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Second-Generation Antipsychotics for Teens: Uses and Possible Side Effects

Author:
Irene Lopez
Irene Lopez
MBA
Editor:
Emma Loker
Emma Loker
B.S.
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For many families, navigating teen mental health treatment, including the possibility of second-generation antipsychotics for teens, can bring up a lot of difficult emotions. 

If you’re concerned about your child’s mental health and are considering medication, you may find yourself asking all kinds of questions. Is medication really necessary? What does this mean for my child’s future? Or, “Will medication allow my child to still be themself?

These questions are normal. As a parent, you don’t want to see your child struggle, but medications can be scary-sounding – and potential side effects could make you feel very uncertain. 

Antipsychotics are typically not used as a first-line form of treatment for mental health issues. However, second-generation antipsychotics for teens, also called atypical antipsychotic medications for adolescents, are sometimes prescribed to treat severe mental health conditions that impact moods, thoughts, and behaviors. While they’re often talked about for their potential side effects, they can offer real relief when prescribed and monitored with care and precision. 

At Mission Prep, we believe that helping families understand the ins and outs of medication is one of the most important aspects of a comprehensive care plan. In this in-depth guide, we will cover:

  • What second-generation antipsychotics are
  • The differences between second-generation antipsychotics vs first-generation antipsychotics
  • How atypical antipsychotics help teens with certain mental health issues
  • Common teen conditions treated by atypical antipsychotics
  • The potential side effects of atypical antipsychotics in teens 
  • Stopping second-generation antipsychotics in teens
  • Finding professional support for deciding if second-generation antipsychotics are the right choice for your teen
Second-Generation Antipsychotics for Teens

What are Second-Generation Antipsychotics (SGAs)?

Second-generation antipsychotics (SGAs), also known as atypical antipsychotics, are medications that were initially developed to treat a condition called psychosis.¹ 

When someone has psychosis, it can show up as a disconnect from reality. For instance, they may have difficulties identifying what’s real from what’s not. Symptoms of psychosis can include delusions, hallucinations, thought disorders, and disorganized behaviors. These issues can make it difficult for a teen to function in daily life, at school, and in social situations.

It’s good to note that psychosis is a symptom, and isn’t considered to be a mental health disorder by itself. And you’re not alone if you’re trying to make sense of it. It is estimated that approximately 100,000 young people experience psychosis each year.² 

Antipsychotics are most commonly associated with conditions like schizophrenia, bipolar disorder, and treatment-resistant depression, among others.

Atypical Antipsychotic Medications for Adolescents: Benefits Beyond Psychosis

If an adolescent is being prescribed an antipsychotic, it doesn’t always mean it’s for psychosis. SGAs have a broader range of benefits compared to the older antipsychotics called first-generation antipsychotics (FGAs) and have lower risks of side effects.  

For example, health care practitioners may use a combination of antipsychotics and other medicines to treat health conditions like delirium and dementia (which are more common in older adults). They can also be used to treat issues like bipolar disorder and severe mood conditions in teens. 

Second Generation Antipsychotics for Teens: Not Always the First Option

Atypical antipsychotics are not typically used as a first-line treatment option, unless the mental health condition is severe or there’s danger of harm (to self or others). The preference is usually to approach mental health issues with techniques like psychotherapy, social skills development, and vocational therapy. 

All of the information around antipsychotics might sound overwhelming. Yet it just means that your provider will complete a comprehensive assessment and exhaust all other options before prescribing antipsychotics. 

It’s best to discuss treatment options, including any risks and benefits, with your provider so you know what to expect and to address any fears and concerns. Medications could help your teen feel more in control of their emotions, behaviors, and life. But sometimes, the side effects can outweigh the benefits. We’ll come to these risks later in this article. First, let’s consider the difference between newer antipsychotics vs older ones.  

Second-Generation Antipsychotics vs First-Generation Antipsychotics

There are three major types of antipsychotics, categorized depending on when they were developed.³ 

Each of these medications works on chemical messengers called “neurotransmitters” to influence moods and behaviors. They can be very helpful in conditions where symptoms include hallucinations, delusions, extreme mood swings, or severe aggression.

However, first-generation psychotics have been associated with several adverse side effects. Second-generation antipsychotics, on the other hand, are an improvement in more ways than one. For instance, they…

  • Can be useful to treat a wider range of conditions, including mood and anxiety disorders. 
  • Have fewer neurological side effects
  • Are better tolerated for long-term use

What Is the Most Widely Used Second-Generation Antipsychotic Drug?

According to studies, quetiapine is the most prescribed second-generation antipsychotic due to its benefits for sleep. However, it can be challenging to point to any single medication as being the most “widely used” second-generation antipsychotic because medications are prescribed based on several factors. These include your teen’s diagnosis, medical history, severity of symptoms, and risk of side effects. In other words, each teen is unique and deserves a tailor-made treatment plan.⁴

Having said as much, the FDA has approved the following SGAs for teen use:⁵

  • Asenapine (Saphris, Secuado)
  • Paliperidone (Invega)

Out of the approved list of antipsychotics, Risperidone and Aripiprazole are considered the better-tolerated antipsychotics.⁶ 

How Do Atypical Antipsychotics Help Teens?

