Disclaimer: I am not a licensed doctor or pharmacist and do not prescribe or provide medical advice. This guide is for informational purposes only.
As a former professional caregiver for people with disabilities, I’ve witnessed firsthand the significant impact these medications can have on individuals’ daily lives. I created this guide to provide a clear, accessible reference for anyone taking these medications—or supporting someone who is. For clarity, each entry includes both the brand name and the generic name.
These medications can affect mood, behavior, and overall well-being, so it’s important to stay informed. I strongly encourage anyone taking them, or caring for someone who does, to ask their doctor detailed questions about the purpose of the medication, how long it should be taken, proper administration, and potential side effects. This guide is intended as a starting point to help you engage in informed discussions with healthcare providers.
With this context in mind, the following section provides a concise overview of commonly prescribed antipsychotic medications. Each entry lists both the brand and generic names, along with key details such as their intended use, notable effects, and potential side effects. This guide is meant to be a quick reference, helping you better understand the medications and prepare informed questions for your healthcare provider.
Overview of Second-Generation Antipsychotics (SGAs)
Second-generation antipsychotics (SGAs), were first introduced with Clozapine (Clozaril) in 1989. They are newer antipsychotic medications that treat schizophrenia and other psychiatric conditions. Unlike older antipsychotics, SGAs affect both dopamine and serotonin. Together these neurotransmitters help manage psychotic symptoms, mood, and anxiety. They also have fewer movement-related side effects (EPS) than first-generation anti-psychotics.
While generally considered safer than first-generation antipsychotics, SGAs may cause weight gain, high cholesterol, and diabetes. Ask your prescribing physician for specific risk factors.
Clozapine (Clozaril)
Introduced: 1989
Original Purpose: Treatment-resistant schizophrenia
FDA Approval: 1989
Current Impact: Clozapine is still considered the gold standard for treatment-resistant schizophrenia. However, its use is limited due to the risk of agranulocytosis, which requires regular blood monitoring.
Current Usage: Primarily used for severe cases of schizophrenia that do not respond to other medications. It is also used to reduce the risk of suicide in people with schizophrenia or schizoaffective disorder.
Risperidone (Risperdal)
Introduced: 1993
Original Purpose: Schizophrenia treatment
FDA Approval: 1993
Current Impact: Risperidone remains widely used due to its versatility in treating schizophrenia, bipolar disorder, and irritability in autism. It has a higher risk of extrapyramidal symptoms (EPS) at higher doses.
Current Usage: Commonly prescribed for schizophrenia, bipolar mania, and behavior issues in children with autism. Available in oral and long-acting injectable forms.
Olanzapine (Zyprexa)
Introduced: 1996
Original Purpose: Schizophrenia and bipolar disorder
FDA Approval: 1996
Current Impact: Olanzapine is effective but is often a second-line choice due to its high risk of metabolic side effects, such as weight gain and diabetes.
Current Usage: Used for schizophrenia, bipolar disorder, and as an add-on for treatment-resistant depression. Often avoided in patients at risk of metabolic syndrome.
Quetiapine (Seroquel)
Introduced: 1997
Original Purpose: Schizophrenia
FDA Approval: 1997
Current Impact: Quetiapine is well-regarded for its calming effects and is often used in lower doses as a sleep aid, despite this not being its primary indication.
Current Usage: Treats schizophrenia, bipolar disorder, and as an adjunct for major depressive disorder. It is sometimes prescribed off-label for anxiety and insomnia.
Ziprasidone (Geodon)
Introduced: 2001
Original Purpose: Schizophrenia and bipolar disorder
FDA Approval: 2001
Current Impact: Ziprasidone is favored for its lower risk of metabolic side effects but is used cautiously due to potential heart-related side effects (QT prolongation).
Current Usage: Effective for schizophrenia and acute agitation. It must be taken with food for proper absorption.
Aripiprazole (Abilify)
Introduced: 2002
Original Purpose: Schizophrenia and bipolar disorder
FDA Approval: 2002
Current Impact: Aripiprazole is known for its unique action as a partial dopamine agonist. It has a lower risk of weight gain and is also used as an add-on for depression.
