NeurolepticFactSheet
Atypical & Typical Neuroleptics
Risperdal, Zyprexa, Seroquel, Geodon, Abilify, Clozaril, Thorazine, Haldol, Prolixin, Trilafon, Navane
Medication Fact Sheet
1) Biochemically a Dopamine-Serotonin Antagonist: Medications in this group can be named or classified by their biochemical action Dopamine-Serotonin Antagonism. They work in certain parts of the brain to decrease the effects of dopamine and serotonin . Excessive dopamine can cause to much agitation, anger, inappropriate good feelings and thought problems like hearing voices and disorganized thinking. Serotonin problems can lead to too much anxiety, phobias, panic, and compulsions or depression with low energy, drive and lack of interest and pleasure in things.
2) Medication in this Class: Included are Zyprexa, Seroquel, Geodon , Abilify and Clozaril. They have the same good and bad effects except for Clozaril which is used only in special situations because of possible negative effects it may on white blood cells that require special blood tests. Abilify has added Dopamine Agonist [enhancing] effects which give it some potentially unique properties.
3) A Class with Many Functions: Their functions as decreasing the effects of serotonin and dopamine is overly simplistic. This class of medications actually works on many brain chemicals and works more as a modulator to rebalance these chemicals, resulting in many effects and functions. This classes name has changed as understanding of these effects and functions, and how they help mental health disorders. Some of the other names are listed below.
4) Second Generation Antipsychotics: They first were called second generation antipsychotics first used to treat psychotic symptoms like hearing voices, paranoia, disorganized thinking. The first generation medications like Thorazine and Haldol, mostly blocked dopamine being called Dopamine Antagonists.
5) Atypical Neuroleptics: Neuroleptic means working on the nerves and what made these atypical was not only did they work on serotonin but helped with negative symptoms of psychotic disorders like no motivation, little to no speech, and lack of emotional responses, and effects on anxiety and depression.
6) Major Tranquilizer: These medication do calm down though do not really tranquilize or sedate, but do so in a non habit forming or dependent manner through their direct chemical effects on dopamine , serotonin, histamine and other brain chemicals and are useful to help over excitement or agitation.
7) Mood Stabilizing Effects: This class helps with emotions that rapidly change and with mood swings and have been found effective as mood stabilizing agents.
8) Anti Aggressive-Irritability Effects: The class as whole not only help calm down, and help excitability, and agitation, but have been shown to have specific effects on aggression and irritability. Risperdal has received approval for these symptoms specifically in Autistic children.
9) Movement-Impulse Effects: this class is effective in the motor and vocalizations of Tourette’s, and similar disorders, such as certain forms of Stuttering and Compulsive Disorders.
10) Antidepressant and Antianxiety Effects: It has been shown clinically that this class through dampening and balancing dopamine-serotonin have even at small doses helpful effects on anxiety and depression much like the class of medications called SSRI/NRI/DRI’s, which include Prozac, Zoloft, Paxil, Celexa, Luvox, Lexapro, Effexor, Cymbalta, Straterra and WelButrin.
11) Advantages Over the SSRI Type : The SSRI type of medication work on a deficit model building up Serotonin, Dopamine and Norepinephrine in the brain, to help uncomplicated, and not too severe Disorders and symptoms of Anxiety, Unipolar Depression, Panic, Obsessions/Compulsions. If these problems are too severe or complicated by mood swings, anger, rage, impulsiveness, thinking problems that may represent an imbalance rather than a deficit of brain chemicals. In this case the SSRI type may worsen the original problems and intensify mood swings, aggression toward self and others, and bring out or cause psychosis and mania, the very symptoms the atypical neuroleptic medications help. As of this writing Seroquel received approval for Bipolar depression, but as group all are effective for this and for Unipolar depression.
12) Anticonvulsant Mood Stabilizers: Depakote and Tegretol are two anticonvulsants that have mood stabilizing effects, helping the high energy excitability, anger, aggression, agitation, and anxiety associated with mood swings and helps stabilize the moods, but they do little for the low energy depressed, slowed down, lack of drive or motivation phase , of up and down mood disorders. Lamictal is another mood stabilizing anticonvulsant that is a stand alone antidepressant and unlike the SSRI type medications wont worsen mood swings or aggravate aggression, however it only has limited usefulness in severe high energy aggressive agitated anxious phase.
13) Brain Mineral Lithium as Mood Stabilizer: Lithium Carbonate a naturally occurring mineral that is in everyone’s brain is in a class by itself, is most helpful in people who have in a sense mood swing disorders or aggressive or depressive disorders that may be caused by a relative lithium deficiency in the brain. There is no way of knowing who may have good lithium responsiveness except by doing a therapeutic trial ,though family history may help. People who are lithium responsive develop very few if any side effects except thirst and a mild tremor, and are helped greatly . Others who are not responsive have very little helpful effect and many negative effects such as nausea, diarrhea, foggy feeling, muscle cramps and other such effects that outweigh what ever good effects may be occurring. Lithium is the only substance that has been proven statistically to prevent suicide and its attempts, and because of this to find if one will have a good response to it, it is worth trying. Often people who have had little good effects from it when rechallenged have good response, with lithium having life changing and perhaps life saving effects. Lithium especially useful for high energy phase of mood swings for racing thoughts, excitability, aggression, and the too good feelings of mania. Some get a moderate antidepressant effect, including preventing recurrent depression.
