What Antipsychotic Drugs Are Used for Schizophrenia?

October 7, 2025 •

3 min read

Approximately 1% of Americans have schizophrenia, a chronic brain disorder that is typically managed with medication. To treat the symptoms of this condition, an array of antipsychotic drugs are used for schizophrenia, offering different mechanisms of action and side effect profiles.

Quick Summary

This article explores the different classes of antipsychotic medications used for schizophrenia treatment. It details the mechanisms, examples, and side effect profiles of first-generation (typical), second-generation (atypical), and newer antipsychotics. A comparison table highlights key differences, and the role of long-acting injectables and treatment personalization is also discussed.

Key Points

Two Main Classes: Antipsychotic drugs are primarily categorized as first-generation (typical) and second-generation (atypical) based on their development and action.
Different Mechanisms: Typical antipsychotics block dopamine D2 receptors, while atypical drugs block both dopamine and serotonin receptors.
Positive vs. Negative Symptoms: Typical drugs are best for positive symptoms like hallucinations, whereas atypicals can also help with negative symptoms like withdrawal.
Side Effect Trade-offs: Typical antipsychotics pose a higher risk of movement-related side effects, while atypical drugs carry a greater risk of metabolic issues like weight gain.
Novel Treatments: Newer drugs like Cobenfy use different mechanisms, such as targeting muscarinic receptors, to potentially reduce common side effects.
Treatment Adherence: Long-acting injectable (LAI) formulations are available to improve medication consistency and adherence for some patients.
Individualized Care: The choice of antipsychotic is highly personalized, and finding the right medication often requires careful adjustment and monitoring by a healthcare professional.

Antipsychotic medications are a primary treatment for schizophrenia, helping to manage symptoms such as hallucinations, delusions, and disorganized thinking. These medications can help control symptoms and prevent relapses, although they do not cure the illness. Antipsychotics are generally classified into different generations based on their development and how they work.

Understanding the Role of Antipsychotics in Schizophrenia

Most antipsychotic medications work by changing the levels of neurotransmitters in the brain. Early focus was on dopamine due to its link to psychotic symptoms. Newer medications also target serotonin and other receptors, creating more complex effects. By influencing these chemical pathways, antipsychotics can help stabilize mood and reduce psychosis severity.

First-Generation (Typical) Antipsychotics

Introduced in the 1950s, first-generation antipsychotics are the original type used for schizophrenia. They primarily block dopamine D2 receptors, effective for positive symptoms like hallucinations and delusions. Common examples include Haloperidol, Chlorpromazine, and Fluphenazine. A drawback is a higher risk of extrapyramidal side effects (EPS), including tardive dyskinesia.

Second-Generation (Atypical) Antipsychotics

Second-generation antipsychotics, introduced in the 1990s, are often the initial treatment choice due to a better side effect profile. They block dopamine D2 receptors and affect serotonin receptors. This can help with both positive and negative symptoms. Common examples include Risperidone, Olanzapine, Quetiapine, Aripiprazole, and Clozapine. While having a lower risk of EPS, atypical antipsychotics carry a higher risk of metabolic side effects like weight gain and elevated cholesterol and blood sugar.

Newer and Novel Antipsychotics

Research continues into new antipsychotics. Cobenfy, approved in 2024, targets muscarinic receptors, potentially reducing metabolic and movement side effects. Other newer agents include brexpiprazole, cariprazine, and lumateperone.

Comparison of Antipsychotic Generations


Feature	First-Generation (Typical)	Second-Generation (Atypical)
Mechanism of Action	Primarily blocks dopamine D2 receptors.	Blocks dopamine D2 receptors and serotonin 5-HT2A receptors.
Primary Symptom Effect	Best for positive symptoms (hallucinations, delusions).	Effective for both positive and negative symptoms (social withdrawal, flat affect).
Key Side Effect Profile	Higher risk of extrapyramidal side effects and tardive dyskinesia.	Lower risk of EPS, but higher risk of metabolic side effects (weight gain, diabetes).
Examples	Haloperidol, Chlorpromazine, Fluphenazine.	Risperidone, Olanzapine, Quetiapine, Aripiprazole, Clozapine.
Patient Adherence	Often hampered by uncomfortable movement-related side effects.	Generally better due to fewer EPS, but metabolic issues can be a concern.

