Illustration of brain pathways being balanced.

Beyond the Stigma: Understanding and Managing Antipsychotic-Induced Side Effects

Elliot Brynn in Health & Wellness August 2025 • 4 min read.

"A practical guide to recognizing and mitigating extrapyramidal symptoms (EPS) for patients on antipsychotics."

Schizophrenia is a long-term mental health condition affecting how a person thinks, feels, and behaves. While the causes are complex, involving both genetic and environmental factors, treatments have greatly improved. Second-generation antipsychotics (SGAs) are frequently used due to their effectiveness in managing symptoms. However, these medications can come with side effects, particularly extrapyramidal symptoms (EPS).

EPS refers to a range of movement-related side effects that can include Parkinsonism (symptoms resembling Parkinson's disease), dystonia (involuntary muscle contractions), dyskinesia (involuntary movements), and oculogyric crises (uncontrolled eye movements). While SGAs are generally considered to have a lower risk of EPS compared to older medications, it remains a significant concern for many patients.

This article explores the nature of EPS, delving into why they occur and what can be done to manage them effectively. We'll discuss treatment strategies and new approaches that minimize the impact on patients' lives, bridging the gap between managing mental health and preserving physical well-being.

Why Do Extrapyramidal Symptoms Occur?

Illustration of brain pathways being balanced.

EPS primarily arises from the way antipsychotic drugs interact with dopamine receptors in the brain, particularly D2 receptors. Dopamine is a neurotransmitter crucial for motor control, and antipsychotics work by blocking dopamine activity to reduce psychotic symptoms. However, this dopamine blockade can disrupt the delicate balance in brain regions responsible for movement, leading to EPS.

The risk of EPS varies depending on the specific medication. Older, first-generation antipsychotics (FGAs) have a higher affinity for D2 receptors and are more likely to cause EPS. SGAs are designed to have a lower affinity or act differently on D2 receptors, often in combination with serotonin receptors, which can reduce the risk.

Dopamine Blockade: Antipsychotics reduce dopamine activity, affecting motor control.
Medication Type: Older FGAs pose a higher risk compared to newer SGAs.
Individual Sensitivity: Genetic factors and other medications can influence susceptibility.

It's also important to recognize that individual sensitivity plays a role. Some people are simply more prone to developing EPS due to genetic factors or other medications they may be taking. Recognizing the underlying mechanisms is the first step in managing and mitigating these side effects.

Moving Forward: A Holistic Approach to Treatment

Managing schizophrenia and related conditions requires a comprehensive approach. While antipsychotic medications are essential, addressing potential side effects like EPS is equally important. Open communication between patients, caregivers, and healthcare providers is key to identifying and managing these challenges effectively.

The development of newer antipsychotics with different mechanisms of action offers hope for minimizing EPS. Partial dopamine agonists and medications with serotonin receptor modulation can provide symptom relief with a lower risk of motor side effects. However, each individual's response to medication varies, and careful monitoring is always necessary.

Ultimately, the goal is to find a treatment plan that effectively manages mental health symptoms while preserving quality of life. By understanding EPS and utilizing the available strategies, patients can lead fuller, more active lives.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4172/jbb.1000333, Alternate LINK

Title: Extrapyramidal Symptoms In Patients Treated With Antipsychotic Drugs

Subject: Pharmaceutical Science

Journal: Journal of Bioequivalence & Bioavailability

Publisher: OMICS Publishing Group

Authors: Werner Fm, Covenas R

Published: 2017-01-01

Everything You Need To Know

What exactly are Extrapyramidal Symptoms (EPS), and why should I be concerned about them?

Extrapyramidal Symptoms (EPS) are a range of movement-related side effects that can occur as a result of taking antipsychotic medications. These symptoms include Parkinsonism, dystonia, dyskinesia, and oculogyric crises. They are a significant concern because they can negatively impact a patient's quality of life, causing physical discomfort and potentially leading to social withdrawal or difficulties with daily activities. The side effects arise from the medications' impact on dopamine activity in the brain.

Why are antipsychotic medications used, and how do they relate to Extrapyramidal Symptoms (EPS)?

Antipsychotic medications, particularly Second-generation antipsychotics (SGAs), are frequently prescribed to manage symptoms associated with conditions like Schizophrenia. These medications work by interacting with dopamine receptors in the brain. However, this interaction, specifically the blocking of dopamine activity, can disrupt the brain's motor control systems, leading to the development of Extrapyramidal Symptoms (EPS). While SGAs are often preferred for having a lower risk compared to first-generation antipsychotics (FGAs), EPS remain a potential side effect that needs careful management.

What causes Extrapyramidal Symptoms (EPS) when taking antipsychotic medication?

The primary cause of Extrapyramidal Symptoms (EPS) is the effect of antipsychotic drugs on dopamine receptors in the brain, especially the D2 receptors. These medications block dopamine activity to reduce psychotic symptoms, but this can also disrupt motor control. The older First-generation antipsychotics (FGAs) tend to have a higher affinity for D2 receptors, increasing the likelihood of EPS. Second-generation antipsychotics (SGAs) are designed with lower affinity or different action on D2 receptors which can reduce the risk. Additionally, individual factors like genetics and other medications can increase the risk.

How can Extrapyramidal Symptoms (EPS) be managed?

Several strategies exist to manage Extrapyramidal Symptoms (EPS). These include a holistic approach which involves open communication between patients, caregivers, and healthcare providers. Regular monitoring for EPS is essential, and dosage adjustments of the antipsychotic medication may be considered to minimize side effects while maintaining therapeutic benefits. Furthermore, there are treatments specifically aimed at managing EPS symptoms, which may include medications that help to restore the balance of the neurotransmitter.

Do all antipsychotic medications have the same risk of causing Extrapyramidal Symptoms (EPS)?

Yes, there are differences. First-generation antipsychotics (FGAs) are generally associated with a higher risk of Extrapyramidal Symptoms (EPS) compared to Second-generation antipsychotics (SGAs). This difference is due to the way these medications interact with dopamine receptors. FGAs have a higher affinity for D2 receptors, which makes them more likely to cause EPS. SGAs are designed to act differently on these receptors, reducing the likelihood of these movement-related side effects. It's important for healthcare providers to consider these differences when choosing an antipsychotic medication for a patient, balancing the efficacy in treating the underlying condition with the potential for side effects.