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Antipsychotic drugs help many people with schizophrenia by suppressing their psychotic symptoms and enabling them to live more meaningful, stable lives with fewer relapses and reducing the need for hospitalization.  But this class of medicines has significant limitations. A sizable percentage of people with schizophrenia get little or no benefit when they take an antipsychotic, and others get only a partial reduction in symptoms. Also, side effects pose a major barrier to continuous use. In one major study, for example, three of every four people stopped taking an antipsychotic or switched to a different one within 18 months.

Newer and quite expensive antipsychotics marketed heavily to doctors and consumers over the past 15 years have largely eclipsed an older generation of drugs developed in the 1950s and 1960s. Research for years appeared to indicate that the newer drugs were better, largely because they had fewer side effects. But more recent large-scale studies now indicate that overall, the older drugs work just as well at a far lower cost.

• Generic perphenazine — for patients with schizophrenia who are not satisfied with their current treatment and whose doctor thinks perphenazine is worth a try. People taking perphenazine should be monitored closely for muscle tremors and spasms.
• Generic risperidone — for people with schizophrenia who take perphenazine first and get minimal benefit and/or experience intolerable side effects.
• Olanzapine (Zyprexa) — for certain people with schizophrenia who take perphenazine first and receive no benefit (or a minimal one) and/or experience intolerable side effects. Zyprexa is not a good option for people who are overweight or have blood sugar abnormalities, diabetes, or heart disease.
• Generic clozapine — for people with moderate to severe schizophrenia who have not responded at all to two or more antipsychotics and have had little reduction in symptoms.

The choice of generic perphenazine—if a person responds well to it—could save you hundreds of dollars a month (adding up to thousands of dollars each year) compared with Zyprexa and Risperdal, the brand-name version of risperidone, depending on the dose required.

We are unable to make a Best Buy selection between antipsychotics for people with bipolar disorder. Unfortunately, there is not enough evidence to do so.

This information was last updated in August 2009.