Long-Acting Injectable (LAI) Antipsychotics

LAI antipsychotics are available for patients who find it difficult to take daily oral medication. These injections, administered periodically, help ensure consistent medication levels and improve adherence. Options include Risperidone, Paliperidone, Aripiprazole, and Haloperidol.

Finding the Right Medication

Selecting the appropriate antipsychotic often involves trying different options. Healthcare professionals consider symptoms, potential side effects, and overall health. For treatment-resistant cases, clozapine is the most effective but requires careful monitoring. Regular follow-up and communication with a healthcare provider are important for managing side effects and optimizing treatment.

Conclusion

Antipsychotic drugs are crucial for managing schizophrenia symptoms. First-generation drugs primarily treat positive symptoms but have a higher risk of movement side effects. Second-generation drugs address a wider range of symptoms with fewer movement issues but have metabolic risks. Newer medications offer different mechanisms that may reduce side effects. Treatment is personalized, requiring collaboration with a healthcare provider to balance symptom control and side effects. LAI formulations can improve adherence.

For more detailed information on specific medications, consult the National Institute of Mental Health (NIMH) website.

Potential side effects of these medications

Side effects vary among individuals and drugs. Discuss any concerns with a healthcare provider. Possible side effects include dry mouth, drowsiness, weight gain, dizziness, movement disorders, metabolic changes, headaches, sexual dysfunction, and constipation. Close monitoring by doctors is important for managing side effects and personalizing treatment.

Frequently Asked Questions

The main difference lies in their mechanism of action and side effect profiles. First-generation (typical) antipsychotics primarily block dopamine D2 receptors and are more likely to cause movement-related side effects. Second-generation (atypical) antipsychotics block both dopamine and serotonin receptors, are effective against a broader range of symptoms, and have a lower risk of movement issues but a higher risk of metabolic side effects.

While effects on anxiety or agitation can be noticeable within hours, it typically takes several days or weeks for antipsychotics to significantly reduce symptoms like hallucinations and delusions. The full therapeutic effect may take even longer, and healthcare providers often adjust dosage over time.

Newer antipsychotics, particularly the atypical ones, are generally the first-line treatment because they have fewer severe movement-related side effects. However, some atypical drugs carry a higher risk of metabolic issues. The most recent drugs, like Cobenfy, offer novel mechanisms that may reduce some traditional side effects, but long-term data is still being gathered. The "best" drug depends on the individual's needs and tolerance.

LAI antipsychotics are injected every few weeks or months rather than taken daily as a pill. They are a valuable option for patients who struggle with medication adherence, ensuring consistent therapeutic levels in the body.

Clozapine (Clozaril) is an atypical antipsychotic considered the most efficacious for treatment-resistant schizophrenia, meaning cases where other medications have not worked. However, it is reserved for these situations due to its serious potential side effects, including a dangerous drop in white blood cell count (agranulocytosis), which requires careful monitoring.

No, not all antipsychotics cause weight gain, but many do, particularly second-generation (atypical) ones like olanzapine. Some newer drugs and some older ones have a lower risk of metabolic side effects. A healthcare provider will monitor weight and other metabolic markers during treatment.

No, you should never stop taking your medication without consulting a doctor. Schizophrenia is a chronic condition, and stopping medication can lead to symptom recurrence and potential relapse. Most people require long-term treatment to manage their symptoms effectively.

If you experience side effects, you should inform your healthcare provider immediately. They may be able to adjust the dosage, prescribe additional medication to manage the side effects, or switch to a different antipsychotic.