Antipsychotic medications, also known as neuroleptics or major tranquilizers, are a class of medications primarily used to manage psychotic symptoms such as those caused by bipolar disorder, schizophrenia or schizoaffective disorder. These medications aim to stabilize mood and reduce symptoms by blocking dopamine receptors in the brain. Some of the most commonly prescribed antipsychotic drugs include olanzapine, risperidone, quetiapine and aripiprazole.

First-Generation vs Second-Generation Antipsychotics

Antipsychotic medications are typically categorized into first-generation (typical) and second-generation (atypical) drugs. The first antipsychotics to be discovered in the 1950s are called first-generation or typical antipsychotics. These drugs, which include chlorpromazine and haloperidol, are very effective at reducing psychotic symptoms but produce more extrapyramidal side effects than second-generation antipsychotics. Second-generation or atypical antipsychotics were developed starting in the 1990s to provide antipsychotic effects with fewer neurological and movement-related side effects. Common second-generation antipsychotics include clozapine, risperidone, olanzapine, quetiapine and aripiprazole.

How Antipsychotics Work in the Brain

Antipsychotic Drugs medications work to control symptoms by blocking dopamine receptors, especially D2 receptors, in the brain's limbic and cortical areas. Dopamine is a neurotransmitter that regulates movement and plays a role in enhancing motivation and reward-motivated behavior. An excess of dopamine activity in the limbic and cortical areas is thought to contribute to psychotic symptoms. By blocking dopamine receptors, especially D2 receptors, antipsychotics can reduce psychotic symptoms. However, this mechanism of action is also the cause of some side effects like extrapyramidal symptoms and hormonal changes.

Uses of Antipsychotic Medications

The primary use of antipsychotic drugs is to treat schizophrenia and other psychotic disorders characterized by disturbances in thought, perception, emotions, language, sense of self and behavior. Common conditions treated with antipsychotics include:

- Schizophrenia: Antipsychotics are first-line treatment for schizophrenia and help control both positive symptoms like hallucinations and delusions as well as negative symptoms.

- Bipolar disorder: Antipsychotics are used as a mood stabilizer in bipolar disorder, primarily for controlling manic episodes. Some may also be used long-term for maintenance treatment.

- Schizoaffective disorder: This condition with symptoms of both schizophrenia and mood disorders responds well to antipsychotic treatment.

- Psychosis caused by other medical conditions: Conditions like Parkinson's disease, dementia, strokes may produce temporary or long-lasting psychotic episodes that require antipsychotics.

- Severe behavioral issues: In some cases, antipsychotics may be used short-term for severe behavioral problems caused by other conditions like autism, personality disorders, etc.

Common Side Effects of Antipsychotic Medications

While antipsychotics provide crucial benefits in managing psychiatric conditions, they are also associated with certain side effects some of which can be troublesome:

- Extrapyramidal side effects (EPS): Dystonia, akathisia, Parkinsonism, tardive dyskinesia. More common with typical than atypical antipsychotics.

- Sedation: Especially with low potency typical antipsychotics in early treatment. Risk decreases with tolerance.

- Weight gain: Risk significantly higher with some second generation antipsychotics like olanzapine and clozapine. Can increase risk for obesity, diabetes etc.

- Metabolic issues: Increased risk for diabetes, high cholesterol, high triglycerides due to weight gain and other factors. Regular monitoring required.

-Prolactin level changes: Elevated prolactin common and linked to sexual dysfunction and other issues. More with typical than atypical antipsychotics.

Get more insights on Antipsychotic Drugs