Uploaded May 2025 | Updated September 2026, 2 weeks ago
Antipsychotics are a class of drugs primarily used to manage the symptoms of psychosis; they are most commonly used to treat schizophrenia. In this video, I discuss first generation (e.g., chlorpromazine, haloperidol) and second generation (e.g., risperidone, quetiapine) antipsychotics, covering their mechanisms and side effects. I also briefly discuss xanomeline-trospium, a new addition to the antipsychotic market.
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If you're looking for accessible and entertaining ways to learn more about the brain, check out my books:
đź“šYour Brain, Explained: What Neuroscience Reveals About Your Brain and its Quirks: amazon.com/Your-Brain-Explained-Neuroscience-Reveals/dp/1473696569
đź“šBizarre: The Most Peculiar Cases of Human Behavior and What They Tell Us About How the Brain Works: amazon.com/Bizarre-Peculiar-Cases-Human-Behavior/dp/139980121X
TRANSCRIPT
Antipsychotics are a class of drugs primarily used to manage the symptoms of psychosis. They are most commonly used to treat schizophrenia, but have indications for the treatment of several conditions.
There are many different antipsychotic medications, and although there are some variations in their mechanisms, almost all antipsychotics decrease dopamine activity, which is thought to be effective because increased dopamine activity may contribute to the symptoms of psychosis.
The first antipsychotics discovered, which are sometimes referred to as first generation antipsychotics, include drugs such as chlorpromazine and haloperidol. Their primary mechanism of action is to act as antagonists at a type of dopamine receptor called the D2 receptor, which means they block activity at these receptors and thus reduce dopamine signaling overall.
A more recently developed group of drugs is sometimes called second generation antipsychotics. These include risperidone, quetiapine, and others. Although drugs in this class have more varied mechanisms, most block dopamine and serotonin receptor subtypes. This serotonin receptor antagonism may be beneficial both for its direct effects on psychotic symptoms and because of serotonin’s role in modulating dopamine release, which might influence symptoms and reduce side effects caused by dopamine antagonism. Other drugs in this class have slightly different mechanisms at dopamine and serotonin receptors as well as actions at other neurotransmitter receptors.
Recently, a new drug called xanomeline was developed; it primarily stimulates acetylcholine receptors, giving it a unique mechanism among antipsychotics.
Antipsychotics are generally associated with movement-related side effects, such as Parkinsonism. The risk of significant movement-related side effects is lower with second generation drugs, but it is still present. Other problematic side effects include weight gain, an increased risk of diabetes, and cardiovascular complications. While these cardiometabolic side effects can occur with any antipsychotic, they are more strongly linked to second generation drugs.
REFERENCES
Brannan SK, Sawchak S, Miller AC, Lieberman JA, Paul SM, Breier A. Muscarinic Cholinergic Receptor Agonist and Peripheral Antagonist for Schizophrenia. N Engl J Med. 2021 Feb 25;384(8):717-726. doi: 10.1056/NEJMoa2017015. PMID: 33626254; PMCID: PMC7610870.
Chen, A., Nasrallah, H.A. (2018). Antipsychotics. In: Grossberg, G., Kinsella, L. (eds) Clinical Psychopharmacology for Neurologists. Springer, Cham. https://doi-org.ezaccess.libraries.psu.edu/10.1007/978-3-319-74604-3_8
Lally J, MacCabe JH. Antipsychotic medication in schizophrenia: a review. Br Med Bull. 2015 Jun;114(1):169-79. doi: 10.1093/bmb/ldv017. Epub 2015 May 8. PMID: 25957394.
Leucht S, Priller J, Davis JM. Antipsychotic Drugs: A Concise Review of History, Classification, Indications, Mechanism, Efficacy, Side Effects, Dosing, and Clinical Application. Am J Psychiatry. 2024 Oct 1;181(10):865-878. doi: 10.1176/appi.ajp.20240738. PMID: 39350614.
Meltzer HY, Massey BW. The role of serotonin receptors in the action of atypical antipsychotic drugs. Curr Opin Pharmacol. 2011 Feb;11(1):59-67. doi: 10.1016/j.coph.2011.02.007. Epub 2011 Mar 21. PMID: 21420906.
đź“ť Pass your next test with my neuroscience videos!
I’m Marc, a university professor at Penn State, and I’m here to take you on a journey into the fascinating world of the brain. I created this channel to break down complex topics into easy-to-understand snippets—perfect for both students and curious minds alike. 📚
My goal is to make learning neuroscience fun and accessible. Whether you're a student looking to supplement your studies or simply eager to understand the basics of the brain, this channel is for you.
