# Are antipsychotics related to benzos chemically? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [August 25, 2014, 11:19am UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454 "2014-08-25T11:19:03Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![protoboard](https://avatars.discourse-cdn.com/v4/letter/p/fbc32d/32.png) [@protoboard](https://boards.straightdope.com/u/protoboard)\ **Post date:** [August 25, 2014, 11:19am UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/1 "2014-08-25T11:19:03Z")
And which would you generally consider to be more “hardcore”? I used to take Seroquel which is a benzene-based antipsychotic and I remember it would knock me out cold. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [August 25, 2014, 3:05pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/2 "2014-08-25T15:05:26Z")
While seroquel is a type of dibenzothiazepine, it is structurally very different from benzodiazepines and does not appear to have any activity at the brain’s benzodiazepine receptors. I don’t know how you define ‘hardcore’. Seroquel is popular due to its relative low risk for causing those nasty extra-pyramidal side-effects that plague 1st generation antipsychotic med users, and is seen as lower risk than some of the other 2nd generation drugs in this regard too. And it’s shorter acting to boot. ---
**Author:** ![BigT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bigt/32/12044_2.png) [@BigT](https://boards.straightdope.com/u/BigT)\ **Post date:** [August 25, 2014, 7:12pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/3 "2014-08-25T19:12:19Z")
Seroquel is nothing. It sedates you. You go off it, you might have to wait 24 extra hours to go to sleep. Benzo withdrawal can ruin your life, making depressed and more anxious than you thought was humanly possible. I’m still reeling from it, and it’s been almost 6 years. ---
**Author:** ![thelurkinghorror](https://avatars.discourse-cdn.com/v4/letter/t/7c8e57/32.png) [@thelurkinghorror](https://boards.straightdope.com/u/thelurkinghorror)\ **Post date:** [August 25, 2014, 8:01pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/4 "2014-08-25T20:01:00Z")
Drowsiness-wise, antipsychotics (Zyprexa, Risperdal) seem worse than Benzos (Xanx, Klonopin, Ativan). As in I’d be more wary to drive on the former. Chemically, they are very unrelated, affecting (primarily) dopamine vs. GABA, respectively. Benzodiazepines are second to alcohol in bad withdrawals. I don’t think typical antipsychotics are prescribed much anymore. ---
**Author:** ![protoboard](https://avatars.discourse-cdn.com/v4/letter/p/fbc32d/32.png) [@protoboard](https://boards.straightdope.com/u/protoboard)\ **Post date:** [August 25, 2014, 10:24pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/5 "2014-08-25T22:24:39Z")
> [@thelurkinghorror](#): > > Drowsiness-wise, antipsychotics (Zyprexa, Risperdal) seem worse than Benzos (Xanx, Klonopin, Ativan). As in I’d be more wary to drive on the former. > Chemically, they are very unrelated, affecting (primarily) dopamine vs. GABA, respectively. Benzodiazepines are second to alcohol in bad withdrawals. I don’t think typical antipsychotics are prescribed much anymore. So would Seroquel be more like an SSRI? ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [August 25, 2014, 11:08pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/6 "2014-08-25T23:08:33Z")
Seroquel is an [atypical antipsychotic](http://en.wikipedia.org/wiki/Atypical_antipsychotic). Still blocks dopamine receptors, but it may cause less tardive dyskinesia (twitching, grimacing, tongue sticking out, eye blinking, etc.) than the first generation of antipsychotics. But we’re not entirely sure about that, because it usually takes many years of being on even the old antipsychotics for tardive dyskinesia to show up, and atypicals haven’t been on the market long enough to really know for sure. In another 10 years, we might revisit that opinion. I sometimes see Haloperidol (Haldol), but I think that’s the only first generation (“typical”) antipsychotic I’ve seen prescribed for home use. (reviewing list…) Oh, I had one little old lady on Chlorpromazine. I think it was off label for migraines, 'cause she didn’t have any Psych diagnoses. I remember it only because I had to look it up, not recognizing it, and I was all, “holy shit! _Thorazine_? Do they even still make that?!” Apparently, they do. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [August 26, 2014, 4:17am UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/7 "2014-08-26T04:17:54Z")
