Are Atypical Antipsychotics the Least Detrimental Alternative?

Abstract

Antipsychotics are typically used for the treatment of schizophrenia, bipolar disorder, and recently, treatment resistant major depressive disorder. A significant, and very concerning, side effect present with first generation antipsychotics is extrapyramidal symptoms, which are disorders of movement. With the advent of atypical antipsychotics, also known as second-generation antipsychotics, these symptoms are purported to be much less frequent and pronounced than they were with the first generation medications. Numerous hypotheses have been proposed as to why atypical antipsychotics produce fewer extrapyramidal symptoms compared to first generation antipsychotics, which this paper will review. Unfortunately, despite the fact that atypicals have reduced extrapyramidal symptoms in those taking antipsychotics, extrapyramidal symptoms are still an unpleasant and potentially dangerous side effect, which can be difficult to detect, and difficult, or even impossible, to treat. Additionally, atypical antipsychotics result in other potentially very serious side effects, specifically and most commonly, metabolic syndrome, which can decrease life expectancy significantly. However, metabolic syndrome, unlike extrapyramidal symptoms, may be preventable in highly motivated and well-supported patients. Thus, this paper concludes that the benefits of the atypical antipsychotics (reduced extrapyramidal symptoms) outweigh the potential risks for the majority of patients.