Current Usage: Treats schizophrenia, bipolar disorder, depression, and irritability in autism. Available in tablet and long-acting injectable forms.
Paliperidone (Invega)
Introduced: 2006
Original Purpose: Schizophrenia (active metabolite of Risperidone)
FDA Approval: 2006
Current Impact: Paliperidone provides consistent blood levels and is available as a long-acting injection, making it useful for people who struggle with daily medication.
Current Usage: Used for schizophrenia and schizoaffective disorder. Its long-acting injectable form improves medication adherence.
Asenapine (Saphris)
Introduced: 2009
Original Purpose: Schizophrenia and bipolar disorder
FDA Approval: 2009
Current Impact: Asenapine is unique as a sublingual tablet (placed under the tongue). It is less likely to cause weight gain but may cause oral numbness.
Current Usage: Prescribed for schizophrenia and bipolar mania, especially in patients needing a fast-dissolving option.
Iloperidone (Fanapt)
Introduced: 2009
Original Purpose: Schizophrenia
FDA Approval: 2009
Current Impact: Iloperidone is less commonly used due to a need for slow dose titration to avoid dizziness and potential heart-related side effects.
Current Usage: Primarily used for schizophrenia. It is often not a first choice due to its side effect profile.
Lurasidone (Latuda)
Introduced: 2010
Original Purpose: Schizophrenia
FDA Approval: 2010
Current Impact: Lurasidone is favored for its lower risk of weight gain and its effectiveness in treating bipolar depression. It must be taken with food.
Current Usage: Treats schizophrenia and bipolar depression. Often chosen for patients with metabolic concerns.
Brexpiprazole (Rexulti)
Introduced: 2015
Original Purpose: Schizophrenia and as an add-on for depression
FDA Approval: 2015
Current Impact: Similar to Aripiprazole, Brexpiprazole has a partial dopamine agonist effect and is well-tolerated with a relatively low risk of metabolic side effects.
Current Usage: Used for schizophrenia and as an adjunct treatment for major depressive disorder.
Cariprazine (Vraylar)
Introduced: 2015
Original Purpose: Schizophrenia and bipolar disorder
FDA Approval: 2015
Current Impact: Cariprazine has a unique profile that makes it particularly effective for bipolar depression and schizophrenia with fewer metabolic risks.
Current Usage: Approved for schizophrenia, bipolar disorder, and as an add-on treatment for depression.
Lumateperone (Caplyta)
Introduced: 2019
Original Purpose: Schizophrenia and bipolar depression
FDA Approval: 2019
Current Impact: Lumateperone is a newer option that balances effectiveness with a low risk of weight gain and metabolic side effects.
Current Usage: Primarily used for schizophrenia and bipolar depression, offering a newer treatment option with a favorable side effect profile.
Although, second-generation antipsychotics may have a lower risk of movement disorders, this is still considered a risk and should be discussed with your physician.
Movement disorders are:
Extrapyramidal Symptoms (EPS): Movement-related side effects like tremors, stiffness, restlessness, or muscle spasms that can occur soon after starting antipsychotics. Ask your prescribing physician about specific risk factors.
Tardive Dyskinesia (TD): Involuntary, repetitive movements (e.g., lip-smacking, grimacing) that can develop after long-term use of antipsychotics and may be permanent. Ask your prescribing physician about specific risk factors.
Sources / References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Arlington, VA: American Psychiatric Publishing, 2013.
- Stahl, Stephen M. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 5th Edition. Cambridge University Press, 2021.
- Muench, Julia & Hamer, Amanda. “Adverse effects of antipsychotic medications.” American Family Physician, 2006; 74(5): 869–876.
Patient and Caregiver Resources
- National Alliance on Mental Illness (NAMI)
- Website: https://www.nami.org
- Offers education, support groups, and resources for caregivers of people with mental illness.
- Medication Guides – U.S. Food & Drug Administration (FDA)
- Website: https://www.fda.gov/drugs/drug-safety-and-availability/medication-guides
- Provides official patient-friendly medication guides for antipsychotics and other drugs.
- Mayo Clinic – Antipsychotic Medications
- Website: https://www.mayoclinic.org
- Offers easy-to-understand information about medication uses, side effects, and safety tips.
