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First-Generation Antipsychotics for Teens: Side Effects, Uses, and How They Work

Author:
Hayley Snelling
Hayley Snelling
B.S. Psychology
Editor:
Emma Loker
Emma Loker
B.S.
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Learning that you or your teen might need antipsychotic medication can be, let’s face it, pretty overwhelming and scary. The term itself often sounds intimidating, doesn’t it? But understanding what these medications actually do – and what they don’t – can help ease some of those fears. 

If you’re a teen struggling with mental health symptoms like mood swings, anxiety, hallucinations, or outbursts, know that you are far from alone. In fact, just under 50% of teens have struggled with a mental health issue at some point.1 

Needing help doesn’t mean there’s anything wrong with you. Sometimes, our brains need a little extra support, and for some people, that can partially come from medication. Something your doctor might bring up is first-generation antipsychotic medications for teens (or “typical” antipsychotics). These medications have been around for decades and can help treat mental health conditions like schizophrenia, bipolar disorder, aggression, and anxiety. 

On this page, we’ll explore teen mental health treatment with typical antipsychotics. We’ll explain what they are, how they work, and why they’re sometimes prescribed for teens. We’ll also look at common side effects, what to expect if you stop taking them, and how they compare to newer medications. We’ll give you clear, honest information so that you can feel more informed and less alone in whatever you’re going through, and whatever you decide. 

First-Generation Antipsychotics for Teens

What Are First-Generation Antipsychotics?

Antipsychotic medications were originally created to help adults with psychosis, and they’re highly effective at doing so. Psychosis causes a person to lose touch with reality, to see or hear things that aren’t really there (hallucinations), or to have beliefs that aren’t really true (delusions).  

For this same reason, doctors may prescribe typical antipsychotics for schizophrenia in adolescents. Antipsychotics are also really effective at helping other emotional and behavioral problems in children and teens, as well as adults.2

Some of the most common types of first-generation antipsychotics for teens are Chlorpromazine and Haloperidol. Let’s take a closer look at how they work. 

How Do They Work?

People with certain conditions – like schizophrenia – might have too much dopamine activity in parts of their brains. Dopamine is a chemical that helps brain cells talk to each other, kind of like a messenger that helps to control your mood, thoughts, and how you act. If there’s too much dopamine in your brain, you might struggle with hallucinations or delusions. 

Typical antipsychotics block the dopamine receptors, particularly a type called D2 receptors, so that you don’t get as many hallucinations, delusions, or other similar symptoms.3 Think of it like noise-canceling headphones – the dopamine is trying to shout loud messages across the brain constantly, and these headphones help to cut down the dopamine noise. That’s what a first-generation antipsychotic does.

Approved and Off-Label Uses in Teens

Antipsychotics can be used to treat a range of conditions, and each separate medication may or may not have FDA approval. FDA approval means the U.S. Food and Drug Administration (FDA) has decided that the medicine is safe and appropriate for treating certain conditions in specific age groups.4 

Medications can also be prescribed “off-label”, which means although they don’t have FDA approval, they have still been proven to be effective and safe for use. Let’s take a look at a few of the reasons why you might be prescribed an antipsychotic. 

First-Generation Antipsychotics for Adolescent Schizophrenia

Typical antipsychotics such as Haloperidol are effective at treating adolescents with schizophrenia.5 Currently, Loxapine, Perphenazine, Chlorpromazine, Prochlorperazine, Thiothixex, Thioridazine, and Trifluoperazine are all FDA-approved for use in children or teens.4

First-Generation Antipsychotics for Adolescent Anxiety

Antipsychotics are not typically the first treatment choice for people with anxiety – that would be an antidepressant called an SSRI. Some typical antipsychotics have FDA approval for treating generalized anxiety in adults, and antipsychotics may be prescribed “off-label” to help children with anxiety when other medications haven’t helped. It can also help them get a better night’s sleep if they have anxiety-induced insomnia. 

First-Generation Antipsychotics for Bipolar Disorder in Teens

Typical antipsychotics such as the FDA-approved Chlorpromazine, are often used as the first treatment type for the mania side of bipolar disorder in teens. However, second-generation antipsychotics are often preferred because they can have more manageable side effects.4

First-Generation Antipsychotics for Treating Aggressive Behavior in Teens

Irritability and aggression, especially in teens with Autistic Spectrum Disorder (ASD), can be treated using antipsychotic medications such as Haloperidol.6

As well as those already mentioned, typical antipsychotics may be prescribed to treat tics or Tourette’s disorder, and the FDA has also approved Chlorpromazine for treating severe behavioral problems.6

Typical Antipsychotics vs Second-Generation for Teens

There are two different types of antipsychotic medication – first-generation (typical) and second-generation (atypical). Let’s take a look at some of the differences and similarities between them:7

What Do They Treat?

