Antipsychotic Drugs

Formerly known as “major tranquilizers” or “neuroleptics,” the antipsychotic
drugs have revolutionized the treatment of schizophrenia and other
psychoses. The underlying cause of psychosis is not known, but it is thought
to be related to the neurotransmitter dopamine. Most of the antipsychotics
block the dopamine receptors in the brain. The older antipsychotic drugs
include thorazine, thioridazine, perphenazine, trifluoperazine, fluphenazine,
thiothixene, and haloperidol. These older drugs treat the so-called
positive symptoms of schizophrenia—hallucinations and delusions—but
they have little effect on the “negative” symptoms—withdrawal, poor interpersonal
relationships, and slowing of the body’s movement. They also have
multiple serious side effects including severe muscle spasm, tremor, rigidity,
shuffling gait, stupor, fever, difficulty speaking, blood pressure changes,
restlessness, and involuntary movements of the face, trunk, arms, and legs.
Some of these are treatable using other drugs, but some are neither treatable
nor reversible.
In an effort to overcome these problems, newer antipsychotics have been
developed. The first of these was clozapine, which was successful in treating
about one-third of the patients who did not respond to other antipsychotic
drugs. While it had fewer of the serious side effects listed above, a small percentage of patients experience a severe drop in the white blood cells, which
puts them at risk for serious infection. For this reason, patients on clozapine
must be followed with frequent blood counts. Other newer antipsychotics
include risperidone, olanzapine, and quetiapine. In addition to fewer of the
serious side effects, the newer antipsychotics seem to have some effect on
the negative symptoms.
Sources for Further Study
Breggin, David, and Peter Cohen. Your Drug May Be Your Problem: How and
Why to Stop Taking Psychiatric Drugs. Cambridge, Mass.: Perseus, 2000. A
controversial book making an important argument that too many people
are taking psychiatric medications and suffering serious side effects from
those drugs. The authors give specifics about how to withdraw from drugs
safely.
Drummond, Edward H. The Complete Guide to Psychiatric Drugs: Straight Talk
for Best Results. New York: John Wiley & Sons, 2000. Covers the state of
knowledge about psychiatric illness, what medications may be helpful,
how to decide whether medication might be useful, managing side effects,
and nondrug therapies.
Gorman, Jack M. The Essential Guide to Mental Health: The Most Comprehensive
Guide to the New Psychiatry for Popular Family Use. New York: St. Martin’s
Press, 1998. Covers psychiatric illness, how to search for a psychiatrist,
drugs, and over-the-counter remedies.
__________. Essential Guide to Psychiatric Drugs. 3d ed. New York: St. Martin’s
Press, 1997. Contains detailed descriptions of the psychiatric medications
available in the United States, including uses, adverse effects, cost, dosages,
and research findings. Written in a straightforward style for the
layperson but also useful to clinicians.
Healy, David. The Creation of Psychopharmacology. Cambridge, Mass.: Harvard
University Press, 2002. Details the discovery and development of psychiatric
medications, the extremely profitable partnership between psychiatrists
and the large pharmaceutical companies, and the frightening consequences
for today’s culture and society.
Kramer, Peter D. Listening to Prozac: A Psychiatrist Explores Antidepressant Drugs
and the Remaking of the Self. New York: Penguin, 1997. An examination of
the growing use of drugs in the treatment of mental illness, with discussion
of the implications of this practice, both positive and negative.
Olson, James. Pharmacology Made Ridiculously Simple. 2d ed. Miami: Med-
Master, 2001. A brief and straightforward explanation of the general
principles of pharmacology. Enhanced by excellent diagrams and tables.
Rebecca Lovell Scott
See also: Cognitive Behavior Therapy; Cognitive Therapy; Psychotherapy:
Goals and Techniques. 306