First-generation antipsychotics (typical antipsychotics, neuroleptics) have been around since the 1950s, but how safe are first-generation antipsychotics like haloperidol? One doctor, Henry A. Nasrallah, MD, suggests that haloperidol and its likenesses should be retired as first generation antipsychotics are not safe for the brain (he and the literature contend). Are first-generation antipsychotics like haloperidol safe or possibly neurotoxic?
Why Were Second-Generation Antipsychotics Created?
First generation antipsychotics were quite effective and Dr. Nasrallah himself attests to haloperidol’s “unquestionable efficacy in treating delusions and hallucinations.” However, first-generation antipsychotics also had a nasty side effect profile and often caused movement disorders that were very unpleasant, distressing and sometimes permanent.
Second-generation antipsychotics (atypical antipsychotics) were designed with movement disorders in mind and, indeed, movement disorders have been drastically reduced in patients using second-generation antipsychotics. At the time, it was also thought that second-generation antipsychotics were more efficacious but studies have shown this not to be the case. First- and second-generation antipsychotics have approximately equal efficacy. (There are certainly nasty side effects to second-generation antipsychotics, too, but more on that another day.)
Is Haloperidol Dangerous and Neurotoxic?
According to Dr. Nasrallah, haloperidol and older-generation antipsychotics are, absolutely, dangerous and neurotoxic. Twenty-eight studies he lists report various destructive effects of first-generation antipsychotics, especially haloperidol. He identifies these categories of the molecular mechanisms of neurotoxicity:
Apoptosis – the death of cells- Necrosis – the death of most or all of the cells in an organ or tissue due to disease, injury, or failure of the blood supply.
- Decreased cell viability
- Inhibition of cell growth
- Increased caspase activity (the “death spiral”)
- Impaired glutamate transport
- Mitochondrial damage
Dr. Nasrallah contends that these drugs would never be allowed by current day Food and Drug Administration (FDA) standards and that if these same effects were seen in other realms (i.e., not invisible) the FDA would likely move to ban them altogether. (But no one cares about crazy* peoples’ brains anyway.)
Is Haloperidol Safe? Should You Ever Take a First-Generation Antipsychotic?
People are prescribed different medications for different reasons and there may be justifiable reasons to prescribe a first-generation antipsychotic to someone. I’m not sure what that would be (see below) given the preponderance of evidence of neurotoxicity, but everyone is different and I’m sure there are cases I haven’t thought of as I’m not a doctor.
However, in light of this evidence, I would suggest that haloperidol is not safe and that safer alternatives, like the atypical antipsychotics which have been shown to “exert neuroprotective properties, such as inducing neurogenesis and increasing neurotrophic factors” should always be investigated to a great degree before putting your brain in harm’s way of a neurotoxic drug. (By the way, you might want to keep those neuroprotective factors in mind the next time someone tells you that antipsychotics are killing your brain.)
At the very least, if you, or someone you love, is taking a first-generation antipsychotic, it’s at least worth a serious conversation with your doctor so you can evaluate your, specific, pros and cons.
Edit: Since writing this I have consulted with a psychiatrist on the matter and he says that he still prescribes first-generation antipsychotics in two cases. In case one, it may happen inpatient temporarily in the case of florid psychosis. In case two, some people simply don’t respond to second-generation antipsychotics but do positively respond to first-generation ones. And if there’s one thing I know to be true it’s that all our brains are very different so this, in fact, does make sense.
For more information and references, please see Current Psychiatry 2013 July;12(7):7-8., Haloperidol clearly is neurotoxic. Should it be banned?. (You’ll likely need a free login to see it.)
* Before you start throwing tomatoes at the screen, this is a snide way of denoting how society views those with mental illness. I’m not suggesting people with mental illnesses are, in fact, crazy.
We use largactil and phenergan in this house as antipsychotics sedatives and even antihistamines…..
First generation drugs and we have been using them for 20 years without a problem…mild side effects.
Seroquel in a matter of weeks caused him to stack on 50kg in weight, developed metabolic syndrome, started bleeding from every orifice and having reactive hypoglycemia seizures,
No thanks in big red marker on his medical file it says DO NO ADMINISTER ATYPICAL ANTIPSYCHOTICS.
I agree that Haldol should be banned by the FDA. It is absolutely a toxic and harmful drug that has caused retrocollis, torticollis and other problems in patients, causing more problems for the patient and increasing healthcare costs to treat the damage done by Haldol.
