Supplement: A Troubled History

A Troubled History Antipsychotics are effective, but carry significant side effects and cost. What's on the horizon? ARTICLE EXTRAS The Treatments First-Generation Antipsychotic Drugs The Atypical Atypical? The next generation? The Lessons of CATIE Second-Generation Antipsychotic Drugs Beyond Drugs Nonmedication Therapies Soon after antipsychotics entered the market in the 1950s, policymakers were so impressed with their benefits th

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The Treatments

First-Generation Antipsychotic Drugs

The Atypical Atypical?

The next generation?

The Lessons of CATIE

Second-Generation Antipsychotic Drugs

Beyond Drugs

Nonmedication Therapies

Soon after antipsychotics entered the market in the 1950s, policymakers were so impressed with their benefits that they felt they could let many patients out of the institutions they had been living in for years, sometimes decades. The drugs were clearly revolutionary, and effective at treating the positive symptoms - hallucinations, paranoid delusions - of schizophrenia, but it soon became apparent that they were largely ineffective at mitigating the negative symptoms such as depression and cognitive defects. It also became clear that they had serious side effects, from stiffness to outright tardive dyskinesia, because of the fact that they targeted dopamine 2 (D2) receptors.

That unmet medical need fueled decades of research. Some of it, detailed on these charts, produced variations on the original "typical" dopamine antagonists, with ...

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