Mental Health
What’s the Difference Between Typical vs. Atypical Antipsychotics?
Antipsychotic medications are medications prescribed to treat multiple mental health conditions. There are two types of antipsychotics: typical and atypical.
Typical antipsychotics more strongly affect the chemical dopamine than atypical antipsychotics. This is why they have a greater risk of movement-related side effects.
Atypical antipsychotics are more commonly prescribed than typical antipsychotics.
banjongseal324/iStock via Getty ImagesAs many as 20% of U.S. adults are estimated to have a mental health condition. Oftentimes, medications are an essential part of managing symptoms of these conditions. Of the many types of mental health medications available, antipsychotics are a commonly prescribed option.
But antipsychotics include two distinct groups of medications. These are called first-generation (“typical”) and second-generation (“atypical”) antipsychotics. While they share some common features, both classes have differences that set them apart from each other.
Typical and atypical antipsychotics can be prescribed for many health conditions, including:
Manic episodes of bipolar disorder
Major depressive disorder (depression)
Agitation in children on the autism spectrum
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Not all antipsychotics are FDA approved to treat all the conditions listed above. These medications may also have “off-label” uses. For example, some healthcare providers may prescribe an atypical antipsychotic to treat post-traumatic stress disorder (PTSD), even though they’re not FDA approved for this reason.
Yes, but atypical antipsychotics are preferred by experts for depression. Still, they’re not first-choice options. Antipsychotics aren’t recommended for depression unless antidepressants, like selective serotonin reuptake inhibitors (SSRIs), aren’t working well enough. They can also be considered if a person living with depression is also experiencing psychosis (a break with reality).
Some atypical antipsychotics are FDA approved for depression when combined with an antidepressant. Examples include aripiprazole (Abilify), olanzapine (Zyprexa), and quetiapine (Seroquel).
Both typical and atypical antipsychotic medications affect certain chemicals in the brain. The chemical they affect most is dopamine. Dopamine is involved in many body processes, including regulating movements and emotions. Both typical and atypical antipsychotics block dopamine’s activity. But typical antipsychotics more strongly block this chemical than atypical antipsychotics.
Besides dopamine, these medications also help balance levels of serotonin — a chemical most known for its role in mood regulation. But not all typical antipsychotics affect serotonin’s actions to the same degree. And atypical antipsychotics typically have greater effects on this chemical than typical antipsychotics.
Antipsychotics also have antihistamine and anticholinergic effects. This means they block the chemicals histamine and acetylcholine in the body, respectively. These actions aren’t thought to help the medications work to treat mental health conditions. But they are driving factors for many common side effects, like dry mouth and constipation.
Some of the side effects reported with antipsychotics — especially those related to body movements — happen because of lowered dopamine activity. Others come from the medications blocking histamine and acetylcholine in the body, as discussed earlier.
Specific side effects vary by medication, but side effects of both typical and atypical antipsychotics include:
Dry mouth
Drowsiness
Dizziness
Low blood pressure when changing positions
High prolactin levels
Breast development in men
Uncontrollable body movements (also called extrapyramidal symptoms)
Antipsychotics can also cause changes to your metabolism. These changes may include weight gain, high cholesterol, and Type 2 diabetes. Atypical antipsychotics are more likely to cause these types of side effects than typical antipsychotics.
Extrapyramidal symptoms (EPS) are involuntary body movements caused by low dopamine levels. The term EPS actually refers to a group of side effects. They’re typically split into four categories:
Akathisia. This is a feeling of being unable to sit still. This can come across in different ways. People often bounce their legs, shift from one leg to the other, or cross and uncross their legs.
Dystonia. These are uncontrollable muscle spasms and can be painful. Dystonia tends to happen within the first 2 to 5 days of starting an antipsychotic. Typically, a body part fixes into an unusual position, or repetitive muscle spasms happen. This may affect any area of the body, such as hands, feet, or the jaw.
Parkinsonism. This form of EPS mimics symptoms of Parkinson’s disease. People may notice tremors, balance problems, or trouble getting up from a seated position.
Tardive dyskinesia (TD). This is a severe and rare type of EPS that can become permanent. Most commonly, people experiencing TD have uncontrollable facial movements. Examples include grimacing, tongue thrusting, and repeated blinking. TD can interfere with eating, drinking, and even breathing in severe cases.
Typical antipsychotics are much more likely to cause EPS. This is because they more strongly block dopamine than atypical antipsychotics. This lower risk for EPS is one reason why healthcare providers may prefer atypical antipsychotics.
As with all medications, antipsychotics can also cause serious side effects. These are rare, but can cause serious harm if they happen. Discuss these risks with your healthcare provider before starting an antipsychotic.
Rare but serious side effects of typical and atypical antipsychotics include:
Higher risk of death for older adults with psychosis caused by dementia
An abnormal heart rhythm called QT prolongation
Neuroleptic malignant syndrome, a severe health condition caused by very low dopamine levels
Low numbers of white blood cells (the cells that fight infections)
TD
Additionally, atypical antipsychotics come with a warning about suicidal thoughts or behavior. The risk of this side effect is highest for people under 25 years old.
There are many antipsychotic medications available. Some well-known typical antipsychotics include:
Atypical antipsychotics are much more commonly prescribed overall. Common examples include:
Aripiprazole
Lurasidone (Latuda)
Olanzapine
Quetiapine
Risperidone (Risperdal)
Ziprasidone (Geodon)
There is no certain answer to this question. Everyone’s treatment plan is unique and may change over time. Conditions like schizophrenia and bipolar disorder are chronic conditions. Some people may need to take an antipsychotic consistently in order to manage their symptoms. But this isn’t true for everyone.
Discuss your treatment goals and preferences with your healthcare provider. They can work with you to develop a plan that meets your needs. It’s important not to stop or change your antipsychotic dosage without your healthcare provider’s OK.
Antipsychotic medications are effective treatments for several mental health conditions. This group of medications is divided into two classes: typical and atypical antipsychotic medications. Typical antipsychotics tend to more strongly block dopamine. Atypical antipsychotics have greater effects on serotonin.
Both groups of antipsychotics share similar side effects, such as dry mouth, sleepiness, and weight gain. But typical antipsychotics have a higher risk of uncontrollable body movements. Both classes can cause serious side effects, including heart rhythm changes and suicidal thoughts. Discuss these risks and your treatment preferences with your healthcare provider. They can help find an antipsychotic medication that works best for you.
If you or someone you know is having thoughts of suicide, you’re not alone, and help is available. Call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
988 Suicide and Crisis Lifeline. (n.d.). 988 Suicide and Crisis Lifeline.
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