There are currently two categories of psychiatric medications available to treat symptoms of psychosis. Older, or typical antipsychotics, include chlorpromazine, also called Thorazine, and other major tranquilizers. Newer, or atypical antipsychotics, are thought to have fewer side effects. Proper diagnosis and medical follow-up are necessary to ensure the health and safety of persons using these medicines. Mild side effects such as drowsiness, dizziness, dry mouth or constipation may get better on a lower dose or may resolve as treatment progresses. Antipsychotic medication is not recommended for children or the elderly and should not be changed or stopped without medical advice.
Extrapyramidal Side Effects
A network of nerve pathways, the extrapyramidal system or EPS helps the brain control body movements. According to the National Alliance on Mental Illness or NAMI, older antipsychotics are more likely to disturb this system. EPS side effects include involuntary movements such as tremors, jerking, writhing, slowed movements and muscle rigidity of the mouth, jaw, body, arms or legs. Akasthisia, literally "without sitting," is the inability to keep still. This side effect can cause patients to pace uncontrollably. Tardive dyskinesia or TD is a permanent impairment of voluntary movement that generally occurs as a side effect of long-term use of major tranquilizers.
Newer medicines are thought to be less likely to cause TD, but research is limited by the short time these drugs have been available. An article published in the May-June 2006 issue of Harvard Review of Psychiatry asserts that atypical antipsychotics continue to have EPS side effects, particularly akathisia, and that TD could occur earlier. The review faults the design of clinical trials, stating the probability of false negatives is high regarding such side effects.
Metabolic Side Effects
Atypical antipsychotic medications olanzapine (Zyprexa) and clozapine (Clozaril) are the most likely to cause weight gain, according to a study published in the January 2010 issue of Pharmacology & Therapeutics. The drugs also have other effects that increase fats, cholesterol and sugars in the blood, raise blood pressure and lead to diabetes and increase the risk of cardiovascular disease. Researchers compared the effects of ziprasidone (Geodon) and aripiprazole (Abilify), medications that are less likely to cause weight gain, in an effort to determine how future pharmaceuticals can be developed to avoid these adverse effects.
Hormonal Side Effects
Sexual side effects of typical and atypical antipsychotics are related to their effects on hormone levels. Impotence in men and irregular periods in women can be a problem for patients using older drugs. NAMI reports that galactorrhea, or leaking fluid from and enlargement of the breasts even in men, is a side effect of the newer medicines quetiapine (Seroquel), risperidone (Risperdal), olanzapine, ziprasidone and aripiprazole. Case studies on sexual dysfunction by French researchers published in the January-February 2006 issue of Encephale assert that reproductive side effects of atypical antipsychotics are common, affect treatment compliance and are dose-dependent. In women, drug-induced overproduction of prolactin may affect the ovaries, increasing the risk of osteoporosis. In men, the result of additional prolactin may prevent ejaculation. The study states that sexual side effects are more common with risperidone and less common with quetiapine.
References
- NAMI: What You Should Know About Antipsychotic Medications
- "Harvard Review of Psychiatry", Shirzadi AA, Ghaemi SN, Side Effects of Atypical Antipsychotics: extrapyramidal symptoms and the metabolic syndrome, May-Jun 2006 14(3)
- "Pharmacology & Therapeutics", Metabolic Side Effects of Antipsychotic Drug Treatment, Reynolds GP, et.al., January, 2010, 125(1)
- "Encephale", Atypical Antipsychotics and Sexual Dysfunction, Hefliger T, et. al., Jan-Feb 2006, 32(1 Pt 1)
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