Learning library · Medication education
Second-generation antipsychoticsMore than psychosis
Why these medications are used well beyond psychosis, how they generally work, and what monitoring keeps them safe.
What these medicines are
Second-generation antipsychotics, sometimes called atypical antipsychotics, were first developed to treat psychosis, when it becomes hard to tell what's real and what isn't, as in schizophrenia.
Today they're used for much more. Several treat bipolar disorder, for mania or depression and to help prevent new episodes, and some are added to an antidepressant when depression hasn't fully lifted. Being offered one doesn't mean anyone thinks you have psychosis.
Names you may hear include aripiprazole, quetiapine, risperidone, and olanzapine. This video is general education. Your own plan is something you and your provider decide together.
How they work
They mainly adjust signals carried by two brain messengers, dopamine and serotonin. That can quiet racing or distorted thoughts, ease the intensity of mania, and help steady mood.
Some changes, like feeling less agitated or sleeping better, can come within days. The full benefit usually builds over several weeks.
Side effects and monitoring
Common side effects include sleepiness, dizziness when you stand up, a bigger appetite, and an inner restlessness that makes it hard to sit still. Tell your provider about any that bother you. There's often something that helps.
Many of these medicines can raise weight, blood sugar, and cholesterol. That's why your provider checks your weight and orders blood tests before you start and along the way. Strong thirst, urinating often, or unusual hunger can be signs of high blood sugar.
Over time, some people develop movements they can't control, often of the face, lips, or tongue. This is called tardive dyskinesia. Your provider will look for it at visits, so mention any new movements, even small ones.
Important warnings
These medicines carry an FDA boxed warning: older adults with dementia who take an antipsychotic have a higher risk of death. They are not approved to treat behavior problems in dementia.
The ones also used for depression carry the antidepressant warning too: in children, teens, and young adults under twenty-five, they can increase suicidal thoughts or actions, especially in the first weeks after starting or after a dose change.
Get help right away for a high fever with stiff muscles, confusion, sweating, or a fast or irregular heartbeat. These can be signs of a rare but serious reaction.
Working together
Don't stop on your own, even when you feel better. Symptoms can come back, sometimes quickly. Alcohol can add to the sleepiness, so ask about it. If you're struggling with side effects, or feel unsafe, reach out. In a crisis, call or text 988, any time.
Everything here is general information, not medical advice for you. Talk with your provider before starting, stopping, or changing any medicine.
3 min · captions with the CC button · 5 chapters · animated diagrams