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Are second generation antipsychotics a distinct class?
Caroline Bonham1, Christopher Abbott
1University of New Mexico, Albuquerque, NM 87131, USA.
Journal of Psychiatric Practice
|July 31, 2008
Summary
Low- and mid-potency first-generation antipsychotics demonstrate comparable efficacy and extrapyramidal symptom profiles to second-generation antipsychotics. Treatment decisions should consider individual medication profiles over broad class distinctions.
Area of Science:
- Psychiatry
- Pharmacology
- Clinical Trials
Background:
- Second-generation antipsychotics are often termed "atypical."
- Clinical trials typically compare second-generation agents to high-potency first-generation antipsychotics.
- Few trials examine second-generation antipsychotics against low- or mid-potency first-generation agents.
Purpose of the Study:
- To review existing literature comparing second-generation antipsychotics with low- or mid-potency first-generation antipsychotics.
- To evaluate efficacy and extrapyramidal symptom outcomes.
Main Methods:
- Systematic review of eight completed, published, double-blind, randomized clinical trials.
- Analysis of outcome measures for efficacy and extrapyramidal symptoms.
- Inclusion of 1,241 patients across the reviewed trials.
Main Results:
- Limited data suggest comparable efficacy between mid- and low-potency first-generation antipsychotics and second-generation antipsychotics.
- Extrapyramidal side effect profiles were also found to be comparable.
Conclusions:
- First-generation and second-generation antipsychotics (excluding clozapine) are diverse but show similar clinical efficacy and potential for extrapyramidal symptoms.
- Clinicians should personalize antipsychotic selection based on individual drug profiles, not solely on generation classification.
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