Hi. It’s Jenny at AnxietyBoss.com. Our question today is from Michele in Camden, New Jersey. What are your thoughts on antipsychotics? Can you tell me more about them please?
Well, antipsychotics are primarily a class of drugs called dopamine antagonists. They work mainly by blocking dopamine receptors. Dopamine receptors bind to dopamine, a neurotransmitter (a chemical) made by nerve cells for communication between neurons. Abnormally high levels of dopamine are linked to psychotic symptoms such as hearing voices, seeing things, and paranoia. By blocking the dopamine receptors, the psychotic symptoms can be relieved. Antipsychotics also have other uses, such as treatment of psychosis due to methamphetamine or cocaine use, delirium from high fever or severe pain or alcohol withdrawal, preoperative sedation, severe intractable hiccups, or as an antiemetic or anti-nausea medication. There are three generations of antipsychotics.
Traditional, first generation antipsychotics include Thorazine and Haldol. They have many side effects, such as weight gain, sexual dysfunction, sedation, difficulty concentrating, a hangover effect, muscle stiffness, a shuffling gait, tongue protrusion, hanging jaw, and drooling. They also do little to relieve some of the symptoms of schizophrenia called negative symptoms. Negative symptoms of psychosis are characterized by inactivity, apathy, social withdrawal, poor hygiene, anergia and lack of motivation. With long term use, 1st generation antipsychotics can produce tardive dyskinesia, a late onset movement disorder, which is a permanent and irreversible condition. Symptoms of tardive dyskinesia include involuntary movements, eyes rolling upward, neck-twisting, mouth opening and closing, and grimacing.
Then along came the atypical antipsychotics, or second generation antipsychotics, such as Clozaril, Risperdal, Zyprexa, Seroquel, Zeldox, and Invega. These medications tend to treat both positive and negative symptoms of psychosis. Positive symptoms of psychosis include hearing voices and seeing things. In addition, 2nd generation antipsychotics have fewer side effects than 1st generation antipsychotics.
Finally, there are the third generation antipsychotics such as Abilify, which have the fewest side effects and are generally effective for schizophrenia. However, psychiatrists tend to prescribe the 1st and 2nd generation antipsychotics for acute symptoms of psychosis, whereas the 3rd generation antipsychotics are generally prescribed for milder symptoms of psychosis, or for maintaining patients when they are not in an acute episode of psychosis.