What is the advantage of using second-generation antipsychotics (SGAs) over first-generation antipsychotics (FGAs)?

The advantage of using second-generation antipsychotics (SGAs) over first-generation antipsychotics (FGAs) primarily lies in their reduced risk of extrapyramidal symptoms (EPS). Unlike FGAs, which are notorious for causing motor-related side effects such as tremors, rigidity, and tardive dyskinesia—symptoms related to dopamine receptor antagonism in certain parts of the brain—SGAs tend to have a lower affinity for D2 receptors in these motor pathways. Instead, SGAs interact more selectively with a variety of other neurotransmitter systems, including serotonin receptors, which helps mitigate the development of EPS.

While SGAs do have metabolic side effects, such as weight gain and diabetes risk, their favorable profile concerning EPS makes them a preferred choice for many patients, especially for those who might be intolerant to the side effects of FGAs. The SGAs' effectiveness for mood stabilization and treating negative symptoms of schizophrenia also contributes to their attractiveness, although this does not necessarily translate into a higher overall efficacy compared to FGAs for positive symptoms.

It’s essential to note that while cost and efficacy can be important factors, the immediate clinical impact of minimizing motor side effects plays a significant role in treatment adherence and patient quality of life,