Atypical Antipsychotics (2nd generation antipsychotics)

Main Effects

Atypical antipsychotics are used to treat psychotic disorders (like schizophrenia and

schizoaffective disorder) and can also be used for other disorders like bipolar disorder. These

medications are helpful in controlling the positive symptoms (hallucination and delusion) and

negative symptoms (anhedonia, avolition, apathy and social withdrawal etc.) of schizophrenia

and other psychotic disorders. Typical and atypical antipsychotics are considered similar in

efficacy for treating positive symptoms (except Clozapine) while atypical antipsychotics are

more efficient in treating negative symptoms.

The main effect of some atypical antipsychotics is on “Dopamine type 4 receptors”.

There are fewer D4 receptors in Nigrostriatal pathway of brain (where the excess or

deficiency of dopamine is related to negative or cognitive symptoms of schizophrenia or

Extrapyramidal symptoms) and more in Mesolimbic pathway of brain (where the excess of

dopamine is related to positive symptoms of schizophrenia). So, when these medications

block D4 receptors in Mesolimbic pathway of brain, the activity of dopamine is reduced in

this area because of more D4 receptors in this area and hence the positive symptoms like

hallucinations or delusions are controlled. But when these medications block D4 receptors in

Nigrostriatal pathway of brain, the effect is very low because of a smaller number of D4

receptors and hence Extrapyramidal side effects are less likely to be caused.

While some other atypical antipsychotics not only block dopamine receptors but also

the serotonin receptors (5HT2A). It is because the serotonin plays role in attenuating the

dopamine activity. When the serotonin activity is blocked, there will be enough dopamine

activity in Nigrostriatal pathway to avoid Extrapyramidal Side effects (like Dystonia,

Akathisia and irregular movements etc.). There are some other receptors on which these
medications exert their effects like D1 or D2 receptors. Medicines like Clozapine or

Risperidone usually blocks the D2 receptors.

Side Effects

Atypical antipsychotics are helpful in controlling positive and negative symptoms of

schizophrenia and are developed to minimize the side effects of antipsychotics but it doesn’t

mean that these medications are without side effects. Following are the common side effects

of atypical antipsychotics,

 Type II Diabetes

 Can increase the cholesterol level

 Drowsiness

 Decreased sex drive

 Weight gain (Like Risperidone or Olanzapine)

 Seizures

 Sedation (like Quetiapine)

 Dyslipidemia

Dyslipidemia is related to lipids or fats. Lipids are very much important for our life and

their balanced presence is important for living cells. In dyslipidemia, there is an abnormal

level of lipids usually high that can cause a heart attack or any heart disease.

Though the atypical antipsychotics are less likely to cause Extrapyramidal side effects

but still there are chances that these medicines can cause EPS when used in high doses.

Research shows that Tardive Dyskinesia (an involuntary neurological movement disorder) is

less likely to appear when using Clozapine, Risperidone or Olanzapine. But research suggests

that if any patient who is more at risk of developing EPS (like elder people or people who
experienced significant parkinsonism or akathisia) should be examined after every 6 months

if he or she is taking atypical antipsychotic medications (Marder, 2002).

References

Marder, S. R., Essock, S. M., Miller, A. L., Buchanan, R. W., Davis, J. M., Kane, J.

M., ... & Schooler, N. R. (2002). The Mount Sinai conference on the

pharmacotherapy of schizophrenia. Schizophrenia bulletin, 28(1), 5-16.