What is the Difference Between Atypical and Typical Antipsychotics?

Antipsychotics are primarily used in the treatment of schizophrenia and schizophrenia-type mental health disorders, but they are sometimes used to treat other mental illnesses. There are two different categories of antipsychotics, typical and atypical, with some important differences between them. The most important difference is the decreased risk of some serious side effects when taking atypical antipsychotics.

Typical antipsychotics, also known as first generation or conventional, were developed in the 1950s for the treatment of schizophrenia. Concern about side effects, patient noncompliance due to side effects, and the relatively high percentage of patients who do not benefit from treatment led to the development of the atypical antipsychotics. Also known as second generation antipsychotics, they were developed in the 1990s and are currently used more frequently than typical antipsychotics. Conventional antipsychotics include chlorpromazine and haloperidol, and atypical include risperidone, olanzapine, and quetiapine.

One of the most concerning side effects of typical antipsychotics is their potential to cause movement related side effects, also known as extrapyramidal side-effects (EPS). These side effects may include muscle spasms, muscle rigidity, restlessness, tremors, and other uncontrollable movements. If used for many years, typical antipsychotics can cause tardive dyskinesia, which commonly displays as involuntary, repetitive facial movements that can be long-lasting or even permanent in some patients.

Atypical antipsychotics are less likely to cause movement related side effects. The side effects of these medications can include drowsiness, dizziness, blurred vision, sun sensitivity, and skin rash. Many patients have mild or no side effects, particularly after a few months of taking the medication.

Patients are more likely to keep taking atypical antipsychotics because the side effects are usually easier to tolerate. This means patients are less likely to relapse because of not taking their medication, which might lead to requiring admission to hospital or other care. Avoiding relapses is important because a relapse can have a severe impact on a patient's quality of life, health, as well as the well-being of family and friends who are supporting the patient, and can also necessitate expensive and time consuming treatment.

First generation antipsychotic medications still have a place in schizophrenia treatment. Some patients will respond better to them or only respond to typical antipsychotics and not atypical ones. Second generation antipsychotic medications are usually the first line of medication treatment in current management of schizophrenia. Proper care will involve listening to the patient and being open to trying different medications, both atypical and typical antipsychotics, in the search for one that is effective and tolerable.