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Anthony Aveni claims that another building associated with the planet Venus in the form of Kukulcan, and the rainy season at Chichen Itza is the Caracol. This is a building with a circular tower and doors facing the cardinal directions. The base faces the most northerly setting of Venus. Additionally the pillars of a stylobate on the building's upper platform were painted black and red. These are colours associated with Venus as an evening and morning star. However the windows in the tower seem to have been little more than slots, making them poor at letting light in, but providing a suitable place to view out. In their discussion of the credibility of archaeoastronomical sites, Cotte and Ruggles considered the interpretation that the Caracol is an observatory site was debated among specialists, meeting the second of their four levels of site credibility. Aveni states that one of the strengths of the brown methodology is that it can explore astronomies invisible to statistical analysis and offers the astronomy of the Incas as another example. The empire of the Incas was conceptually divided using "ceques", radial routes emanating from the capital at Cusco. Thus there are alignments in all directions which would suggest there is little of astronomical significance, However, ethnohistorical records show that the various directions do have cosmological and astronomical significance with various points in the landscape being significant at different times of the year. In eastern Asia archaeoastronomy has developed from the history of astronomy and much archaeoastronomy is searching for material correlates of the historical record. This is due to the rich historical record of astronomical phenomena which, in China, stretches back into the Han dynasty, in the second century BC.
A criticism of this method is that it can be statistically weak. Schaefer in particular has questioned how robust the claimed alignments in the Caracol are. Because of the wide variety of evidence, which can include artefacts as well as sites, there is no one way to practice archaeoastronomy. Despite this it is accepted that archaeoastronomy is not a discipline that sits in isolation. Because archaeoastronomy is an interdisciplinary field, whatever is being investigated should make sense both archaeologically and astronomically. Studies are more likely to be considered sound if they use theoretical tools found in archaeology like analogy and homology and if they can demonstrate an understanding of accuracy and precision found in astronomy. Both quantitative analyses and interpretations based on ethnographic analogies and other contextual evidence have recently been applied in systematic studies of architectural orientations in the Maya area and in other parts of Mesoamerica. Source materials. Because archaeoastronomy is about the many and various ways people interacted with the sky, there are a diverse range of sources giving information about astronomical practices.
Alignments. A common source of data for archaeoastronomy is the study of alignments. This is based on the assumption that the axis of alignment of an archaeological site is meaningfully oriented towards an astronomical target. Brown archaeoastronomers may justify this assumption through reading historical or ethnographic sources, while green archaeoastronomers tend to prove that alignments are unlikely to be selected by chance, usually by demonstrating common patterns of alignment at multiple sites. An alignment is calculated by measuring the azimuth, the angle from north, of the structure and the altitude of the horizon it faces The azimuth is usually measured using a theodolite or a compass. A compass is easier to use, though the deviation of the Earth's magnetic field from true north, known as its magnetic declination must be taken into account. Compasses are also unreliable in areas prone to magnetic interference, such as sites being supported by scaffolding. Additionally a compass can only measure the azimuth to a precision of a half a degree.
A theodolite can be considerably more accurate if used correctly, but it is also considerably more difficult to use correctly. There is no inherent way to align a theodolite with North and so the scale has to be calibrated using astronomical observation, usually the position of the Sun. Because the position of celestial bodies changes with the time of day due to the Earth's rotation, the time of these calibration observations must be accurately known, or else there will be a systematic error in the measurements. Horizon altitudes can be measured with a theodolite or a clinometer. Artifacts. For artifacts such as the Sky Disc of Nebra, alleged to be a Bronze Age artefact depicting the cosmos, the analysis would be similar to typical post-excavation analysis as used in other sub-disciplines in archaeology. An artefact is examined and attempts are made to draw analogies with historical or ethnographical records of other peoples. The more parallels that can be found, the more likely an explanation is to be accepted by other archaeologists.
A more mundane example is the presence of astrological symbols found on some shoes and sandals from the Roman Empire. The use of shoes and sandals is well known, but Carol van Driel-Murray has proposed that astrological symbols etched onto sandals gave the footwear spiritual or medicinal meanings. This is supported through citation of other known uses of astrological symbols and their connection to medical practice and with the historical records of the time. Another well-known artefact with an astronomical use is the Antikythera mechanism. In this case analysis of the artefact, and reference to the description of similar devices described by Cicero, would indicate a plausible use for the device. The argument is bolstered by the presence of symbols on the mechanism, allowing the disc to be read. Art and inscriptions. Art and inscriptions may not be confined to artefacts, but also appear painted or inscribed on an archaeological site. Sometimes inscriptions are helpful enough to give instructions to a site's use. For example, a Greek inscription on a stele (from Itanos) has been translated as:"Patron set this up for Zeus Epopsios. Winter solstice. Should anyone wish to know: off 'the little pig' and the stele the sun turns." From Mesoamerica come Mayan and Aztec codices. These are folding books made from Amatl, processed tree bark on which are glyphs in Mayan or Aztec script. The Dresden codex contains information regarding the Venus cycle, confirming its importance to the Mayans.
