Coping with Atypical Antipsychotic Side Effects
Atypical antipsychotics are widely believed to be better tolerated in adults than first-generation, or typical antipsychotics, and more likely to be taken long-term. They are less likely to cause tremors and other serious movement disorders that affect users of typical antipsychotics.
In contrast to the earlier drugs, atypicals usually work on serotonin receptors in addition to dopamine receptors. Drugs in this group include olanzapine (Zyprexa), clozapine (Clozaril), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify) and paliperidone (Invega).
The drugs are prescribed for conditions such as schizophrenia and bipolar disorders and may also be given for agitation, anxiety, psychotic episodes and obsessive behaviors. Their off-label use is increasing, and the Food and Drug Administration has now approved Abilify for use in adults who do not respond to antidepressants alone.
The most common side effects include dry mouth, blurred vision and constipation, dizziness or lightheadedness, and weight gain. Sometimes atypical antipsychotics can cause problems sleeping, extreme tiredness and weakness.
With long-term use, atypical antipsychotics can also carry a risk of tardive dyskinesia, a condition involving repetitive, involuntary movements often of the mouth, tongue, facial muscles and upper limbs. Physicians aim to prevent its development by using the lowest effective dose of antipsychotics for the shortest time.
When possible the medication should be stopped, or reduced, if tardive dyskinesia is diagnosed. But the condition may remain for months, years, or even permanently. Its symptoms may be reduced with the drug tetrabenazine (Xenazine), but this drug has been linked with its own side effects, including depression, dizziness, drowsiness, insomnia, fatigue and nervousness.
Other medications may also help tardive dyskinesia, including ondansetron (Zofran) and several anti-Parkinsonian drugs. Benzodiazepines have been tried, but a 2006 review found this treatment “did not result in any clear changes” so routine clinical use is not recommended. Changing to a newer form of atypical antipsychotic might be beneficial.
Associate Professor Thomas Schwartz from the Department of Psychiatry at the State University of New York says that the lower-potency atypical antipsychotics, Seroquel, Abilify and Geodon, “are probably associated with the smallest risk for tardive dyskinesia.”