Atypical antipsychotics, also called second-generation antipsychotics, are medications developed from the 1990s onward that treat psychosis with a lower risk of the movement side effects associated with older drugs such as haloperidol. They act mainly on dopamine D2 and serotonin 5-HT2A receptors, with each drug having its own profile. Common examples include aripiprazole (Abilify), quetiapine (Seroquel), olanzapine (Zyprexa), risperidone (Risperdal), lurasidone (Latuda), ziprasidone (Geodon), cariprazine (Vraylar), brexpiprazole (Rexulti) and lumateperone (Caplyta). Clozapine, the first atypical, remains the most effective option for treatment-resistant schizophrenia but requires blood monitoring.
Despite the name, these medications are used far beyond schizophrenia. Several are approved for bipolar mania and bipolar depression, and aripiprazole, brexpiprazole, quetiapine and cariprazine are approved as add-on treatments for major depression that has not fully responded to an antidepressant. That augmentation use is one of the most common reasons a Stedfast Psychiatry provider might prescribe one. Side effects vary by drug and include weight gain, elevated blood sugar and cholesterol, sedation, restlessness called akathisia, and, less often, movement disorders. Because of the metabolic risks, your provider will check weight, blood pressure, fasting glucose and lipids at baseline and periodically. Choosing among atypicals involves balancing effectiveness against these risks for your situation, and lower-dose use for depression augmentation generally carries fewer side effects than full antipsychotic dosing.