More problematic are those cases where the movement of the Sun at different times and seasons causes light and shadow interactions with petroglyphs. A widely known example is the Sun Dagger of Fajada Butte at which a glint of sunlight passes over a spiral petroglyph. The location of a dagger of light on the petroglyph varies throughout the year. At the summer solstice a dagger can be seen through the heart of the spiral; at the winter solstice two daggers appear to either side of it. It is proposed that this petroglyph was created to mark these events. Recent studies have identified many similar sites in the US Southwest and Northwestern Mexico. It has been argued that the number of solstitial markers at these sites provides statistical evidence that they were intended to mark the solstices. The Sun Dagger site on Fajada Butte in Chaco Canyon, New Mexico, stands out for its explicit light markings that record all the key events of both the solar and lunar cycles: summer solstice, winter solstice, equinox, and the major and minor lunar standstills of the Moon's 18.6 year cycle. In addition at two other sites on Fajada Butte, there are five light markings on petroglyphs recording the summer and winter solstices, equinox and solar noon. Numerous buildings and interbuilding alignments of the great houses of Chaco Canyon and outlying areas are oriented to the same solar and lunar directions that are marked at the Sun Dagger site.
If no ethnographic nor historical data are found which can support this assertion then acceptance of the idea relies upon whether or not there are enough petroglyph sites in North America that such a correlation could occur by chance. It is helpful when petroglyphs are associated with existing peoples. This allows ethnoastronomers to question informants as to the meaning of such symbols. Ethnographies. As well as the materials left by peoples themselves, there are also the reports of other who have encountered them. The historical records of the Conquistadores are a rich source of information about the pre-Columbian Americans. Ethnographers also provide material about many other peoples. Anthony Aveni uses the importance of zenith passages as an example of the importance of ethnography. For peoples living between the tropics of Cancer and Capricorn there are two days of the year when the noon Sun passes directly overhead and casts no shadow. In parts of Mesoamerica this was considered a significant day as it would herald the arrival of rains, and so play a part in the cycle of agriculture. This knowledge is still considered important amongst Mayan Indians living in Central America today. The ethnographic records suggested to archaeoastronomers that this day may have been important to the ancient Mayans. There are also shafts known as 'zenith tubes' which illuminate subterranean rooms when the Sun passes overhead found at places like Monte Albán and Xochicalco. It is only through the ethnography that we can speculate that the timing of the illumination was considered important in Mayan society. Alignments to the sunrise and sunset on the day of the zenith passage have been claimed to exist at several sites. However, it has been shown that, since there are very few orientations that can be related to these phenomena, they likely have different explanations.
Ethnographies also caution against over-interpretation of sites. At a site in Chaco Canyon can be found a pictograph with a star, crescent and hand. It has been argued by some astronomers that this is a record of the 1054 Supernova. However recent reexaminations of related 'supernova petroglyphs' raises questions about such sites in general. Cotte and Ruggles used the Supernova petroglyph as an example of a completely refuted site and anthropological evidence suggests other interpretations. The Zuni people, who claim a strong ancestral affiliation with Chaco, marked their sun-watching station with a crescent, star, hand and sundisc, similar to those found at the Chaco site. Ethnoastronomy is also an important field outside of the Americas. For example, anthropological work with Aboriginal Australians is producing much information about their Indigenous astronomies and about their interaction with the modern world. Recreating the ancient sky. Once the researcher has data to test, it is often necessary to attempt to recreate ancient sky conditions to place the data in its historical environment.
Declination. To calculate what astronomical features a structure faced a coordinate system is needed. The stars provide such a system. On a clear night observe the stars spinning around the celestial pole can be observed. This point is +90° of the North Celestial Pole or −90° observing the Southern Celestial Pole. The concentric circles the stars trace out are lines of celestial latitude, known as "declination". The arc connecting the points on the horizon due East and due West (if the horizon is flat) and all points midway between the Celestial Poles is the Celestial Equator which has a declination of 0°. The visible declinations vary depending where you are on the globe. Only an observer on the North Pole of Earth would be unable to see any stars from the Southern Celestial Hemisphere at night (see diagram below). Once a declination has been found for the point on the horizon that a building faces it is then possible to say whether a specific body can be seen in that direction. Solar positioning. While the stars are fixed to their declinations the Sun is not. The rising point of the Sun varies throughout the year. It swings between two limits marked by the solstices a bit like a pendulum, slowing as it reaches the extremes, but passing rapidly through the midpoint. If an archaeoastronomer can calculate from the azimuth and horizon height that a site was built to view a declination of +23.5° then he or she need not wait until 21 June to confirm the site does indeed face the summer solstice. For more information see History of solar observation.
