Antipsychotic drug treatment of bipolar or depression is highly dependent on the target symptoms, which present a chronic or persistent disruption to an individual's life. The underlying psychosis for prescribing antipsychotic drugs include hallucinations, severe mood disturbances, acute mania and psychotic forms of depression. Classes of antipsychotic drugs include phenothiazines, thioxanthenes, butyrophenones and other heterocyclic (atypical) antipsychotics.
Phenothiazines
Phenothiazines, such as Thorazine, Mellaril and Compazine, are classified as first-line (conventional/typical) antipsychotics that also work as neuroleptics, dopamine-2 antagonists and antiemetics. Some of the drawbacks pertaining to the phenothiazines include considerable weight gain and excessive drowsiness. In many cases, these drugs are prescribed only after newer types have failed.
Thioxanthenes
Thioxanthenes, such as Navane and Accuphase, are the next first-line (conventional/typical) class that may be prescribed for bipolar or depression. This group of drugs can be considered chemically similar to phenothiazines in their ability to antagonize dopamine-2 receptors, but they seem to have fewer side effects associated with weight gain and may be the preferred approach.
Butyrophenones
Butyrophenones (Haldol) are a first-line (conventional/typical) antipsychotic drug most commonly used and FDA-approved for the treatment of the more severe forms of mixed/manic bipolar disorder. In the event of a psychotic episode, intramuscular haldol injections are given to immediately calm and suppress combativeness or self-injurious behaviors. This group of drugs is generally prescribed in pill form when the individual presents a danger to himself or others and no other option is available.
Heterocyclic (Atypical)
Heterocyclic (atypical) antipsychotics, such as Risperdal, Zyprexa, Seroquel, Geodon and Clozaril, are considered atypical antipsychotics, most notably because they are serotonin-dopamine antagonists, are mood-stabilizing drugs and rank in a second-generation and second-line method of pharmacotherapy. These antipsychotics are both prescribed for and FDA-approved in the treatment of acute/mixed episodes of bipolar mania and have proved effective in the treatment of bipolar depression with disturbed behaviors and problems with impulse control.
A newer "third generation" (atypical) group of antipsychotic drugs, such as Abilify, are readily becoming available and prescribed. They have shown great promise as partial dopamine agonists in which the mechanism of action is thought to reduce the risk of metabolic symptoms attributed to permanent health problems in previous drug generations.
References
- "The Prescriber's Guide: Stahl's Essential Psychopharmacology (3rd ed.)"; S. Stahl; 2009
- "Pharmacology for Nursing Practice"; K. Gutierrez and S. Queener; 2003
- "Prescription Drugs: Alternative Uses, Alternative Cures."; K. Loughlin and J. Generali; 2006
