In 1989, a new generation of antipsychotics -- called atypical or second generation antipsychotics -- was introduced. At the correct doses, fewer of the neurological side effects -- which often include such symptoms as muscular rigidity, painful spasms, restlessness, or tremors -- are seen.
The first of the new generation, clozapine (Clozaril) is the only drug that has been shown to be effective where other antipsychotics have failed. It is not linked with the side effects mentioned above, but it can produce other side effects, including weight gain, changes in blood sugar and cholesterol, and possible decrease in the number of infection-fighting white blood cells. Blood counts need to be monitored every week during the first six months of treatment and then every two weeks and eventually once a month indefinitely in order to catch this side effect early if it occurs.
Other atypical antipsychotics include: aripiprazole (Abilify), asenapine (Saphris), brexpiprazole (Rexulti), cariprazine (Vraylar), lurasidone (Latuda), paliperidone (Invega Sustenna), paliperidone palmitate (Invega Trinza), quetiapine (Seroquel), risperidone (Risperdal), olanzapine (Zyprexa), and ziprasidone (Geodon). Another atypical antipsychotic, iloperidone (Fanapt), has been FDA-approved for acute (but not long-term) treatment of schizophrenia. The use of all of these medications has allowed successful treatment and release back to their homes and the community for many people suffering from schizophrenia.
Although sometimes more effective and better tolerated than older conventional neuroleptics, atypical antipsychotics also have side effects, and current medical practice is developing better ways of understanding these effects, identifying people at risk, and managing complications. Importantly, all atypical antipsychotics carry the possible risk for causing weight gain and raising blood sugar, cholesterol, and triglyceride levels, which must be periodically monitored during treatment. Some antipsychotics -- typical and atypical -- can cause heart rhythm problems that may require monitoring by a doctor.
Most of these medications take at least two to four weeks to take effect. Patience is required if the dose needs to be adjusted, the specific medication changed, and another medication added. In order to be able to determine whether an antipsychotic is effective or not, it should be tried for at least four weeks (or even as long as several months in the case of clozapine).