Some folks for whom newer medications don’t work (or cause agranulocytosis or other effects) still use the first wave -zines. ---
**Author:** ![protoboard](https://avatars.discourse-cdn.com/v4/letter/p/fbc32d/32.png) [@protoboard](https://boards.straightdope.com/u/protoboard)\ **Post date:** [October 10, 2014, 6:14pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/8 "2014-10-10T18:14:14Z")
Can anyone explain the difference between a minor and a major tranquilizer? I did some more research and apparently benzos are minor tranquilizers and Seroquel and other anti-psych meds are major tranquilizers. > [@Qadgop\_the\_Mercotan](#): > > While seroquel is a type of dibenzothiazepine, it is structurally very different from benzodiazepines and does not appear to have any activity at the brain’s benzodiazepine receptors. Right - so chemically it’s a cousin to benzodiazepine, but its effect on the brain is quite different? ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [October 10, 2014, 6:19pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/9 "2014-10-10T18:19:05Z")
> [@BigT](#): > > Seroquel is nothing. It sedates you. You go off it, you might have to wait 24 extra hours to go to sleep. Benzo withdrawal can ruin your life, making depressed and more anxious than you thought was humanly possible. I’m still reeling from it, and it’s been almost 6 years. I’m sorry. I wish we could figure out how to ID people likely to have a problem with these meds before they do. I have read the low-dose Prozac can help with this. I’ve used benzos several times over the years, and a few times they (with my other meds) kept me functional. And I just…cycled down when I didn’t need them anymore. There wasn’t a “going off” phase, just needing less and less and taking less and less until I realized the three remaining in the bottle were a year old. I wish everyone had the same experience. ---
**Author:** ![susan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/susan/32/17537_2.png) [@susan](https://boards.straightdope.com/u/susan)\ **Post date:** [October 10, 2014, 6:55pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/10 "2014-10-10T18:55:23Z")
This is a nomenclature issue. “Minor tranquilizer” means a tranquilizer. “Major tranquilizer” means an anti-psychotic. “Mood stabilizer” means an anti-bipolar. These medications may be used for other purposes, but these are their central meanings. ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [October 10, 2014, 7:00pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/11 "2014-10-10T19:00:29Z")
AHhhh! Fuck Seroquel. I was recently prescribed this medication to treat my chronic insomnia and all I can say is it didn’t treat my insomnia but it _did_ successfully treat my problem of having big, satisfying erections. :mad: ---
**Author:** ![tapu](https://avatars.discourse-cdn.com/v4/letter/t/49beb7/32.png) [@tapu](https://boards.straightdope.com/u/tapu)\ **Post date:** [October 10, 2014, 9:57pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/12 "2014-10-10T21:57:58Z")
threadkiller? ---
**Author:** ![Ambivalid](https://avatars.discourse-cdn.com/v4/letter/a/a5b964/32.png) [@Ambivalid](https://boards.straightdope.com/u/Ambivalid)\ **Post date:** [October 10, 2014, 11:05pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/13 "2014-10-10T23:05:59Z")
> [@tapu](#): > > threadkiller? _Something_killer. ---
