Antihistamines can be very effective sleep aids for many patients, although some patients may experience too much grogginess (“hangover”) in the morning.

Ziprasidone has an appealing weight and metabolic profile, but many clinicians are overly cautious due to its reputation for QT interval prolongation.

Thioridazine prolongs the cardiac QT interval more than any other antipsychotic, rendering it too risky for the majority of patients.

Quetiapine’s low risk for extrapyramidal symptoms and broad spectrum of efficacy make it an appealing first-choice agent. However, sedation, weight gain, and orthostasis may limit use.

Pimavanserin is the only antipsychotic with virtually no dopamine receptor activity.

Perphenazine, first introduced in 1957, is an older first-generation antipsychotic (FGA) that became newly popular after the 2005 CATIE trial showed it to be as effective as most second-generation antipsychotics (SGAs) with minimal weight gain or metabolic problems. Many clinicians now consider it an effective, well tolerated, inexpensive alternative to SGAs.

Molindone is an effective, well-tolerated first-generation antipsychotic (FGA) of medium potency—a solid medication favored by some clinicians for select patients. It was recently reintroduced to the market and remains generic and inexpensive.

Lumateperone is the newest second-generation antipsychotic, approved for adults with schizophrenia or bipolar depression.

Dr. Carlat and Dr. Puzantian have no financial relationships with companies related to this material.
Full Fact Sheet Editorial Information

Aripiprazole is a good choice for minimizing risk of weight gain and metabolic side effects, but beware of akathisia.