14) Advantages of Atypical Neuroleptics as Mood Stabilizers: The main advantage is that unlike the other mood stabilizers it can work on the all three part of mood swing disorders. It helps the highs, the lows and stabilizes the mood. Also if psychotic symptoms are present they will be helped. It does this in most people whether the disorder is mild or severe. Lithium may also do this but mostly in responsive people whose symptoms are moderate to severe, , and Lamictal may do this if the high energy symptom are on the milder side. The older typical neuroleptics help mostly with the high energy phases, and can be very effective if aggressiveness is the main problem. The other advantages are safety, ease of use, with a very favorable side effect profile and no need for blood work. Also because of their broad spectrum of functions and effects if there are significant anxiety symptoms and those of Unipolar depression they may helped without the need for other medications.
15) Broad Spectrum of Functions: To summarize this class of medications have at least four functions or helps the following,
a) The Highs: dampens and eliminates the high energy states and symptoms like anxiety, aggression, the too happy feeling, and thought problems like racing thoughts and hallucinations
b) The Lows: dampens and eliminates the low energy state and symptoms of depression, decreased interest and pleasure, lack of motivation, poor drive with low mental and physical energy
c) Stabilizer: stabilizes symptom clusters so in mood swings or anxiety/depression there are less alternation between the two poles, energy, mood or feeling states
d) Organizing – Connecting-Ego gluing: These effects help psychotic disorganized, loose, disconnected thinking , moods, emotions, with the core split between reality and fantasy.
16) Organizing- Gluing Elaborated: Many non psychotic disorders need these ego gluing or connecting and organizing effect. In severe mood swings where there is splitting of the high energy mania agitation from the low energy states and depression and the mania takes on a life of its own. Similarly in many disorders like Unipolar depression when severe there is a splitting between thinking, emotions and body. This have the effects of having a slow body, yet a too fast mind, or vice versa, with similar splits in anxiety disorders where these medications reconnect and organize.
17) Proper Medication Management: Modern psychiatric medications if properly managed are safe, effective, working remarkably quickly, with a minimal of side effects. This occurs if one starts low and go slow, increasing or adjusting the dose based on response. The prescriber must be available and very responsive to possible negative and good effects, especially at the onset to educate, support, and make the appropriate adjustments. Never should the negative effects be greater than the good effects. If that occurs the medication should be stopped, either the medication or the biochemical diagnosis is wrong. You should be your normal self not feeling drugged or medicated.
18) Side Effects-Mild-Easily Managed: These are usually mild, controlled by adjusting the dose and pass quickly and hardly ever a reason for stopping the medication. They include mild sleepiness, but the medicine can be given a bedtime with no tiredness during the day. Occasionally there may be a mild caffeine type of stimulation which passes and the medication can be given in the morning. Less frequently nausea may occur and can be managed by using a medicine like meclazine or phenergan, until it goes away. Dizziness on awakening may occur and dose needs to lowered. Muscle cramps or stiffness is rare and is easily managed by lowering the dose or temporarily adding a medicine like Benadryl or Cogentin. There is motor restlessness that can also be managed with a Inderal which is rarer but can be troublesome and should not be confused with you getting more agitated, anxious or worried.
19) Negative Effects that Could Cause Discontinuation: The number one reason is weight gain that is usually temporary but it persists, next would be that it doesn’t work well enough and is stopped. Occasionally one of other side effects especially a muscular movement problems may persist.
20) Long Term Concerns: The major concerns in susceptible individuals ,usually with a family history are changes in blood sugar, and blood fats with increased cholesterol and triglycerides, called the metabolic syndrome which may lead to diabetes. Blood work should be done once or twice a year if one is going to be on these medications long term. The other long term concern is a movement problem called Tardive Dyskinesia which is movements around the mouth, lips and tongue, that can get worse and spread, but usually is mild and if the medicine is stopped it goes away. It is much less likely to occur with the atypical neuroleptics compared with the older typicals. It is not dangerous or harmful but could become a cosmetic issue for family members, the individual with this usually in unaware of it and doesn’t see it as a problem.
21) Risk vs. Benefit Analysis: As with all treatment you must look at the potential benefits compared to the risks. Most people take these medication for years with no serious consequences and excellent results and the serious side effects are rare and usually go away once the medication is stopped. Also these problems occur usually when you take large doses of the medication for a long periods of time. Most people in treatment are taking smaller doses for a limited time.