Several long-term effectiveness studies over the past few years have come to the same conclusion about antipsychotic medications: that the first-generation is comparable to the second. Undoubtedly, efficacy appears comparable between generations (except for clozapine, which is superior to all). And the second generation is hardly free of side effects. They’re just different.
But let’s not forget movement disorders. A colleague and I were reminiscing about what it was like until the 1990s when we walked onto an in-patient ward or a clinic for chronically mentally ill people. A substantial number of patients showed tardive dyskinesia or dystonia—visible in many cases from across a room.
The newer agents cause far fewer of these disfiguring, disabling abnormal movements. That in itself is a blessing. If you are prescribing for someone I love, please try to avoid first-generation antipsychotics.