First generation Antipsychotics
Old or Older Antipsychotics
Second generation antipsychotics
New or Novel antipsychotics
Antipsychotic medications are prescribed for a range of disorders, including psychotic disorders. While antipsychotic medications cannot ‘cure’ an individual of their mental illness, they are often prescribed with an aim to reduce or stop psychotic symptoms. Antipsychotics are also sometimes prescribed for anxiety disorders, or to supplement antidepressants for people with severe depression. They are also sometimes used to control agitation and psychotic experiences in dementia (1). Often consumer’s will feel the effects of a medication within six weeks of commencing a medication regime, however, it can take several months to take dull effect (2). Antipsychotics are often referred to as being in one of two categories – first generation or second generation antipsychotics. Some organisations use other terms for this, as illustrated in table 1. For the purpose of this resource, we will use the terms first generation and second generation antipsychotics.
Table 1 Categories of antipsychotic medication
What are depot medications?
You may notice that some of your clients receive an antipsychotic ‘depot’ medication. This occurs when their antipsychotic medication is given via injection, rather than as tablets. This form of medication slowly releases over a number of weeks, so that the depot is only needed once every two to four weeks (5). This can be easier for some people than remembering to take a medication each day. For others, they are required to receive their depot medication as a condition of their community treatment order.
Are antipsychotic medications addictive?
Antipsychotic medications are not addictive medications, that is, an individual’s dose of medication will not need to continually increase in order to achieve the same effect. They do change the way people think and feel, so it is likely if someone ceases their medication against recommendations they may experience a relapse of symptoms (5).
What are the common side effects?
First generation antipsychotics were first developed in the 1950s (3). They tend to be effective in treating some of the ‘positive’ symptoms of psychosis/schizophrenia, such as hallucinations, but are thought to have less impact on negative symptoms, such as amotivation (1). First generation antipsychotics also tend to result in more neuromuscular side effects, which often present as undesirable involuntary muscular movements. Second generation antipsychotics are viewed to be less likely to cause neuromuscular side effects, but more likely to impact cardio-metabolic health. A table which compares common side effects can be viewed in Table 2 below (4).
Although antipsychotics are generally categorised into two areas, more recently, several large scale studies have indicated that there are few significant differences (in core illness symptoms, functional outcomes, adverse events, etc.) between first generation antipsychotics and second generation antipsychotics (3).
Common side effects of antipsychotic medication
Keep in mind that different side effects will present for different people. Generally speaking, a higher dose of medication is more likely to induce side effects. It is really important to consider how the side effects of a client’s medication may impact your role as an exercise physiology student – will this influence goal setting? How might this impact your client’s ability to engage in your exercise prescription? How you might use the information you have to educate clients about the side effects of their medication.
Specific Medications: Antipsychotic Medications
There are lots of different medications that patients may be on. This list below includes some first generation antipsychotics and some second generation antipsychotics that your patients may be on. Click on the hyperlinks below for specific information about individual medications.
First generation Antipsychotics:
Haloperidol, e.g. Haldol
Chlorpromazine, e.g. Largactil
Zuclopenthixol, e.g. Clopixol
Flupentixol, e.g. Fluanxol
Second Generation Antipsychotics:
Clozapine, e.g. Clozaril
Risperidone, e.g. Risperdal
Olanzapine, e.g. Zyprexa
Quetiapine, e.g. Seroquel
Paliperidone, e.g. Invega
Amisulpride, e.g. Solian
Aripiprazole, e.g. Abilify
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0049165/ (accessed on 10/11/2015)
First-Generation Versus Second-Generation Antipsychotics in Adults: Comparative Effectiveness [Internet].
Comparative Effectiveness Reviews, No. 63.
Abou-Setta AM, Mousavi SS, Spooner C, et al.
Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Aug.
4. http://www.rethink.org/diagnosis-treatment/medications/antipsychotics/side-effects (accessed on 10/11/2015)
5. http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/depotmedication.aspx (accessed on 10/11/2015)
Metabolic SEs, e.g. weight gain & increased risk of T2D
Anticholinergic SEs, e.g. constipation & dry mouth
Sexual problems due to hormone changes
Akithesia, e.g. restlessness, inability to sit
Tardive Dyskinesia (involuntary movements of the mouth)
Sexual problems due to hormone changes