By Dr. Brandon Krout
During my time at Georgia South Psychiatry, I have come across many patients that would benefit from treatment with an atypical or second-generation antipsychotic medicine. Unfortunately, due to the nomenclature of this class of medication, I have observed many people reluctant to try them, mostly due to perceived bias and stereotypes centered around the name “antipsychotic.” My goal is to provide some education about this class of medication with the intent to dispel the unfortunate stigma associated with them. In hopes that we as a community can evaluate our biases and support one another.
Antipsychotic medications were first used in the 1950s as an anesthetic during surgery. They were then prescribed to psychiatric patients for their effects on reducing symptoms of psychosis which decreased the number of patients in inpatient psychiatric hospitals. These medications were so effective that between the years of 1954 to 1975, forty new medications were introduced to patients globally, with fifteen approved for use in patients in the United States. These medications came to be known as “antipsychotics.” In 1990 a new medication in this class was approved for use in patients known as clozapine. What made it popular was how well it worked along with its improved side effect profile. Clozapine’s success led to the development of further medications in the same class which came to be known as “atypical or second generation” antipsychotics.
Atypical antipsychotics work in the brain by affecting the ability of neurotransmitters called dopamine and serotonin to bind to specific receptors. When a patient is diagnosed with a mental health disorder, it is often due to an imbalance in dopamine and/or serotonin in specific regions of the brain. Not all atypical antipsychotics do the exact same thing, there are variations and nuances that make each unique with respect to these brain neurotransmitters and their receptors. A well-trained psychiatrist will be able to use specific atypical antipsychotics to help a patient achieve therapeutic results. Often, there is not a “one size fits all” approach to atypical antipsychotic medication regimens and a patient-centered approach to treatment is used.
Besides clozapine, there are many atypical antipsychotics that a psychiatrist can recommend and prescribe to help patients. A few examples are quetiapine (Seroquel), aripiprazole (Abilify), brexpiprazole (Rexulti), olanzapine (Zyprexa), lurasidone (Latuda), cariprazine (Vraylar), lumateperone (Caplyta), risperidone (Risperdal), ziprasidone (Geodon), and paliperidone (Invega) to name a few. Some come in pill form, others can dissolve under the tongue, and others come as fast-acting as well as long-acting injections.
Most atypical antipsychotic medications are FDA approved for indications like acute agitation associated with mental illness, psychosis, schizophrenia, mania in bipolar disorder, treatment resistant depression, and behavioral disorders in patients with autism spectrum disorders. A well-trained psychiatrist also knows how to use these medications with their patient’s consent for common off label uses, generally in much smaller doses, like frequent awakening and insomnia due to poor REM sleep, anxiety, depression, behavioral disorders related to dementia, borderline personality disorder, obsessive compulsive disorder, post-traumatic stress disorder, attention deficit hyperactivity disorder, substance use disorders and eating disorders.
What is often painful and difficult to observe is when patients reject trials of these medications simply because the genre of medication has the term “antipsychotic” in it. Being on an antipsychotic medication, first or second generation, does not necessarily mean that someone is psychotic or should be stigmatized as such. But rather, they should be seen as someone who has decided to seek help from a physician who is appropriately trained and willing to provide care for a disease process that they often cannot control. It shows that the patient is willing to do what is necessary to promote and improve their mental health and wellness for themselves and often for their family. They should be encouraged and supported by all of us, isn’t that what community is?
You should not be afraid of a medication because of its name or the class of medication that it is. When prescribing a medication like an antipsychotic, your physician at Georgia South Psychiatry has listened to you and has done a proper examination. The treatment plan developed is tailored to you and your circumstances. Your physician will go over all the potential risks, benefits, side effects, including good ones, and alternatives prior to initiating any medication with your consent and your questions will be answered. It is also important to communicate with your physician how you are feeling and if you feel there are side effects as you work together to manage your care. If you have questions about your mood, or you’ve noticed a friend or family member is struggling or about behavioral health in general, rest assured that there are well trained and friendly folks at Georgia South Psychiatry who are ready and willing to help.
