Comparison of first and second generation antipsychotics: An update.

The modern era in the treatment of psychotic disorders began in the early ’50s with the discovery of chlorpromazine. This was a real revolution and maybe the most important single contribution in the treatment of psychiatric illnesses. Clorpromazine and the subsequent drugs that were introduced in the next 10–15 years, shared a common element in that they all were potent dopamine2(D2) receptor antagonists. The next landmark in the pharmacotherapy of psychoses was the introduction, in the early ’90s, of the novel or atypical or second generation antipsychotics (SGAs). The prototype of these new drugs was clozapine, an “old” drug, originally synthesized in 1958. What all new agents have in common –in contrast to the traditional antipsychoticsis similar or greater activity at serotonin receptors than at dopamine type 2 receptors and for this reason they have been called serotonin-dopamine antagonists.