Lunar positioning. The Moon's appearance is considerably more complex. Its motion, like the Sun, is between two limits—known as "luni"stices rather than "sol"stices. However, its travel between lunistices is considerably faster. It takes a sidereal month to complete its cycle rather than the year-long trek of the Sun. This is further complicated as the lunistices marking the limits of the Moon's movement move on an 18.6 year cycle. For slightly over nine years the extreme limits of the Moon are outside the range of sunrise. For the remaining half of the cycle the Moon never exceeds the limits of the range of sunrise. However, much lunar observation was concerned with the "phase" of the Moon. The cycle from one New Moon to the next runs on an entirely different cycle, the Synodic month. Thus when examining sites for lunar significance the data can appear sparse due to the extremely variable nature of the Moon. See Moon for more details. Stellar positioning. Finally there is often a need to correct for the apparent movement of the stars. On the timescale of human civilisation the stars have largely maintained the same position relative to each other. Each night they appear to rotate around the celestial poles due to the Earth's rotation about its axis. However, the Earth spins rather like a spinning top. Not only does the Earth rotate, it wobbles. The Earth's axis takes around 25,800 years to complete one full wobble. The effect to the archaeoastronomer is that stars did not rise over the horizon in the past in the same places as they do today. Nor did the stars rotate around Polaris as they do now.
The movement of the Earth's axis was already noticed by the Sumerians over six thousand years ago, when they were able to observe the star Canopus culminating directly above the horizon on the southern meridian for the first time in their oldest and southernmost city Eridu. For several decades, Canopus was not yet visible in the neighbouring town of Ur to the north-east of Eridu, and therefore, it was called the "Star of the City of Eridu" in Sumerian. In the case of the Egyptian pyramids, it has been shown they were aligned towards Thuban, a faint star in the constellation of Draco. The effect can be substantial over relatively short lengths of time, historically speaking. For instance a person born on 25 December in Roman times would have been born with the Sun in the constellation Capricorn. In the modern period a person born on the same date would have the Sun in Sagittarius due to the precession of the equinoxes. Transient phenomena. Additionally there are often transient phenomena, events which do not happen on an annual cycle. Most predictable are events like eclipses. In the case of solar eclipses these can be used to date events in the past. A solar eclipse mentioned by Herodotus enables us to date a battle between the Medes and the Lydians, which following the eclipse failed to happen, to 28 May, 585 BC.
Some comets are predictable, most famously Halley's Comet. Yet as a class of object they remain unpredictable and can appear at any time. Some have extremely lengthy orbital periods which means their past appearances and returns cannot be predicted. Others may have only ever passed through the Solar System once and so are inherently unpredictable. Meteor showers should be predictable, but some meteors are cometary debris and so require calculations of orbits which are currently impossible to complete. Other events noted by ancients include aurorae, sun dogs and rainbows all of which are as impossible to predict as the ancient weather, but nevertheless may have been considered important phenomena. Major topics of archaeoastronomical research. The use of calendars. A common justification for the need for astronomy is the need to develop an accurate calendar for agricultural reasons. Ancient texts like Hesiod's Works and Days, an ancient farming manual, would appear to partially confirm this: astronomical observations are used in combination with ecological signs, such as bird migrations to determine the seasons. Ethnoastronomical studies of the Hopi of the southwestern United States indicate that they carefully observed the rising and setting positions of the Sun to determine the proper times to plant crops. However, ethnoastronomical work with the Mursi of Ethiopia shows that their luni-solar calendar was somewhat haphazard, indicating the limits of astronomical calendars in some societies. All the same, calendars appear to be an almost universal phenomenon in societies as they provide tools for the regulation of communal activities.
One such example is the "Tzolk'in" calendar of 260 days. Together with the 365-day year, it was used in pre-Columbian Mesoamerica, forming part of a comprehensive calendrical system, which combined a series of astronomical observations and ritual cycles. Archaeoastronomical studies throughout Mesoamerica have shown that the orientations of most structures refer to the Sun and were used in combination with the 260-day cycle for scheduling agricultural activities and the accompanying rituals. The distribution of dates and intervals marked by orientations of monumental ceremonial complexes in the area along the southern Gulf Coast in Mexico, dated to about 1100 to 700 BCE, represents the earliest evidence of the use of this cycle. Other peculiar calendars include ancient Greek calendars. These were nominally lunar, starting with the New Moon. In reality the calendar could pause or skip days with confused citizens inscribing dates by both the civic calendar and "ton theoi", by the moon. The lack of any universal calendar for ancient Greece suggests that coordination of panhellenic events such as games or rituals could be difficult and that astronomical symbolism may have been used as a politically neutral form of timekeeping. Orientation measurements in Greek temples and Byzantine churches have been associated to deity's name day, festivities, and special events.