Hit subscribe and get to know your brain, one video at a time! đź§
Antipsychotics are a class of drugs primarily used to manage the symptoms of psychosis; they are most commonly used to treat schizophrenia. In this video, I discuss first generation (e.g., chlorpromazine, haloperidol) and second generation (e.g., risperidone, quetiapine) antipsychotics, covering their mechanisms and side effects. I also briefly discuss xanomeline-trospium, a new addition to the antipsychotic market.
🧠Take your learning further with my free, self-paced Introduction to Neuroscience course featuring my videos, articles, and hundreds of quiz questions: neuroscientificallychallenged.com/course
If you're looking for accessible and entertaining ways to learn more about the brain, check out my books:
đź“šYour Brain, Explained: What Neuroscience Reveals About Your Brain and its Quirks: amazon.com/Your-Brain-Explained-Neuroscience-Reveals/dp/1473696569
đź“šBizarre: The Most Peculiar Cases of Human Behavior and What They Tell Us About How the Brain Works: amazon.com/Bizarre-Peculiar-Cases-Human-Behavior/dp/139980121X
TRANSCRIPT
Antipsychotics are a class of drugs primarily used to manage the symptoms of psychosis. They are most commonly used to treat schizophrenia, but have indications for the treatment of several conditions.
There are many different antipsychotic medications, and although there are some variations in their mechanisms, almost all antipsychotics decrease dopamine activity, which is thought to be effective because increased dopamine activity may contribute to the symptoms of psychosis.
The first antipsychotics discovered, which are sometimes referred to as first generation antipsychotics, include drugs such as chlorpromazine and haloperidol. Their primary mechanism of action is to act as antagonists at a type of dopamine receptor called the D2 receptor, which means they block activity at these receptors and thus reduce dopamine signaling overall.
A more recently developed group of drugs is sometimes called second generation antipsychotics. These include risperidone, quetiapine, and others. Although drugs in this class have more varied mechanisms, most block dopamine and serotonin receptor subtypes. This serotonin receptor antagonism may be beneficial both for its direct effects on psychotic symptoms and because of serotonin’s role in modulating dopamine release, which might influence symptoms and reduce side effects caused by dopamine antagonism. Other drugs in this class have slightly different mechanisms at dopamine and serotonin receptors as well as actions at other neurotransmitter receptors.
Recently, a new drug called xanomeline was developed; it primarily stimulates acetylcholine receptors, giving it a unique mechanism among antipsychotics.
Antipsychotics are generally associated with movement-related side effects, such as Parkinsonism. The risk of significant movement-related side effects is lower with second generation drugs, but it is still present. Other problematic side effects include weight gain, an increased risk of diabetes, and cardiovascular complications. While these cardiometabolic side effects can occur with any antipsychotic, they are more strongly linked to second generation drugs.
REFERENCES
Brannan SK, Sawchak S, Miller AC, Lieberman JA, Paul SM, Breier A. Muscarinic Cholinergic Receptor Agonist and Peripheral Antagonist for Schizophrenia. N Engl J Med. 2021 Feb 25;384(8):717-726. doi: 10.1056/NEJMoa2017015. PMID: 33626254; PMCID: PMC7610870.
Chen, A., Nasrallah, H.A. (2018). Antipsychotics. In: Grossberg, G., Kinsella, L. (eds) Clinical Psychopharmacology for Neurologists. Springer, Cham. https://doi-org.ezaccess.libraries.psu.edu/10.1007/978-3-319-74604-3_8
Lally J, MacCabe JH. Antipsychotic medication in schizophrenia: a review. Br Med Bull. 2015 Jun;114(1):169-79. doi: 10.1093/bmb/ldv017. Epub 2015 May 8. PMID: 25957394.
Leucht S, Priller J, Davis JM. Antipsychotic Drugs: A Concise Review of History, Classification, Indications, Mechanism, Efficacy, Side Effects, Dosing, and Clinical Application. Am J Psychiatry. 2024 Oct 1;181(10):865-878. doi: 10.1176/appi.ajp.20240738. PMID: 39350614.
Meltzer HY, Massey BW. The role of serotonin receptors in the action of atypical antipsychotic drugs. Curr Opin Pharmacol. 2011 Feb;11(1):59-67. doi: 10.1016/j.coph.2011.02.007. Epub 2011 Mar 21. PMID: 21420906.
đź“ť Pass your next test with my neuroscience videos!
I’m Marc, a university professor at Penn State, and I’m here to take you on a journey into the fascinating world of the brain. I created this channel to break down complex topics into easy-to-understand snippets—perfect for both students and curious minds alike. 📚
My goal is to make learning neuroscience fun and accessible. Whether you're a student looking to supplement your studies or simply eager to understand the basics of the brain, this channel is for you.
Hit subscribe and get to know your brain, one video at a time! đź§