**Author:** ![KarlGauss](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/karlgauss/32/3713_2.png) [@KarlGauss](https://boards.straightdope.com/u/KarlGauss)\ **Post date:** [October 10, 2014, 11:59pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/14 "2014-10-10T23:59:31Z")
> [@susan](#): > > This is a nomenclature issue. “Minor tranquilizer” means a tranquilizer. “Major tranquilizer” means an anti-psychotic. “Mood stabilizer” means an anti-bipolar. This. **susan** is spot on and what she said above deserves re-saying. At the time these drugs were developed, there was very little ‘real’ understanding of neurochemistry (alas, the situation really isn’t too much better 60 years later . . . but I digress). So, in the absence of understanding, and without any framework on which to anticipate and incorporate new observations and discoveries, chlorpromazine (and related drugs) were called _major tranquilizers_. After all, they _did_ tranquilize and were more potent than benzodiazepines (e.g. Librium/chlordiazepoxide, Valium/diazepam). And, although benzodiazepines _do_ tranquilize, they are less effective in that regard than drugs like chlorpromazine. Hence, they were named _minor tranquilizers_. So, for historical reasons, then, we inherited the uninformative, if not downright misleading, category labels: minor tranquilizers and major tranquilizers. After those drugs’ discovery, subsequent advances in neurochemistry (and in neuropharmacology, neurophysiology, etc.), led to the use of newer, and I’d say more informative, drug category labels. For example, chlorpromazine is now known to be a prototype dopamine antagonist drug. And, when you look at it that way and view chlorpromazine as a dopamine antagonist (and not as the nebulous and rather silly term ‘major tranquilizer’), you’re immediately able to understand its effects on apparently unrelated things like motor function (e.g. in other words, you can relate it to other diseases caused by deranged dopamine function). The classic example might be Parkinson’s disease, a disorder due to dopamine deficiency and characterized by various motor disturbances (dyskinesias). Things which were previously though to be unrelated may actually have a link - and that’s a good sign that you’re on the road to ‘real’ understanding. Sorta like the the moon’s orbit and the tides, or relativity and the ‘anomalous’ orbit of Mercury. Likewise, benzodiazepine drugs are now known to work by augmenting the effect of an entirely different neurotransmitter called GABA (i.e. a neurotransmitter that is totally different than dopamine). It’s not surprising, then, that the _dopamine antagonist_ drug chlorpromazine (and related medications) has very different effects than the _GABA agonist_ agent diazepam (and related drugs). To call them major and minor tranquilizers is an anachronism rooted in what passed for understanding over 60 years ago. ---
**Author:** ![asterion](https://avatars.discourse-cdn.com/v4/letter/a/4da419/32.png) [@asterion](https://boards.straightdope.com/u/asterion)\ **Post date:** [October 11, 2014, 12:21am UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/15 "2014-10-11T00:21:39Z")
> [@protoboard](#): > > Right - so chemically it’s a cousin to benzodiazepine, but its effect on the brain is quite different? From a structural point of view, they’re really not very similar. Other chemists might disagree with me, but I don’t think of them as similar types of molecules. ---
**Author:** ![protoboard](https://avatars.discourse-cdn.com/v4/letter/p/fbc32d/32.png) [@protoboard](https://boards.straightdope.com/u/protoboard)\ **Post date:** [October 11, 2014, 12:23am UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/16 "2014-10-11T00:23:05Z")
> [@KarlGauss](#): > > Likewise, benzodiazepine drugs are now known to work by augmenting the effect of an entirely different neurotransmitter called GABA (i.e. a neurotransmitter that is totally different than dopamine). It’s not surprising, then, that the _dopamine antagonist_ drug chlorpromazine (and related medications) has very different effects than the _GABA agonist_ agent diazepam (and related drugs). To call them major and minor tranquilizers is an anachronism rooted in what passed for understanding over 60 years ago. GABA eh? Same as alcohol. Is being on benzos a bit like being drunk, then? ---
**Author:** ![protoboard](https://avatars.discourse-cdn.com/v4/letter/p/fbc32d/32.png) [@protoboard](https://boards.straightdope.com/u/protoboard)\ **Post date:** [October 11, 2014, 12:24am UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/17 "2014-10-11T00:24:09Z")
> [@asterion](#): > > From a structural point of view, they’re really not very similar. Other chemists might disagree with me, but I don’t think of them as similar types of molecules. Interesting. Seroquel has two benzene molecules and benzos have one, does that make a major difference in the way they react to the brain’s receptors? ---
