Translating basic science into clinical practice while dosing the second generation antipsychotics

Introduction: The second generation antipsychotics are often utilized in the treatment of schizophrenia, bipolar depression, bipolar mania, autism, major depressive disorder, anxiety disorder, sleep disorder, pervasive developmental disorder, conduct disorder and attention deficit hyperactivity disorder. Each agent is unique in its pharmacodynamic profile and knowledge of basic pharmacology science may allow for unique dosing strategies while treating specific disorders. A MEDLINE and recent textbook review was conducted regarding current and investigational second generation antipsychotics and cross-referenced with searches for major mental disorders. Conclusion: The second generation antipsychotics are clearly approved for the treatment of psychosis and mania at higher doses which highly utilize dopamine-2 receptor antagonism for efficacy and serotonin-2a receptor antagonism for extrapyramidal side effect tolerability. Otherwise, each agent has a unique pharmacodynamic profile where some agents carry more, or less antidepressant, anxiolyic, or hypnotic properties. This review suggests ways clinicians may utilize basic science information and clinical trial results to formulate and optimize second generation antipsychotic treatment plans.