What are the different types of antipsychotics?

There are two types of antipsychotic medication:

• typical (older drugs) 
• atypical (more recently developed drugs).

There are differences between these types, especially in relation to the side effects they may cause.

It is important to remember that each person reacts differently to a medication, so it is never certain how they will be affected by side effects, or how effective the prescribed drug will be in reducing symptoms. This can mean that the first medication you try may not be the right one for you.

Many people find the side effects of the newer atypical drugs easier to cope with than those of the typical drugs. If you have been on an antipsychotic for several weeks and the side effects are too difficult to put up with, you should ask your psychiatrist about trying a different one.

Antipsychotic medication can come as

• tablets
• syrup
• an injection (this is called a ‘depot’).

The injections could be useful for someone who may not remember to take their medications when they are supposed to.

The current guideline from the National Institute of Health and Clinical Excellence advises that the choice of medication is to be made by the service user together with the clinician.

They should consider together the side effect profiles of each drug. The carer should be involved in the decision unless the service user objects.

Typical antipsychotics

Typical antipsychotics have been available since the 1950s and are the most researched. They were also the most prescribed for a long time.

The following medications are typical antipsychotics (with the brand name in brackets):

• Chlorpromazine (Largactil)
• Fluphenazine (Modecate)
• Trifluoperazine (Stelazine)
• Flupenthixol (Depixol)
• Zuclopenthixol (Clopixol)
• Haloperidol (Haldol)
• Pimozide (Orap)
• Levomepromazine (Nozinan)
• Fluspirilene (Redeptin)
• Benperidol (Anquil)
• Promazine (Sparine)
• Pericyazine (Neulactil)
• Sulpiride (Dolmatil, Sulpitil)
• Perphenazine (Fentazin)
• Pipothiazine (Piportil)

Atypical antipsychotics

The following medications are atypicals (with the brand name in brackets):

• Amisulpride (Solian)
• Aripiprazole (Abilify)
• Clozapine (Clozaril, Denzapine, Zaponex) – used when other medications have no effect
• Risperidone (Risperdal & Risperdal Consta)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Zotepine (Zoleptil)

Clozapine is an antipsychotic that works in a different way to other available medications. The NICE guidelines for schizophrenia state that clozapine should be offered to people who have not responded to treatment (where two other antipsychotics including one atypical have not been effective). In rare cases, clozapine can reduce the levels of white blood cells. This can be a potentially very serious side effect, so it is necessary for people on clozapine to have regular blood tests.