Antipsychotics.
Introduction.
Also known as "major tranquillizers" and "neuroleptics", antipsychotics are sometimes referred to as the cornerstone of treatment for psychosis. They are somewhat broadly split into two groups. Typical or first generation antipsychotics are the older drugs, whereas Atypical or second generation drugs are newer. All of these drugs work on neurotransmitters (chemical messengers) in the brain, but different individual drugs can work on different neurotransmitters. Please see this page. They are available as pills, liquids, fast acting injections (for crises) and long lasting depot injections. When treated with antipsychotics, a patient can regain control over their life and go on to achieve their goals.
Typical Antipsychotics.
The first medication of this kind, Chlorpromazine/Thorazine was stumbled upon almost by chance in the 1950s, and then tested to prove its effectiveness in treating psychosis. Since then, many other typical antipsychotics have been developed. The typical drugs work largely by blocking dopamine d2 receptors (a specific kind of dopamine receptor) in the brain. This explains their effectiveness in treating psychotic symptoms.
Pros.
There are many advantages to treatment with these older drugs. First of all, they have been proven to be effective in countless studies since the fifties so to a certain extent they are 'tried and trusted'. Also, there exists a lot of this long term data about them and their effectiveness and side effects, whereas the same cannot really be said for some of the newer drugs, that have only been around for a few years.
Another advantage is that they are generally available in a variety of preparations, more so than the atypicals. If someone, for whatever reason, does not take their pills every day they can be switched to a depot injection. This ensures they get their medicine and so don't run the risk of becoming ill again. While there are depot versions of some newer drugs (Risperdal/Risperidone for example), with most of the newer drugs this option is not available yet. The proven effectiveness of older drugs and the fact they come in different forms is used in the hospital setting. When someone is very ill and agitated, they are often treated with a fast-acting injection of a typical antipsychotic.
Yet another plus point is that there are lots of different Typical antipsychotics to choose from. While some could argue that they are all essentially the same (or fall into two basic groups), they are all different in terms of side effects caused, and of course every medication affects every person differently. This means there is more choice with these older drugs than with the newer ones.
Though most of us probably feel it should not enter into things, these older drugs are much, much cheaper than the newer ones. When a new medication is developed, the company that produces it have sort of 'exclusive rights' to manufacture and market it for a number of years. During this time the drug is said to be under patent. After this period of time, other pharmaceutical companies are allowed to develop what are called generic versions of the drug. These are essentially identical to the original in every respect. When this happens prices drop considerably. Most of the older drugs are available as cheap generic versions because their patents have expired, but the newer drugs are still under patent and so, expensive. This is not a really a concern for service users in the UK, but elsewhere in the world it can be.
Even if they were no longer useful in treatment, there is one more use for typical antipsychotics. They are almost always used as 'benchmarks' for testing the effectiveness of newer drugs in studies. The effectiveness of the drug being investigated is often compared to that of an older drug. The aim is usually for the new drug to be at least as effective as the older one at controlling psychotic symptoms, but with fewer side effects.
Cons.
Earlier it was mentioned that typical antipsychotics work (largely) by blocking dopamine d2 receptors in parts of the brain. Unfortunately, a limitation of these drugs is that they are not selective as to which parts of the brain they perform this action in. Because of this, they can affect other parts of the brain, causing side effects. Side effects are the major drawback of treatment with these kinds of drugs.
They can be sedating and cause drowsiness, but the biggest concern is what are known as extra pyramidal side effects (EPS). The older drugs cause these much more than the newer drugs because of their 'blanket bombing' action in the brain. EPS includes things like uncontrollable shaking, muscle stiffness, restlessness and other movement disorders. The good news is that these effects can be treated with different medication, so a patient needn't suffer through them without help. The bad news goes by the name of Tardive Dyskinesia. This is a potentially irreversible movement disorder brought about (predominantly) by treatment with typical antipsychotics. It usually only occurs after long term treatment with high doses, which is becoming less common these days, but it is still a real concern to anyone taking a typical antipsychotic. If a person is affected by Tardive Dyskinesia, the condition can often be reversed by switching them to a different medication, but this is not always the case.
The other big disadvantage of older drugs when compared to newer ones is that, while they can be very effective in controlling the positive symptoms of psychosis such as hallucinations and delusions, it is believed they offer no help with the negative and cognitive symptoms that can be a feature of psychotic illnesses. In this respect, the newer drugs are superior, as they are proven to help with these other symptoms too.
Conclusions.
Typical antipsychotic medications can cause rather severe side effects and do not treat every symptom of psychosis. For these reasons, they are not first choice treatments. Having said that, there are situations where they are preferable to the newer drugs, such as in crises. They can work where newer drugs fail at controlling positive symptoms, are available in many different preparations, are cheap and are tried and tested over decades. They may not be first choice anymore, but there is still a place for them in the treatment of psychotic illnesses. These drugs have helped many people regain control over their lives, and will continue to help others for the foreseeable future. Typicals on Wikipedia.
UK Typical Drug Names. In the format chemical name (brand names)
Benperidol (Anquil, Benquil)
Chlorpromazine (Largactil, Thorazine)
Flupentixol (Depixol, Fluanxol, Flupenthixol)
Haloperidol (Dozic, Haldol, Serenace)
Levomepromazine/methotrimeprazine (Nozinan)
Pericyazine (Neulactil)
Perphenazine (Fentazin)
Pimozide (Orap)
Prochlorperazine (Stemetil)
Promazine
Sulpiride (Dolmatil, Sulpitil, Sulpor)
Trifluoperazine (Stelazine)
Zuclopenthixol (Clopixol Acuphase)
Zuclopenthixol Decanoate/Dihydrochloride (Clopixol)
Comment on typical medication
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