The principal side effect of<unk>  is weight gain, which may be profound in some cases and/or associated with derangement in blood-lipid and blood-sugar profiles (see section metabolic effects). A 2013 meta-analysis of the efficacy and tolerance of 15 antipsychotic drugs (APDs) found that it had the highest propensity for causing weight gain out of the 15 APDs compared with an SMD of 0.74. Extrapyramidal side effects, although potentially serious, are infrequent to rare from<unk> , but may include tremors and muscle rigidity. It is not recommended to be used by IM injection in acute myocardial infarction, bradycardia, recent heart surgery, severe hypotension, sick sinus syndrome, and unstable angina. Several patient groups are at a heightened risk of side effects from<unk>  and antipsychotics in general.<unk>  may produce nontrivial high blood sugar in people with diabetes mellitus. Likewise, the elderly are at a greater risk of falls and accidental injury. Young males appear to be at heightened risk of dystonic reactions, although these are relatively rare with<unk> . Most antipsychotics, including<unk> , may disrupt the body's natural thermoregulatory systems, thus permitting excursions to dangerous levels when situations (exposure to heat, strenuous exercise) occur. Other side effects include galactorrhea, amenorrhea, gynecomastia, and erectile dysfunction (impotence). Paradoxical effects<unk>  is used therapeutically to treat serious mental illness. Occasionally, it can have the opposite effect and provoke serious paradoxical reactions in a small subgroup of people, causing unusual changes in personality, thoughts, or behavior; hallucinations and excessive thoughts about suicide have also been linked to<unk>  use. Drug-induced OCD Many different types of medication can create or induce pure obsessive-compulsive disorder (OCD) in patients who have never had symptoms before. A new chapter about OCD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (2013) now specifically includes drug-induced OCD. Atypical antipsychotics (second-generation antipsychotics), such as<unk>  (Zyprexa), have been proven to induce de novo OCD in patients. Metabolic effects The US Food and Drug Administration (FDA) requires all atypical antipsychotics to include a warning about the risk of developing hyperglycemia and diabetes, both of which are factors in the metabolic syndrome. These effects may be related to the drugs' ability to induce weight gain, although some reports have been made of metabolic changes in the absence of weight gain. Studies have indicated that<unk>  carries a greater risk of causing and exacerbating diabetes than another commonly prescribed atypical antipsychotic, risperidone. Of all the atypical antipsychotics,<unk>  is one of the most likely to induce weight gain based on various measures. The effect is dose dependent in humans and animal models of<unk> -induced metabolic side effects. There are some case reports of<unk> -induced diabetic ketoacidosis.<unk>  may decrease insulin sensitivity, though one 3-week study seems to refute this. It may also increase triglyceride levels. Despite weight gain, a large multicenter, randomized National Institute of Mental Health study found that<unk>  was better at controlling symptoms because patients were more likely to remain on<unk>  than the other drugs. One small, open-label, nonrandomized study suggests that taking<unk>  by orally dissolving tablets may induce less weight gain, but this has not been substantiated in a blinded experimental setting. Post-injection delirium/sedation syndrome Postinjection delirium/sedation syndrome (PDSS) is a rare syndrome that is specific to the long-acting injectable formulation of<unk> ,<unk>  pamoate. The incidence of PDSS with<unk>  pamoate is estimated to be 0.07% of administrations, and is unique among other second-generation, long-acting antipsychotics (e.g. paliperidone palmitate), which do not appear to carry the same risk. PDSS is characterized by symptoms of delirium (e.g. confusion, difficulty speaking, and uncoordinated movements) and sedation. Most people with PDSS exhibit both delirium and sedation (83%). Although less specific to PDSS, a majority of cases (67%) involved a feeling of general discomfort. PDSS may occur due to accidental injection and absorption of<unk>  pamoate into the bloodstream, where it can act more rapidly, as opposed to slowly distributing out from muscle tissue. Using the proper, intramuscular-injection technique for<unk>  pamoate helps to decrease the risk of PDSS, though it does not eliminate it entirely. This is why the FDA advises that people who are injected with<unk>  pamoate be watched for 3 hours after administration, in the event that PDSS occurs. Animal toxicology<unk>  has demonstrated carcinogenic effects in multiple studies when exposed chronically to female mice and rats, but not male mice and rats. The tumors found were in either the liver or mammary glands of the animals. Discontinuation The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse. Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite. Other symptoms may include restlessness, increased sweating, and trouble sleeping. Less commonly, vertigo, numbness, or muscle pains may occur. Symptoms generally resolve after a short time. Tentative evidence indicates that discontinuation of antipsychotics can result in psychosis. It may also result in reoccurrence of the condition that is being treated. Rarely, tardive dyskinesia can occur when the medication is stopped.
Olanzapine
Aripiprazole
Risperidone
Ziprasidone
Clozapine
Sertraline
Electroconvulsive therapy
Lorpiprazole