Typical antipsychotic medications tend to treat schizophrenia, bipolar mania, agitation, and psychosis. In contrast, atypical antipsychotics typically treat schizophrenia, bipolar disorder, depression, anxiety, and PTSD.

How Do They Work?

Typical antipsychotics affect dopamine in the brain, whereas atypical antipsychotics affect both dopamine and serotonin. 

What Are Their Main Side Effects?

Atypical antipsychotics are more likely to be prescribed as they have fewer side effects that can affect your coordination and motor control.1 The main downside is that they usually come with significant weight gain. Typical antipsychotics come with fewer side effects that impact your metabolism, meaning you are less likely to have issues with weight and appetite changes.8

When it comes down to one being “better” than the other, it’s a tie, especially for schizophrenia. Plus, it all depends on your unique situation and symptoms. However, both first- and second-generation antipsychotics are effective for treating schizophrenia in children and teens, according to research.5

Side Effects of First-Generation Antipsychotics in Teens

All medications come with the potential of side effects – ways the medicine can affect you which aren’t the main result you wanted. For example, allergy tablets can stop you from sneezing or itching (the main result), but they may also make you feel sleepy (the side effect). 

First-generation antipsychotics are associated with something called extrapyramidal side effects (EPS). These are side effects that affect your movement and coordination. Some of the most common side effects from typical antipsychotics are:3,9

  • Involuntary or uncontrollable movements (EPS)
  • Tremors (EPS)
  • Muscle contractions (EPS)
  • Stiff muscles (EPS)
  • Feeling restless
  • Feeling irritable, agitated, or anxious
  • Dry mouth
  • Constipation
  • Urinary retention (bladder not completely emptying)
  • Feeling sleepy

First-generation antipsychotics and sleep issues in teens aren’t very common, as their sedative effect can make you feel drowsy and sleepy. In fact, antipsychotics are sometimes prescribed to help treat insomnia in adolescents. 

One thing teens can be worried about when starting a new medication is weight gain. However, there is no common issue with first-generation antipsychotics and weight gain in adolescents – this is mostly associated with the second-generation types. 

If you feel worried looking at the list of possible side effects, remember that they aren’t guaranteed to happen and that your doctor will be making the decision they believe will help you the most. 

Medications affect everyone differently, and dosage and specific medications can affect how you respond as well. Not everyone gets side effects – some people don’t experience them at all. Make sure to keep a note on your phone or a notepad about how you feel when taking antipsychotics. That way, when you have reviews with your doctor, you can explain any symptoms or side effects you are having. They can then look at adjusting the dose or medication type so that you can get the maximum benefit with minimum downsides. 

Serious and Long Term Risks

If you’re considering taking typical antipsychotics, one thing you may be wondering is whether there are any long-term risks to taking them. 

Although antipsychotic medications are used increasingly to treat conditions in children and adolescents, the long-term use of first-generation antipsychotics in teens hasn’t been researched much.10 

Neurological effects like rigid muscles, restlessness, and Parkinson’s syndrome movements have been found, as well as a potentially permanent movement disorder called tardive dyskinesia. This is a condition where your face or body (or both) make sudden random movements that you can’t control, such as smacking your lips or grimacing, with the risk of tardive dyskinesia in teens being up to 20%.11

But while the long-term effects aren’t fully understood yet, research is being conducted all the time to understand more about the impact of these medications. 

Stopping First-Generation Antipsychotics Safely

At some point, you may want to stop taking your medication, like if you have unpleasant side effects or your symptoms ease. If you want to stop taking antipsychotics, it’s always best to involve your doctor and create a plan. 

It’s always safer to slowly reduce how much you take instead of stopping it suddenly. If you quit ‘cold turkey’, you risk feeling your original mental health symptoms again and also getting some unpleasant sensations called withdrawal effects.12 These could include:

  • Anxiety
  • Diarrhea
  • Dizziness
  • Feeling like you have the flu (hot and cold, aching muscles, headache)
  • Losing your appetite or nausea
  • Mood changes
  • Restlessness, agitation, or irritability
  • Shaking
  • Sleep problems
  • Sweating
  • Tardive dyskinesia

If you’re considering stopping your medication, it’s important to think about how you’re feeling, whether you have any stressful events coming up and whether you have support available to you like family, friends, therapy, or a support group. 

We recommend putting yourself in the best and most supportive position for stopping your antipsychotics. Always keep up with your doctor’s appointments – they are so important for helping you stop taking your medication and keeping you well at the same time. Dose reduction plans can be altered to make things easier for you, and other medications can be used to help, too. 