**Author:** ![elfkin477](https://avatars.discourse-cdn.com/v4/letter/e/a9a28c/32.png) [@elfkin477](https://boards.straightdope.com/u/elfkin477)\ **Post date:** [October 11, 2014, 12:29am UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/18 "2014-10-11T00:29:21Z")
> [@WhyNot](#): > > Seroquel is an [atypical antipsychotic](http://en.wikipedia.org/wiki/Atypical_antipsychotic). Still blocks dopamine receptors, but it may cause less tardive dyskinesia (twitching, grimacing, tongue sticking out, eye blinking, etc.) than the first generation of antipsychotics. But we’re not entirely sure about that, because it usually takes many years of being on even the old antipsychotics for tardive dyskinesia to show up, and atypicals haven’t been on the market long enough to really know for sure. In another 10 years, we might revisit that opinion. Ah hah, this makes a lecture on psychopharmacology I was transcribing at work yesterday make more sense. The doctor said that they learned the connection between Thorazine and tardive dyskinesia after the atypical antipsychotics were on the market. I didn’t get that he was implying that Thorazine hadn’t been taken long enough by anyone at that point to cause the issue. According to him, though, Torazine is making a resurgence. Last night I got to learn what the hell a reuptake inhibitor was (er, mechanically, I know which drugs they are), and this is helpful too. It’s no fun transcribing something you only follow 90% of. ---
**Author:** ![asterion](https://avatars.discourse-cdn.com/v4/letter/a/4da419/32.png) [@asterion](https://boards.straightdope.com/u/asterion)\ **Post date:** [October 11, 2014, 12:48am UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/19 "2014-10-11T00:48:05Z")
> [@protoboard](#): > > Interesting. Seroquel has two benzene molecules and benzos have one, does that make a major difference in the way they react to the brain’s receptors? I’m not a med chemist, I’m a process chemist. So you really want one of them in here to answer that. However, when I look at the structures, you’ve got a somewhat related but completely different heterocycle in use. It’s not just like one of the nitrogens moved to a different position but that one of the nitrogen atoms has been substituted with a sulfur. That’s a big change for a lot of reasons. Plus, the molecules have very different side chains. Take a look at the 3D models on Wikipedia and you might see why I don’t think they’re very similar. In any case, structure defines activity on the receptors. In the simplest model, if a molecule isn’t the right shape and size to get into a receptor, there can’t be an effect. These compounds are hitting entirely different receptors. ---
**Author:** ![JayRx1981](https://avatars.discourse-cdn.com/v4/letter/j/71e660/32.png) [@JayRx1981](https://boards.straightdope.com/u/JayRx1981)\ **Post date:** [October 11, 2014, 1:16pm UTC](https://boards.straightdope.com/t/are-antipsychotics-related-to-benzos-chemically/696454/20 "2014-10-11T13:16:54Z")
> [@thelurkinghorror](#): > > Drowsiness-wise, antipsychotics (Zyprexa, Risperdal) seem worse than Benzos (Xanx, Klonopin, Ativan). As in I’d be more wary to drive on the former. > Chemically, they are very unrelated, affecting (primarily) dopamine vs. GABA, respectively. Benzodiazepines are second to alcohol in bad withdrawals. I don’t think typical antipsychotics are prescribed much anymore. Actually, I’m generally concerned about both having an effect on driving. Antipsychotic induced sedation tends to go away slowly, over time, while tolerance to benzodiazepine-induced sedation develops more rapidly. Both, however, remain capable of interfering with cognitive function long past their sedating effects having worn off, so caution should still be advised if needing to drive. > [@WhyNot](#): > > I sometimes see Haloperidol (Haldol), but I think that’s the only first generation (“typical”) antipsychotic I’ve seen prescribed for home use. (reviewing list…) > > Oh, I had one little old lady on Chlorpromazine. I think it was off label for migraines, 'cause she didn’t have any Psych