Atypical Antipsychotics

Atypical antipsychotics can be lifesaving for people who have schizophrenia, bipolar disorder or severe depression. But patients should think twice... before using these drugs to deal with... unhappiness, anxiety and insomnia - Richard A Friedman MD

Atypical Antipsychotics

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HWN Suggests

The rise and fall of the atypical antipsychotics

In creating successive new classes of antipsychotics over the years, the industry has helped develop a broader range of different drugs with different side-effect profiles and potencies, and possibly an increased chance of finding a drug to suit each of our patients. 4 But the price of doing this has been considerable – in 2003 the cost of antipsychotics in the USA equalled the cost of paying all their psychiatrists. The story of the atypicals and the SGAs is not the story of clinical discovery and progress; it is the story of fabricated classes, money and marketing

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 The rise and fall of the atypical antipsychotics

The antipsychotics brought hope and optimism to people with schizophrenia and to those who care for them. There have been successive classes of antipsychotics used by the pharmaceutical industry to persuade doctors and patients that ‘new’ is better. Evidence is growing that the primary purpose of these fabricated classes is for marketing. It is time we stopped using these expensive labels – they are all just antipsychotics.


Treatment of atypical antipsychotic overdose is mainly supportive. Activated charcoal may be considered if administered within an hour of ingestion, as long as no contraindications exist, such as the presence of sedation or vomiting. Treatment of antimuscarinic effects is generally symptomatic. The most life-threatening issue with this toxicity is often the agitated behavior of the patient. Although these individuals are not usually violent as are those exhibiting sympathomimetic toxicity, they can hallucinate and may need physical or chemical restraint. Physostigmine, a carbamate-type cholinesterase inhibitor can also be used in the management of antimuscarinic delirium. Small doses of 1–2 mg administered intravenously can usually reverse the delirium, and patients often will not be as agitated after the pharmacologic effects of physostigmine wear off in 30–60 min. If NMS is suspected, the most important aspect of treatment is withdrawal of the offending agent and particular attention to fluid and electrolyte balance.


In recent years, atypical antipsychotics or second-generation antipsychotics have become the drugs of choice for acute psychoses. They are “atypical” as they are differentiated from “conventional” or first-generation antipsychotics based on their clinical profile.

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