Name for New Class of Antipsychotic Medications

To the Editor: A recent commentary by James B. Lohr, M.D., and David L. Braff, M.D. (1), suggested that for the new class of antipsychotic medications that includes clozapine, olanzapine, quetiapine, risperidone, and ziprasidone, the term “second-generation antipsychotic medications” should be used.

While I do not particularly advocate other terms used (e.g., “atypical antipsychotics”), I do not believe that the term “second generation” is the best either. Where does the first generation end and the second generation begin? What criteria should be used for inclusion in the first or second generation? Is risperidone closer in its profile to the first-generation antipsychotic medications or to the second-generation ones? Should clozapine be included, although it is not really a “newer” antipsychotic medication? Should aripiprazole be included in the second or third generation?

A similar terminology attempt in the classification of antidepressants (first- versus second-generation antidepressants) did not take off in the past. Perhaps from a practical and economical point of view, we should use a name inspired by Paul Janssen. When asked during one of his lectures what he thought about the classification and name for the so-called atypical antipsychotic medications, he responded (as quoted from memory by the participants), “We do not know how to call these new antipsychotics because it is difficult to find their common denominator. They are called atypical, but I would rather say ‘expensive’ because that is what they have in common.” They really are, compared to the typical (a.k.a. “cheap”) antipsychotics.