Side Effects of First-Generation Versus Second-Generation Drugs

Older medications carry a greater risk of a movement disorder called tardive dyskinesia. While several of the side effects that were mentioned previously stop once the medication is stopped, tardive dyskinesia may sometimes be irreversible even if the medication is stopped.

Although newer medications may cause tardive dyskinesia much less frequently than the older, first generation drugs, they have their own risks, including weight gain, diabetes, high blood pressure, heart disease, and other complications. As more medications are developed, more options become available for finding one that minimizes or counters side effects for individual patients.

The word “antipsychotic” refers to the symptoms these medications relieve best: positive symptoms, including hallucinations and delusions. Negative symptoms are not controlled by typical antipsy-chotic medications. Furthermore, in some cases they may be made worse by these medications.

The brain and the body have different cells that are responsible for different functions. Different cells are targets of different drugs. The interaction between antipsychotic medications and one type of cell may bring about the intended benefits, while the interaction between these drugs and other cells may cause unwanted side effects.


Antipsychotic side effects are a complicated medical issue and require an experienced physician to negotiate. If you suspect a medication is causing a troublesome side effect, the safest thing to do is stop taking the medication and call your doctor immediately. Always tell the doctor if someone stops taking prescribed medication for any reason.

Side effects involving the brain may also involve changes in certain hormone secretions. The majority of antipsychotic medications can raise levels of prolactin, which stimulates breast cells and causes the secretion of milk in women. Prolactin also maintains a part of the ovary that provides progesterone, a female sex hormone.

Side Effects of Older or Typical Antipsychotic Drugs

  • Restlessness, muscle spasms, Parkinsonian symptoms (extrapyramidal side effects, EPS)

  • Involuntary, rhythmical muscle movements (tardive dyskinesia) Dry mouth, constipation, blurred vision (anticholinergic effects)

  • Elevated prolactin

  • Sedation

  • Neuromalignant syndrome (a rare neurological disorder)

  • Too much prolactin may suppress menstruation. Excess amounts of this hormone can produce brittle bones (osteoporosis) and decrease interest in sex. Elevated levels of the hormone can cause men to experience impotence.


    It is important to remember that different people have different experiences with side effects. The selection of a medication should take into account its side effect profile and the patient's past and current medical history. All or most of the side effects are expected to go away once the medication is stopped.

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