1st vs 2nd Generation Antipsychotics
Retired Doc recently compared 1st to 2nd Generation Antipsychotics.Here are my thoughts:My opinion on atypicals vs 1st generation antipsychotics is:
1. Clozaril has clearly superior efficacy, Zyprexa is moderately more effective, and the rest of the atypicals are marginally more effective than the 1st generation.
2. Although ALL antipsychotics(old and new) can cause weight gain and diabetes and hypercholesterolemia, the risk is clearly greater with zyprexa and clozaril.
3. Risperidone frequently causes hyperprolactinemia. This commonly causes sexual side effects, including breast enlargement in men. Whether this hyperprolactinemia causes osteoporosis in the long term is unknown.
4. Seroquel, Geodon, and Abilify are reasonable initial choices when an antipsychotic is indicated. Like all of the atypicals, the risk of tardive dyskinesia is lower than the 1st generation drugs. In my opinion, their side effect profile is better than zyprexa/risperidone.
5. Clozaril remains the drug of choice in treatment resistant patients, but because of the risk of agranulocytosis, should not be used initially.
(republished from several weeks ago with copyrighted cartoon deleted. Sorry, I didn't save the comments).