basically have the same side effects listed, but each medication produces them to a different degree. This is why it is important to discuss medications with a professional that can discern these differences.
Side Effects: Extrapyramidal Symptoms (drug-induced Parkinson’s, akathisia, dystonia), Tardive Dyskinesia, Metabolic Syndrome (diabetes, weight gain, increased cholesterol, weight gain), sedation, orthostasis (dizziness upon standing), anticholinergic (dry mouth), cardiac (QTC prolongation), hematologic complications (decreased white blood cell count), sexual dysfunction.
First Generations Antipsychotics have stronger Extrapyramidal and Tardive Dyskinesia side effects then the other two generations
Second Generations Antipsychotics have stronger metabolic side effects
Third Generation Antipsychotics have stronger akathisia side effects
*There are many other medications that can help augment other medications or relieve signs and symptoms of Schizophrenia based on individual presentation.
First Generation or Typical Antipsychotics
*These medications are strong D2 antagonists. This means that they drastically decrease the level of dopamine in the brain. These medications best treat the positive symptoms of Schizophrenia. Many of these medications have been discontinued in the United States. The ones listed below are the most common still in use.
- Haloperidol (Haldol)
- Fluphenazine (Prolixin)
- Chlorpromazine (Thorazine)
- Perphenazine (Tilafon)
- Loxapine (Loxitane)
Second Generation or Atypical Antipsychotics
*These medications are also full D2 antagonists (decrease dopamine), but work on other receptors to try and treat the negative symptoms as well as the positive symptoms.
- Clozapine (Clozaril)
- Iloperidone (Fanapt)
- Lurasidone (Latuda)
- Olanzapine (Zyprexa)
- Paliperidone (Invega)
- Quetiapine (Seroquel)
- Risperidone (Risperdal)
- Ziprasidone (Geodon)
Third Generation Antipsychotics
*These medications are partial D2 agonists, which means they don’t deplete dopamine in the brain as much as other medications. They more regulate it. This helps to minimize side effects and also make them well tolerated in treating Bipolar or augmenting antidepressants.
- Aripiprazole (Abilify)
- Brexpiprazole (Rexulti)
- Cariprazine (Vraylar)
- Lumateperone (Caplyta)
Long-Acting Injectables (LAI)
Long acting injections are a newer delivery system for antipsychotic medications. Haloperidol, Fluphenazine, Abilify, Risperdal, Zyprexa and Invega all have versions of their medication that come as an intramuscular injection (like a flu shot). Depending on the medication it can stay in your system anywhere between 2 weeks and 6 months. These medications stay in the muscle and slowly defuse into the bloodstream overtime, the same way as Depo-Provera does (the birth control). The allows for a more even distribution of medication, often resulting in fewer side effects.
If you don't think an injection is for you...here are some pretty convincing statistics
- The relapse risk is a 20%-30% lower than with oral medications.
- LAI's reduce suicide risk by 50%
- They reduce
- Increases the life-expectancy compared to oral medications
Side Effects
*All antipsychotics basically have the same side effects listed, but each medication produces them to a different degree. This is why it is important to discuss medications with a professional that can discern these differences.
Side Effects: Extrapyramidal Symptoms (drug-induced Parkinson’s, akathisia, dystonia), Tardive Dyskinesia, Metabolic Syndrome (diabetes, weight gain, increased cholesterol, weight gain), sedation, orthostasis (dizziness upon standing), anticholinergic (dry mouth), cardiac (QTC prolongation), hematologic complications (decreased white blood cell count), sexual dysfunction.
First Generations Antipsychotics have stronger Extrapyramidal and Tardive Dyskinesia side effects then the other two generations
Second Generations Antipsychotics have stronger metabolic side effects
Third Generation Antipsychotics have stronger akathisia side effects
*There are many other medications that can help augment other medications or relieve signs and symptoms of Schizophrenia based on individual presentation.
If you would like to be evaluated for a psychotic disorder or seek pharmacological treatment.