Schizophrenia The first-line psychiatric treatment for schizophrenia is antipsychotic medication, with<unk>  being one such medication.<unk>  appears to be effective in reducing symptoms of schizophrenia, treating acute exacerbations, and treating early-onset schizophrenia. The usefulness of maintenance therapy, however, is difficult to determine, as more than half of people in trials quit before the 6-week completion date. Treatment with<unk>  (like clozapine) may result in increased weight gain and increased glucose and cholesterol levels when compared to most other second-generation antipsychotic drugs used to treat schizophrenia. Comparison The National Institute for Health and Care Excellence, the British Association for Psychopharmacology, and the World Federation of Societies for Biological Psychiatry suggest that little difference in effectiveness is seen between antipsychotics in prevention of relapse, and recommend that the specific choice of antipsychotic be chosen based on a person's preference and the drug's side-effect profile. The U.S. Agency for Healthcare Research and Quality concludes that<unk>  is not different from haloperidol in the treatment of positive symptoms and general psychopathology, or in overall assessment, but that it is superior for the treatment of negative and depressive symptoms. It has a lower risk of causing movement disorders than typical antipsychotics. In a 2013 comparison of fifteen antipsychotic drugs in schizophrenia,<unk>  was ranked third in efficacy. It was 5% more effective than risperidone (fourth), 24-27% more effective than haloperidol, quetiapine, and aripiprazole, and 33% less effective than clozapine (first). A 2013 review of first-episode schizophrenia concluded that<unk>  is superior to haloperidol in providing a lower discontinuation rate, and in short-term symptom reduction, response rate, negative symptoms, depression, cognitive function, discontinuation due to poor efficacy, and long-term relapse, but not in positive symptoms or on the clinical global impressions (CGI) score. In contrast, pooled second-generation antipsychotics showed superiority to first-generation antipsychotics only against the discontinuation, negative symptoms (with a much larger effect seen among industry- compared to government-sponsored studies), and cognition scores.<unk>  caused less extrapyramidal side effects and less akathisia, but caused significantly more weight gain, serum cholesterol increase, and triglyceride increase than haloperidol. A 2012 review concluded that among ten atypical antipsychotics, only clozapine,<unk> , and risperidone were better than first-generation antipsychotics. A 2011 review concluded that neither first- nor second-generation antipsychotics produce clinically meaningful changes in CGI scores, but found that<unk>  and amisulpride produce larger effects on the PANSS and BPRS batteries than five other second-generation antipsychotics or pooled first-generation antipsychotics. A 2010 Cochrane systematic review found that<unk>  may have a slight advantage in effectiveness when compared to aripiprazole, quetiapine, risperidone, and ziprasidone. No differences in effectiveness were detected when comparing<unk>  to amisulpride and clozapine. A 2014 meta-analysis of nine published trials having minimum duration six months and median duration 52 weeks concluded that<unk> , quetiapine, and risperidone had better effects on cognitive function than amisulpride and haloperidol. Bipolar disorder<unk>  is recommended by the National Institute for Health and Care Excellence as a first-line therapy for the treatment of acute mania in bipolar disorder. Other recommended first-line treatments are haloperidol, quetiapine, and risperidone. It is recommended in combination with fluoxetine as a first-line therapy for acute bipolar depression, and as a second-line treatment by itself for the maintenance treatment of bipolar disorder. The Network for Mood and Anxiety Treatments recommends<unk>  as a first-line maintenance treatment in bipolar disorder and the combination of<unk>  with fluoxetine as second-line treatment for bipolar depression. A review on the efficacy of<unk>  as maintenance therapy in patients with bipolar disorder was published by Dando & Tohen in 2006. A 2014 meta-analysis concluded that<unk>  with fluoxetine was the most effective among nine treatments for bipolar depression included in the analysis. Other uses<unk>  may be useful in promoting weight gain in underweight adult outpatients with anorexia nervosa. However, no improvement of psychological symptoms was noted.<unk>  has been shown to be helpful in addressing a range of anxiety and depressive symptoms in individuals with schizophrenia and schizoaffective disorders, and has since been used in the treatment of a range of mood and anxiety disorders.<unk>  is no less effective than lithium or valproate and more effective than placebo in treating bipolar disorder. It has also been used for Tourette syndrome and stuttering.<unk>  has been studied for the treatment of hyperactivity, aggressive behavior, and repetitive behaviors in autism.<unk>  is frequently prescribed off-label for the treatment of insomnia, including difficulty falling asleep and staying asleep. The daytime sedation experienced with<unk>  is generally comparable to quetiapine and lurasidone, which is a frequent complaint in clinical trials. In some cases, the sedation due to<unk>  impaired the ability of people to wake up at a consistent time every day. Some evidence of efficacy for treating insomnia is seen, but long-term studies (especially for safety) are still needed.<unk>  has been recommended to be used in antiemetic regimens in people receiving chemotherapy that has a high risk for vomiting. Specific populations Pregnancy and lactation<unk>  is associated with the highest placental exposure of any atypical antipsychotic. Despite this, the available evidence suggests it is safe during pregnancy, although the evidence is insufficiently strong to say anything with a high degree of confidence.<unk>  is associated with weight gain, which according to recent studies, may put<unk> -treated patients' offspring at a heightened risk for neural tube defects (e.g. spina bifida). Breastfeeding in women taking<unk>  is advised against because<unk>  is secreted in breast milk, with one study finding that the exposure to the infant is about 1.8% that of the mother. Elderly Citing an increased risk of stroke, in 2004, the Committee on the Safety of Medicines in the UK issued a warning that<unk>  and risperidone, both atypical antipsychotic medications, should not be given to elderly patients with dementia. In the U.S.,<unk>  comes with a black box warning for increased risk of death in elderly patients. It is not approved for use in patients with dementia-related psychosis. A BBC investigation in June 2008 found that this advice was being widely ignored by British doctors. Evidence suggested that the elderly are more likely to experience weight gain on<unk>  compared to aripiprazole and risperidone.
Olanzapine
Aripiprazole
Risperidone
Ziprasidone
Clozapine
Sertraline
Electroconvulsive therapy
Lorpiprazole