Supporting Teen Mental Health Holistically

If your teen is struggling with their mental health, and you’re not sure what you can do to support them, don’t worry – we’ve got you. Here are our top tips for how to support a teenager’s mental health.

1. Create Connections

Encourage your teen to have healthy friendships. Let them know that they can talk to you about anything and that you will help them however you can. Make home a supportive and positive environment where they can talk about their problems and also have fun. Mental health challenges aren’t to be made fun of, and home can be a place where talking about emotions isn’t taboo. It can be their safe place.

2. Know That Self Care Isn’t Selfish

Self-care is a great way to help you cope, no matter your age. It’s not all bubble baths though – it’s getting exercise, having a balanced diet, and getting enough sleep. It’s making time for things you enjoy, like sports, arts and crafts, or spending time in nature. Nourish your mind, body, and soul. 

3. Seek Professional Help When Needed

Encourage your teen to talk to a therapist, counselor, or mental health professional if they are struggling. Therapy can help with a wide range of conditions and challenges, and it doesn’t have to be the traditional type where two people sit in a room and talk. There are therapies like art therapy, music therapy, and equine therapy, as well as other ways to explore feelings and find ways to manage and cope. 

First-Generation Antipsychotics for Teens: Side Effects, Uses, and How They Work

Finding the Right Treatment

Finding the right treatment for a teen facing mental health challenges can feel overwhelming – especially when medications like antipsychotics are part of the conversation. But with the right support, knowledge, and care, you can help your teen find relief from their symptoms and start to feel like themself again. 

Here at Mission Prep, we specialize in working with teens and their families to understand their unique needs and create individualized treatment options that make sense to you. If you’re looking for mental health treatment, whether it’s 24-hour residential care, medication management, or outpatient therapy, we are here to answer your questions and help guide you every step of the way. 

We believe cost shouldn’t be a barrier to getting the mental health care you need, which is why we have a range of payment options available, including sliding scale fees. 

If you’re ready to take the next step, or just want to learn some more, reach out to us today. We’re here to listen – and to help. 

References

  1. U.S. Department of Health and Human Services, National Institute of Mental Health. (2021). Mental illness. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
  2. Miller, C. (2024, June 24). Children and antipsychotic medications. Child Mind Institute. https://childmind.org/article/children-and-antipsychotic-medications-child-mind-institute/
  3. Chokhawala, K., & Stevens, L. (2023, February 26). Antipsychotic medications. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK519503/
  4. Christian, R., Saavedra, L., Gaynes, B. N., Sheitman, B., Wines, R. C., Jonas, D. E., Viswanathan, M., Ellis, A. R., Woodell, C., & Carey, T. S. (2012, February 1). Tables of FDA-approved indications for first- and second-generation antipsychotics. In Future research needs for first- and second-generation antipsychotics for children and young adults. Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK84656/
  5. Grover, S., & Sarkar, S. (2013). Antipsychotics in children and adolescents with schizophrenia: A systematic review and meta-analysis. Indian Journal of Pharmacology, 45(5), 439–445. https://doi.org/10.4103/0253-7613.117720
  6. American Academy of Child and Adolescent Psychiatry. (n.d.). Parents’ medication guides. https://www.aacap.org/AACAP/Families_and_Youth/Family_Resources/Parents_Medication_Guides.aspx
  7. Psychopharmacology Institute. (n.d.). First vs second-generation antipsychotics. https://psychopharmacologyinstitute.com/publication/first-vs-second-generation-antipsychotics-2082
  8. Pillay, J., Boylan, K., Carrey, N., Newton, A., Vandermeer, B., Nuspl, M., MacGregor, T., Jafri, S. H. A., Featherstone, R., & Hartling, L. (2017, March 1). First- and second-generation antipsychotics in children and young adults: Systematic review update. Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK442352/
  9. Raypole, C. (2019, April 17). Understanding extrapyramidal symptoms and the medications that cause them. Healthline. https://www.healthline.com/health/symptom/extrapyramidal-symptoms
  10. Daviss, W. B., Barnett, E., Neubacher, K., & Drake, R. E. (2016). Use of antipsychotic medications for nonpsychotic children: Risks and implications for mental health services. Psychiatric Services, 67(3), 339–341. https://doi.org/10.1176/appi.ps.201500272
  11. Besag, F. M. C., Vasey, M. J., Salim, I., & Hollis, C. (2024). Tardive dyskinesia with antipsychotic medication in children and adolescents: A systematic literature review. Drug Safety. https://doi.org/10.1007/s40264-024-01446-0
  12. Mind. (n.d.). Coming off antipsychotics. https://www.mind.org.uk/information-support/drugs-and-treatments/antipsychotics/coming-off-antipsychotics/

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