Medications and Supplements
AntiPsychotic Medications: What You Need to Know
Virginia J. Duffy PhD, NPP
Medications used to treat psychotic
disorders are called antipsychotics. They have also been
referred to as neuroleptics and major tranquilizers. The first
antipsychotic, Chlorpromazine (Thorazine) was discovered in 1952 by
French psychiatrist Pierre Deniker. At the time, it was considered a
miracle drug because it helped many people with schizophrenia be
able to live outside the institution for the first time.
Antipsychotic medication is the most important aspect of treatment
for schizophrenia and quickly becoming a first choice for Bi-Polar 1
(not Bi-Polar 2) disorder. These drugs do not cure these illnesses
but rather manage and control the symptoms just as medication and
insulin can do for diabetes.
There have been many questions lately about use of these medications
"off label". This means using the medication for illnesses it is not
yet approved by the FDA for. This is not as bad as it sounds. The
FDA is very slow and potentially political and it could take years
to get approval for other uses that clearly help patients.
Clinicians are often on there own about how to best use these
medications. Good clinicians keep up with the latest research and
information from colleagues.
The other to me more serious concern is the overuse of these
medications, especially in children and older adults. There has been
lots of much needed discussion of these issues recently.
How Antipsychotics Work.
Antipsychotics are dopamine antagonists. Dopamine is a
neurotransmitter that allows messages to pass between cells in the
brain. It is believed that an excess of dopamine in the brain can
cause too much stimulation between brain cells and that results in
confusing messages and symptoms of psychosis. Dopamine antagonists
block the reuptake of dopamine from the blood which results in
decreased dopamine in the cells.
Antipsychotic are classified as typical and atypical
Typical Antipsychotics. These were the first drugs to treat
psychosis and schizophrenia in the 1950s. They are also referred to
as conventional ot first generation antipsychotics. Typical
antipsychotics are very effective but have worrisome side effects
especially tardive dyskinesia. The typical antipsychotics are
relatively inexpensive and are still used.
Typical Antipsychotics include:
Atypical Antipsychotics
These are the newer antipsychotic drugs that are
equally effective but have fewer side effects then the typical
antipsychotics. They are also referred to as second generation.
Clozapine was the first atypical antipsychotic introduced in the US
in 1990. The risk of TD is said to be ten times less with these new
medications. Atypical antipsychotics are the drug of choice in the
US. They are very effective but are also expensive. They are the
drugs of choice in the US. As time goes on however, we are learning
that the atypical antipsychotic drugs also have significant side
effects. There continues to be growing concern about weight gain,
metabolic syndrome and endocrine changes.
Atypical Antipsychotics include:
References:
Torrey, E ( 2001). Surviving Schizophrenia. Quill, NY
Physicians Desk Reference (2008) American Psychiatric Association,
Stahl, S. Essential Psychopharmacology 2nd ed. (2004)
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