It’s normal to feel some level of anxiety when there’s a possibility your teen child may need an antipsychotic. However, antipsychotics can offer powerful benefits in the right circumstances.

Psychiatrists, as part of their comprehensive assessment, look at potential benefits and side effects, and also how best to minimize risks in a treatment plan. Careful monitoring is also carried out to ensure the safety of your teen. 

Yet, a provider may consider an atypical antipsychotic if your teen needs one, as they can benefit teens in the following ways:

  • Helping stabilize moods and behaviors in conditions like bipolar disorder or schizophrenia. This way, a teen can feel more in control of how they function.⁷
  • Improving a teen’s quality of life.⁸ This means that adolescents can self-assess and work on where they are in terms of:
    • Fulfilling personal goals
    • Meeting expectations 
    • Their ability to function day to day
  • Limiting aggressive behaviors and improving sleep quality.⁹ 
  • Reducing self-harming thoughts and behaviors.¹º 

Additionally, studies have shown that symptoms like agitation and hallucinations can start to subside within a few days of starting SGAs. Plus, delusions may subside in a matter of weeks. However, it can take up to six weeks in most cases for adolescents to experience the full benefits of atypical antipsychotics.¹¹

When combined with psychotherapy and life skills development, antipsychotics can create a calmer and more stable foundation for long-term recovery. 

Common Teen Conditions Treated by Atypical Antipsychotics

There are a number of teen conditions that can benefit from treatment with antipsychotics. Some of the most common ones include:

  • Schizophrenia
  • Treatment-resistant depression
  • Tourette Syndrome
  • Autism spectrum disorder
  • Borderline personality disorder
  • Obsessive‐Compulsive Disorder (OCD)
  • Anorexia Nervosa
  • Insomnia
  • Delirium
  • Dementia syndromes, including Alzheimer’s disease
  • Behavioral disorders, such as oppositional defiant disorder (ODD) and conduct disorder (CD)

Side Effects of Atypical Antipsychotics in Teens

All medications come with risks, even if they’re OTC (over-the-counter) medications.¹² If your teen is starting on second-generation antipsychotics, it’s important to be aware of the side effects so that they can be efficiently managed. 

Whether side effects happen can vary depending on the specific medication, your teen’s unique response to it, and the dose taken. The following are some of the most important risks to take note of:¹³

  • Low blood pressure
  • Sleepiness
  • Thoughts of self-harm
  • Difficulties thinking or concentrating
  • Rapid heartbeat
  • Sensitivity to the sun
  • Skin rashes
  • Restlessness or agitation
  • Uncontrollable movements, like tics and tremors¹⁴ 
  • Dizziness 
  • Headaches
  • Dry mouth 
  • Neuroleptic Malignant Syndrome. This is a rare, life-threatening condition that includes high fever, sweating, variations in blood pressure, and muscle stiffness. However, the risk of this is low

In addition to these side effects, there are weight gain risks with atypical antipsychotics in teens.  They could also increase levels of cholesterol and triglycerides in the blood and potentially increase blood sugar levels or the risk for Type 2 diabetes. 

Healthcare providers take baseline readings of any physiological signs prior to treatment and continue to monitor at regular intervals. This way, they can keep a close watch on side effects and whether medication needs to be altered.

Can Antipsychotics Affect Puberty?

Depending on various factors, including the medication type, dose, and a teen’s overall health, another potential side effect of atypical antipsychotics is an increase in the production of a hormone called “prolactin.” If these levels rise too much, it could lead to a condition called “hyperprolactinemia.”¹⁵ 

Hyperprolactinemia can cause menstrual problems in girls, delay in the start of menses, and sometimes, stoppage of periods altogether. It has also been linked to arrested development and delays in the start of puberty and has been linked to abnormal breast development in both boys and girls.

Your provider should be able to comprehensively discuss and monitor the risks associated with any medication being prescribed. 

Stopping Second-Generation Antipsychotics in Teens

Stopping second-generation antipsychotics in teens should only be done one way: slowly. SGAs are powerful medications, and any discontinuation should only be done gradually and under medical supervision.¹⁶ If you’re looking to stop medication, discuss your concerns with your provider, as sudden stoppage can cause adverse withdrawal side effects. 

Mission Prep can help you and your teen create a tapering plan for coming off second-generation antipsychotics. 

How Mission Prep Healthcare Supports Teens on SGAs

At Mission Prep Healthcare, we believe medication is just one part of a teen’s journey to recovery. Our approach goes beyond symptom relief to long-term recovery through compassionate care, family involvement, and customized treatment. 

Our board-certified medical and mental health professionals work with teens and their families one-on-one to find the best treatment plan for their unique needs. If an SGA is seen to be required, our care team will ensure your teen is supported and, more importantly, monitored, every step of the way. 

Our programs include:

We ensure that the families are integrated in all aspects of treatment, whether it’s planning, education on conditions and medications required, nutritional and wellbeing support, and ongoing emotional care. 