diagnoses. I remember it only because I had to look it up, not recognizing it, and I was all, “holy shit! _Thorazine_? Do they even still make that?!” Apparently, they do. While many prescribers these days now prefer drugs like Zofran (Ondansetron), “typical” antipsychotics are still sometimes also used for nausea/vomiting as well. This holds true particularly for chlorpromazine (also used off label for hiccups, iirc) and haloperidol. > [@KarlGauss](#): > > This. **susan** is spot on and what she said above deserves re-saying. > > At the time these drugs were developed, there was very little ‘real’ understanding of neurochemistry (alas, the situation really isn’t too much better 60 years later . . . but I digress). > > So, in the absence of understanding, and without any framework on which to anticipate and incorporate new observations and discoveries, chlorpromazine (and related drugs) were called _major tranquilizers_. After all, they _did_ tranquilize and were more potent than benzodiazepines (e.g. Librium/chlordiazepoxide, Valium/diazepam). And, although benzodiazepines _do_ tranquilize, they are less effective in that regard than drugs like chlorpromazine. Hence, they were named _minor tranquilizers_. > > So, for historical reasons, then, we inherited the uninformative, if not downright misleading, category labels: minor tranquilizers and major tranquilizers. > > After those drugs’ discovery, subsequent advances in neurochemistry (and in neuropharmacology, neurophysiology, etc.), led to the use of newer, and I’d say more informative, drug category labels. For example, chlorpromazine is now known to be a prototype dopamine antagonist drug. And, when you look at it that way and view chlorpromazine as a dopamine antagonist (and not as the nebulous and rather silly term ‘major tranquilizer’), you’re immediately able to understand its effects on apparently unrelated things like motor function (e.g. in other words, you can relate it to other diseases caused by deranged dopamine function). The classic example might be Parkinson’s disease, a disorder due to dopamine deficiency and characterized by various motor disturbances (dyskinesias). Things which were previously though to be unrelated may actually have a link - and that’s a good sign that you’re on the road to ‘real’ understanding. Sorta like the the moon’s orbit and the tides, or relativity and the ‘anomalous’ orbit of Mercury. > > Likewise, benzodiazepine drugs are now known to work by augmenting the effect of an entirely different neurotransmitter called GABA (i.e. a neurotransmitter that is totally different than dopamine). It’s not surprising, then, that the _dopamine antagonist_ drug chlorpromazine (and related medications) has very different effects than the _GABA agonist_ agent diazepam (and related drugs). To call them major and minor tranquilizers is an anachronism rooted in what passed for understanding over 60 years ago. KarlGauss pretty much nailed it, with a slight nitpick (sorry). Benzodiazepines don’t act as agonists, but rather as positive allosteric modulators of GABA, enhancing GABA induced signal transmission at certain types of GABA-A receptors (mostly synaptic). By themselves, they cannot actually cause the GABA-A ion channel to open (unlike their cousins, though not structurally, the barbiturates). > [@protoboard](#): > > GABA eh? Same as alcohol. Is being on benzos a bit like being drunk, then? They can be, though alcohol tends to hit quite a few different types of receptors, depending on how much is floating around in your system. Ethanol can interfere with the function of GABA receptors (particularly extra-synaptic GABA-A receptors composed of one or two alpha-4 units, two beta units, and a delta unit in place of the more common gamma unit), NMDA receptors (acting as an antagonist), and at higher concentrations, AMPA receptors (also as an antagonist) as well. > [@protoboard](#): > > Interesting. Seroquel has two benzene molecules and benzos have one, does that make a major difference in the way they react to the brain’s receptors? Yes, among other things. Even taking a molecule as relatively simple as GABA and cyclizing it (ie making it a ring) changes it’s effect. Gabapentin (Neurontin) is a good example of this.