Question: What are antipsychotics, how do they work, and are they helpful in the treatment of anxiety disorders?
Answer: Antipsychotics comprise a large family of medications. They're primarily used to treat psychotic symptoms that are most commonly found in schizophrenia and bipolar disorder. However, as time has gone on, we've realized that they may have benefit in other disorders as well in psychiatry, including anxiety disorders. They work in a variety of different ways. But predominantly they work by binding to and blocking the D2 or dopamine receptor in the brain. They also bind to other receptors that potentially have some contribution to their effectiveness. And specifically the serotonin receptor is another receptor that they block -- which is important in anxiety disorders. None of the antipsychotic medications carry an FDA indication for the treatment of anxiety disorders. However there is some preliminary evidence that a fewer of the newer antipsychotics may have benefit in the treatment of disorders like PTSD and obsessive compulsive disorder when added to SSRIs. There's also some anecdotal evidence that's growing that suggests that some of the newer antipsychotics, and specifically things like quetiapine, or Seroquel, or Risperidal, or risperidone, might have benefit in the treatment of generalized anxiety or social anxiety. And there are actually some scale clinical studies investigating this right now. But given the significant side effect profile of these medications and the fact that we don't really have good evidence to support their use in anxiety disorders, they really should be medications that are used only when people have not responded to the typical first line treatments in anxiety disorders.
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