Which type of antipsychotic medication is less likely to cause extrapyramidal symptoms?

Atypical antipsychotics are considered less likely to cause extrapyramidal symptoms (EPS) compared to typical antipsychotics. The reason for this difference lies in the pharmacological profiles of these drug classes.

Typical antipsychotics primarily block dopamine D2 receptors in the brain, which is effective for managing psychotic symptoms but also leads to a higher incidence of EPS due to the disruption of normal dopaminergic activity in areas of the brain that control motor function. These symptoms can include tremors, rigidity, and bradykinesia.

In contrast, atypical antipsychotics not only block D2 receptors but also affect other neurotransmitter systems, particularly serotonin receptors (5-HT2A). This broader mechanism of action appears to mitigate the risk of EPS, making atypical antipsychotics generally more tolerable in terms of movement disorders. This unique action helps to balance the dopaminergic pathways in a way that reduces the likelihood of movement-related side effects.

Therefore, the characteristic differences in receptor activity and side effect profiles between typical and atypical antipsychotics clarify why atypicals are preferred in many cases, particularly in individuals who are at higher risk or already experiencing EPS.