Antipsychotic "Guide"

Hey all! Today in my neuropsychopharmacology class we covered all the different kinds of antipsychotics. It was very interesting to learn how they all worked and how psychiatrists choose which medication would work best. I think that it’s good to be knowledgeable on medications so you can have an informed discussion with your doctor about them. So I’m gonna share what I learned for anyone thinking of switching, who’s not happy with their current meds or who just wants to know more about what they’re on!

There’s three types of antipsychotic classes, dones, pines, and 2 pips and a rip. (They’re called that because they have those things in their names, like risperiDONE, clozaPINE…etc) Dones and 2 pips and a rips aren’t going to have as many side effects as drugs in the pines class but pines are overall more effective.

2 Pips and a Rip
-Abilify (Aripiprazole): One of the most popular APs due to its minimal side effects, very unlikely to cause weight gain and also isn’t supposed to make you sleepy either, BUT it’s not effective for severe cases of sz
-Rexulti (Brexpiprazole) & Vraylar (Cariprazine): Very new medications. Vraylar I don’t think is FDA approved in the US yet. They are supposed to have the same minimal side effects as Abilify but are more effective than it at the same time. Not much research has been done on them though.

-Risperdal (Risperidone): One of best APs for those who may become aggressive during episodes second to Clozapine (and has much less side effects), works best in low dosages so you don’t need a lot in your system
-Invega (Paliperidone): Breaks down really slowly in your system so you only need to take one dose of it a day. Good if you’re someone who’s gonna forget to take their meds multiple times a day.
-Fanapta (Iloperidone): One of the newest dones, I don’t know too much about it other than you need to start it in small doses because too much too fast causes big problems (hypertension…) But still it’s another option if you want something with less side effects but the other options haven’t been working.

Pines (note these have a LOT of side effects but they’re very effective at eliminating positive symptoms…if you’re on one of the other meds and they aren’t working consider switching to one of these)
-Seroquel (Quetiapine): Most common side effects dry mouth, constipation, will make you sleepy. Different doses have different effects. High doses it’s an antipsychotic, mid doses it’s an antidepressant, low doses it’s pretty much just a sedative.
-Zyprexa (Olanzapine): Same side effects as Seroquel. Likely to cause weight gain :frowning: Also it increases insulin resistance (meaning if you’re diabetic this is NOT the AP for you, and could be very dangerous to your health, tell your doc if you are diabetic)
-Clozapine: Hands down the most effective medication for treating sz out there. Will work for almost all people with sz. Most effective for treating those with violent episodes. Very unlikely to cause tardive dyskinesia or other motor issues over time. Unfortunately it’s also the med with the most side effects. Has all the side effects of dry mouth, constipation, etc, will make you very sleepy, causes the most weight gain of any other AP, causes seizures at high doses, and has a low chance of making you develop a condition that gives you less white blood cells (like a 2% chance so it’s probably not even worth mentioning). Even though its side effects are nasty, like I said it’s currently the most effective treatment for sz. If nothing else is working for you, this likely will.

Anyways that’s my little guide! :slight_smile: Disclaimer, medications affect everyone differently so some people on these meds may not experience those listed side effects at all, may experience different side effects or maybe not even get any. Also I’m not a doctor obviously, so refer to them first if you ever have any concerns with your medication. (Also a warning-our professor told us that while switching meds, sometimes in the middle of switching them while you’re on the old and new med, you may improve, and a bad doctor will just keep you on both. This is NOT OK and don’t let your doctor do this! Use of multiple antipsychotics at the same time should only be used for those w SEVERE and TREATMENT RESISTANT schizophrenia. There has been little to no research done on how antipsychotics interact with one another long term and it is considered dangerous to do this if not absolutely necessary!)

Anyways hope this was helpful or at least informative! Time to go back to studying :sunny:


I’m on Abilify but still hear voices. I’m also on Seroquel to reduce voices at night so I can sleep.

My pdoc says I’m on last chance for abilify because I’m on 25 mg. She won’t rise it more.

I think it is very common to mix other AP’s with seroquel.

Yeah, like I said seroquel doesn’t always act as an antipsychotic, it depends on the dosage. My first psychiatrist prescribed me abilify and seroquel as well. (I ended up taking neither because I was paranoid, knew nothing about the drugs because she didn’t talk about it with me and was offended by how I was treated by her, whoops)

Bad pdoc. She should have informed you about them.

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Feels sort of like speed dating. I think I’d like to go home with Risperidone.

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Yeah I switched pdocs pretty quickly, ha.

@Turnip lol

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