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Overview

Atypical antipsychotics (aka “third-generation antipsychotics”) are a group of medications that are used in various conditions including schizophrenia and mood conditions. (These medications are called “antipsychotics”, because they were originally used mainly in conditions with psychosis such as schizophrenia, however medications in this group are also used with other conditions as well, such as mood conditions. 

Medications in this group (generic name followed by the tradename®) include: 

• Aripiprazole (Abilify®)
• Ziprasidone (Geodon®)
• Risperidone (Risperdal®)
• Olanzapine (Zyprexa®, Zydis®)
• Quetiapine (Seroquel®)

What are these types of medications used for?

These medications have various uses, which include:

• Schizophrenia and other thought disorders
• Bipolar disorder
• Depression
• Irritability associated with autism
• Tic disorders like Tourette syndrome
• Disruptive behaviour disorders (including aggression)

Your doctor may be using this medication for another reason. If you are unclear why this medication is being prescribed, please ask your doctor.

How do these medications work?

Atypical antipsychotics affect the levels of certain chemicals in the brain called dopamine and serotonin, which has been shown to help people who have disorders like schizophrenia and bipolar disorder with their symptoms. 

Atypical Antipsychotics in Children and Adolescents

There are clinical trials that show that certain atypical antipsychotics may be useful with children and adolescents with certain conditions such as bipolar and schizophrenia.

Certain atypical antipsychotics are officially approved by Health Canada for certain conditions. For example, aripiprazole has been approved by Health Canada for treatment of schizophrenia and other thought disorders in adolescents 15 years of age or older and for treatment of bipolar disorder in adolescents 13 years of age and older. Note however, that many atypical antipsychotics are not officially approved by Health Canada for other uses in children and adolescents.

Nonetheless, when the potential benefits (e.g., reducing your symptoms) of using aripiprazole outweigh the potential risks (e.g., the side effects), many doctors may prescribe it “off-label” to treat several conditions.

How should these medications be taken?

Atypical antipsychotics are generally available as a tablet that is usually taken once daily with or without food. If you find that taking this medication causes stomach discomfort, try taking it with food. This medication should be taken at the same time each day as directed by your doctor. Try to connect taking it with something you do each day (like eating breakfast, or brushing your teeth) so you don’t forget.

Usually, your doctor will start with a low dose which is then slowly increased over a few weeks based on how you respond to it. You and your doctor can then discuss the best dosage to stay on based on how you tolerate this medication (how well it helps decrease your symptoms and how you are doing with side effects). Try to avoid alcohol while medication.

When do atypical antipsychotics start working?

Improvements are typically seen within a week or so, but may take up to several weeks (e.g. 6-weeks) before seeing full benefits.

These medications do not work for everyone. If you are not feeling better within a few weeks, your doctor may recommend switching you to a different medication.

How long do I have to take this medication?

This depends on the symptoms you have, how frequently they occur, and how long you have had them. Most people will need to take these medications for at least several months. You can talk with your doctor about how long you may need to take this medication.

Do not increase, decrease, or stop taking this medication without discussing it with your doctor.  If you stop taking these medications suddenly, it is possible that your symptoms may return or you may have a bad reaction.

Are atypical antipsychotics addictive?

No, these types of medications are not addictive and you will not have “cravings” for this medication like you might with nicotine or street drugs. If you and your doctor decide it is best for you to stop taking this type of medication, your doctor will explain how to safely come off this medication so you don’t feel negative effects as your body adjusts to being without it.

What are the side effects of this type of medication and what should I do if I get them?

As with most medications, side effects may occur when taking this type of medication. However, most side effects are mild and temporary. Sometimes the side effects may occur before any of the beneficial effects. It is also possible for some individuals to experience side effects that they feel are concerning or long-lasting. If this occurs, speak to your doctor about ways to manage them. Below are some of the more common side effects of taking this medicine. In brackets are suggested ways to lessen these effects.

Common side effects

Side effects are usually more common when starting a medication or after a dose increase. If any of these side effects is troublesome for you, please discuss them with your doctor, nurse or pharmacist.

• Agitation (avoid caffeine from energy drinks, colas, tea and coffee)
• Blurred vision (usually disappears in 1-2 weeks; use bright lights or a magnifying glass when reading)
• Constipation (increase exercise, fluids, vegetables, fruits, and fiber)
• Dizziness or feeling lightheaded (try getting up slowly from a sitting or lying down position)
• Feeling tired, drowsiness, or difficulty falling asleep (speak with your doctor if these effects persist)
• Headache (try using a pain reliever like acetaminophen (plain Tylenol®))
• Muscle spasms or stiff muscles (there is a medication to relieve this, talk to your doctor)
• Nausea or stomach ache (try taking the medication with food)
• Weight gain (monitor your food intake, increase your exercise)

Tip: These medications can make some individuals feel drowsy, dizzy or slowed down. If you experience these temporary side effects, it is important to avoid operating heavy machinery or driving a car.

Uncommon side effects (e.g. those that occur in less than 5% of patients)

Contact your doctor IMMEDIATELY if you have any of these side effects:

• Fainting, feeling lightheaded or difficulties with balance
• Fast or irregular heart beat
• Feelings of restlessness
• Fever or excessive sweating
• Frequent urination accompanied by excessive thirst
• Rash
• Seizures
• Shaking, stiffness or difficulty moving, muscle spasm or stiffness in your throat or tongue
• Thoughts of hurting yourself, suicide, increased irritability/hostility or feeling worse
• Weakness or severe muscle pain

Rare side effects

• Neuroleptic Malignant Syndrome: This is a rare side effect with symptoms including severe muscle stiffness, high fever, increased heart rate and blood pressure, irregular heartbeat (pulse) and sweating. Contact your doctor right away if this occurs.
• Tardive dyskinesia: This is a rare side effect that can sometimes become permanent in patients who take antipsychotic medications. It involves involuntary movements of some muscles in the body like the lips, tongue, toes, hands and neck. Stopping the antipsychotic at the first signs of it occurring or switching to another “atypical” antipsychotic can decrease the chances of having this side effect continue.

What should I be aware of when taking this type of medication?

Tell your doctor or pharmacist if you:

• Have any allergies, or have experienced a reaction to a medication
• Are taking, or plan to start taking any other prescription or non-prescription medications (including herbal products).
• Have a history of heart disease, diabetes (or a family history of diabetes) or low blood pressure.
• Miss a period, are pregnant (or are planning to become pregnant) or are breast-feeding. Tell your doctor if you become pregnant while taking this type of medication.
• Are currently using alcohol or street drugs. These substances may interfere with how well the medication works for you and/or make you feel drowsy.

Tip: When taking this medication, your body may have difficulty regulating your temperature.  Make sure you drink lots of fluids and water to avoid becoming dehydrated.  You should avoid doing a lot of physical activities on hot days.

What special instructions should I follow while taking this medication?

• Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check how you are responding to aripiprazole, and to monitor for side effects.
• Try to keep a healthy and well-balanced diet and exercise regularly. Some individuals who take aripiprazole may gain weight due to an increase in appetite.
• Do not allow anyone else to use your medications

About this document

Special thanks to the Kelty Centre for Mental Health for permission to adapt this document. The original document was developed by health professionals of BC Mental Health and Addiction Services, and reviewed by the staff of the Kelty Mental Health Centre. French translation provided courtesy of the Ontario Centre of Excellence for Child and Youth Mental Health.

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Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.