That said, there are some instances where a first line antipsychotic may help someone. For instance, in doing a genetic test, one may find a patient has a certain mutation. Digging deeper, a good doc finds that the mutation involves dysregulation of oligodendrocytes. By giving Thorazine, it elevates Prolactin. Prolactin stimulates oligodendrocytes, thus enhancing mylein sheath. Thus helping regulate the dysregulation in brain. But let’s be honest, how many doctors take the time to personalize medicine for their patients? Almost none, even though there are Genecept Assay tests now available to the tune of only 400 bucks, that could easily help any doctor treat their patient with more effective drugs, targeted to their unique make up. The days of trial and error and just come back in 5 weeks when you’ve lost your mind and ended up in the ER room 55 times should be over by now, but intellectual laziness is at an all time high. Last month the doctor stopped midway in a conversation with me during our appointment, to read a news alert on the storm in East Coast. “A big storm is coming,” chimed the doc. I was not impressed. We’re in the West Coast. I don’t give a damn. “That’s irrelevant doctor,” I said. But who cares, right? I have Aspergers and we are considered strange enough by most neurotypicals. My point is we are in very dangerous times where doctors are making more and more medication mistakes. They could stop this madness by taking the time to clinically evaluate their patients through things like Genecept Assay kits. I did my own research. Not everyone is an Aspie, so they won’t do this.
Any medication to stabilize neurochemical balance in brain isn’t safe for the user. Neuro medications could be safe only for the society. Who is in safety after a misbalanced person is neutralised by a medication.
Compazine (brand) is, or was, a first-generation antipsychotic and I took it as such when I was only a teen. Within a month of taking it, I developed such severe muscle spasms and rigidity that I had to have emergency medical treatment.
Thorazine, I was given when completely bonkers and on a 28 day Inpatient stay.. stayed on it for nearly 6 months thereafter. I had to take meds in addition to, due to what happened with the Compazine and the pdocs not wanting the same thing for me on the Thorazine.
What I did get was massive weight gain, sensitivity to light, difficulty emptying my bladder and not being able to find my feet when walking (shuffling)… oh and well, the awesome thing was: nearly not a thought in my head. Sometimes, I crave Thorazine so as to not have nearly a thought in my head.
Moving forward in life… I have had Seroquel and Abilify.
Seroquel knocked me unconscious as if a I ingested a “Mickey and a Minnie” together. I gained considerable weight, had an insatiable craving for sugary things, could not hold a conversation that made sense to me or to others, was cognitively awake for maybe 5 hours a day and then developed stiff/rigid neck and leg muscles with a weird fever. Primary care doc took me off that, said it a adverse reaction.
Abilify… the very 1st and only dosage I ingested… i slept soundly which was the good part. I also endured burning eyelids, puckering lips, tongue movement and my knee kept jerking. That was on the 1 and only dose I took. The pdoc I had at the time insisted I keep taking it… I shoved it in the trash. The burning eyelids was bad enough; add in the puckering goldfish lips and tongue moving? no.
No drug is safe.. not a single solitary one… none. If made in a lab, not safe and before the naturalists want to give me a “high five” hand slap… many of the so called “natural” supplements bought over the counter or online- ain’t too safe as well.
It just all depends on your comfort level of danger you are willing, and your doc is willing, to tolerate and accept. Ya know “the potential benefits outweigh the known risks” type thing.
I find the evidence always changes depending on what book you read, what journal, what doctor. In addition, I do agree the side effects from these drugs can certainly lead to a shorter lifespan. Haven’t you touched upon that somewhere before, Natasha,that folks with bipolar disorder could die sooner than those without mental illness? Doing your homework about medication as best as possible can only help.
Hi Rose,
You’re right, medication research matters, but the reason I wrote this article is because I stumbled upon this information for the first time (proven by research). And people aren’t going to know this just by doing average research. They need a better means of finding out about stuff like this. Yes, there’s your doctor, but, honestly, they can’t keep up with every, single study either. I just hope this article helps a few people understand an important subject and maybe help them look for alternatives.
– Natasha Tracy
We do the best we can with what we have. I have a serious disease and it can’t be treated with baby aspirin. I need the big guns. Cancer will kill you, so you’re put on chemo with radiation thrown in for good measure. Why aren’t people marching in the streets against the use of chemo and radiation? No, really. Why?
Phil,
very simple.. Doctors are businessmen and if they don’t give you chemo they don’t make money and if they don’t radiate you they dont make money. Simple as that. If I come down with cancer,and its staged high, no chemo or radiation for me..No dialysis for my kidneys. Nothing. I have learned trust anyone in the medical profession and I mean no one. They asked doctors if they would opt for chemo or radiation or kidney dialysis and a major percentage said no. I am not on a 5 drug cocktail either anymore, switching from one to another. I am nobodys guinea pig anymore. I learned the hard way and have mourned the fact that my life span will be a lot shorter. I am 60.
Here’s the sad thing:every last drug ever produced as for so called “mental illness” is dangerous in that it cuts your life short. This is all well known among scientists, but you see Psychiatry wants to keep burying this truth because it cuts into their argument that they are “saving lives” by what they do. Thus I agree with you Michael, all of it will come out eventually, but Peter Breggin is going about it now and it will mostly be the scientists because it is too salacious for Psychiatry to admit to.
Hello endrun,
There is absolutely no evidence that every last drug every produced for mental illness cuts your life short. That is ridiculous and untrue.
Moreover, the life-threatening effects of untreated mental illness are well known. Suicide tends to kill people considerably deader considerably quicker than medication.
– Natasha Tracy
Wnen will they say this about second generation antispychotics? We all know it will happen… Just a matter of time after the 3rd generation comes out with new 12 year patents.