Second-Generation Antipsychotics for Teens: Uses and Possible Side Effects

Are Second-Generation Antipsychotics the Right Step for Your Teen?

Mission Prep recognizes that deciding whether to start your teen on a second-generation antipsychotic can be challenging, complex, and overwhelming. But you don’t have to fight the battle alone. 

With evidence-based expertise on hand, you’ll be able to narrow down the right medication, not only to stabilize but also empower your teen, so they have hope for a better future.

Looking to discuss medication options for your teen or consider alternatives? 

Connect with a member of Mission Prep Healthcare’s care team today. Call us today or fill out our contact form. 

Help is just one call away. 

References

  1. National Institute of Mental Health. (n.d.). Mental health medications. https://www.nimh.nih.gov/health/topics/mental-health-medications
  2. National Alliance on Mental Illness. (2024, November 12). Psychosis | National Alliance on Mental Illness (NAMI). https://www.nami.org/about-mental-illness/mental-health-conditions/psychosis/
  3. Chokhawala, K., & Stevens, L. (2023, February 26). Antipsychotic medications. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK519503/
  4. Cicala, G., Barbieri, M. A., Santoro, V., Tata, C., Colucci, P. V., Vanadia, F., Drago, F., Russo, C., Cutroneo, P. M., Gagliano, A., Spina, E., & Germanò, E. (2020). Safety and tolerability of antipsychotic drugs in pediatric patients: Data from a 1-year naturalistic study. Frontiers in Psychiatry, 11, Article 152. https://doi.org/10.3389/fpsyt.2020.00152
  5. Centers for Medicare & Medicaid Services. (2015). Atypical antipsychotic medications: Use in pediatric patients. https://www.cms.gov/Medicare-Medicaid-Coordination/Fraud-Prevention/Medicaid-Integrity-Education/Pharmacy-Education-Materials/Downloads/atyp-antipsych-pediatric-factsheet11-14.pdf
  6. Cicala, G., Barbieri, M. A., Santoro, V., Tata, C., Colucci, P. V., Vanadia, F., Drago, F., Russo, C., Cutroneo, P. M., Gagliano, A., Spina, E., & Germanò, E. (2020b). Safety and tolerability of antipsychotic drugs in pediatric patients: Data from a 1-year naturalistic study. Frontiers in Psychiatry, 11, Article 152. https://doi.org/10.3389/fpsyt.2020.00152
  7. McCormack, P. L. (2010). Olanzapine. CNS Drugs, 24(5), 443–452. https://doi.org/10.2165/11204430-000000000-00000
  8. Sampogna, G., Di Vincenzo, M., Giuliani, L., Menculini, G., Mancuso, E., Arsenio, E., Cipolla, S., Della Rocca, B., Martiadis, V., Signorelli, M. S., & Fiorillo, A. (2023). A systematic review on the effectiveness of antipsychotic drugs on the quality of life of patients with schizophrenia. Brain Sciences, 13(11), Article 1577. https://doi.org/10.3390/brainsci13111577
  9. Golubchik, P., Sever, J., & Weizman, A. (2011). Low-dose quetiapine for adolescents with autistic spectrum disorder and aggressive behavior. Clinical Neuropharmacology, 34(6), 216–219. https://doi.org/10.1097/WNF.0b013e31823349ac
  10. Huang, X., Harris, L. M., Funsch, K. M., Fox, K. R., & Ribeiro, J. D. (2022). Efficacy of psychotropic medications on suicide and self-injury: A meta-analysis of randomized controlled trials. Translational Psychiatry, 12(1), Article 34. https://doi.org/10.1038/s41398-022-02173-9
  11. National Institute of Mental Health. (n.d.). Mental health medications. https://www.nimh.nih.gov/health/topics/mental-health-medications
  12. U.S. Food and Drug Administration. (2018, June 18). Think it through: Managing the benefits and risks of medicines. https://www.fda.gov/drugs/information-consumers-and-patients-drugs/think-it-through-managing-benefits-and-risks-medicines
  13. Tandon, R., Lenderking, W. R., Weiss, C., Shalhoub, H., Barbosa, C. D., Chen, J., Greene, M., Meehan, S. R., Duvold, L. B., Arango, C., Agid, O., & Castle, D. (2020). The impact on functioning of second-generation antipsychotic medication side effects for patients with schizophrenia: A worldwide, cross-sectional, web-based survey. Annals of General Psychiatry, 19(1), Article 30. https://doi.org/10.1186/s12991-020-00292-5
  14. CHIP. (n.d.). Antipsychotic medicines for children and teens. https://chip.wv.gov/SiteCollectionDocuments/Antipsychotic%20Medicines%20for%20Children%20%20Teens.pdf
  15. Thapa, S., & Bhusal, K. (2023, July 24). Hyperprolactinemia. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK537331/
  16. Horowitz, M. A., Jauhar, S., Natesan, S., Murray, R. M., & Taylor, D. (2021). A method for tapering antipsychotic treatment that may minimize the risk of relapse. Schizophrenia Bulletin, 47(4), 1116–1129. https://doi.org/10.1093/schbul/sbab017




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