Myth and cosmology. Another motive for studying the sky is to understand and explain the universe. In these cultures myth was a tool for achieving this, and the explanations, while not reflecting the standards of modern science, are cosmologies. The Incas arranged their empire to demonstrate their cosmology. The capital, Cusco, was at the centre of the empire and connected to it by means of ceques, conceptually straight lines radiating out from the centre. These ceques connected the centre of the empire to the four "suyus", which were regions defined by their direction from Cusco. The notion of a quartered cosmos is common across the Andes. Gary Urton, who has conducted fieldwork in the Andean villagers of Misminay, has connected this quartering with the appearance of the Milky Way in the night sky. In one season it will bisect the sky and in another bisect it in a perpendicular fashion. The importance of observing cosmological factors is also seen on the other side of the world. The Forbidden City in Beijing is laid out to follow cosmic order though rather than observing four directions. The Chinese system was composed of five directions: North, South, East, West and Centre. The Forbidden City occupied the centre of ancient Beijing. One approaches the Emperor from the south, thus placing him in front of the circumpolar stars. This creates the situation of the heavens revolving around the person of the Emperor. The Chinese cosmology is now better known through its export as feng shui.
There is also much information about how the universe was thought to work stored in the mythology of the constellations. The Barasana of the Amazon plan part of their annual cycle based on observation of the stars. When their constellation of the Caterpillar-Jaguar (roughly equivalent to the modern Scorpius) falls they prepare to catch the pupating caterpillars of the forest as they fall from the trees. The caterpillars provide food at a season when other foods are scarce. A more well-known source of constellation myth are the texts of the Greeks and Romans. The origin of their constellations remains a matter of vigorous and occasionally fractious debate. The loss of one of the sisters, Merope, in some Greek myths may reflect an astronomical event wherein one of the stars in the Pleiades disappeared from view by the naked eye. Giorgio de Santillana, professor of the History of Science in the School of Humanities at the Massachusetts Institute of Technology, and Hertha von Dechend, professor at Goethe University Frankfurt, argued that the old mythological stories handed down from antiquity were not random fictitious tales but were accurate depictions of celestial cosmology clothed in tales to aid their oral transmission. The chaos, monsters and violence in ancient myths are representative of the forces that shape each age. They argued that ancient myths are the remains of preliterate, late Neolithic astronomy that was lost. Santillana and von Dechend argued in their book "Hamlet's Mill: An Essay on Myth and the Frame of Time" (1969) that ancient myths have no historical or factual basis other than a cosmological one encoding astronomical phenomena, especially the precession of the equinoxes. Santillana and von Dechend's approach is not widely accepted.
Displays of power. By including celestial motifs in clothing it becomes possible for the wearer to make claims the power on Earth is drawn from above. It has been said that the Shield of Achilles described by Homer is also a catalogue of constellations. In North America shields depicted in Comanche petroglyphs appear to include Venus symbolism. Solsticial alignments also can be seen as displays of power. When viewed from a ceremonial plaza on the Island of the Sun (the mythical origin place of the Sun) in Lake Titicaca, the Sun was seen to rise at the June solstice between two towers on a nearby ridge. The sacred part of the island was separated from the remainder of it by a stone wall and ethnographic records indicate that access to the sacred space was restricted to members of the Inca ruling elite. Ordinary pilgrims stood on a platform outside the ceremonial area to see the solstice Sun rise between the towers. In Egypt the temple of Amun-Re at Karnak has been the subject of much study. Evaluation of the site, taking into account the change over time of the obliquity of the ecliptic show that the Great Temple was aligned on the rising of the midwinter Sun. The length of the corridor down which sunlight would travel would have limited illumination at other times of the year.
In a later period the Serapeum of Alexandria was also said to have contained a solar alignment so that, on a specific sunrise, a shaft of light would pass across the lips of the statue of Serapis thus symbolising the Sun saluting the god. Major sites of archaeoastronomical interest. Clive Ruggles and Michel Cotte recently edited a book on heritage sites of astronomy and archaeoastronomy which discussed a worldwide sample of astronomical and archaeoastronomical sites and provided criteria for the classification of archaeoastronomical sites. Newgrange. Newgrange is a passage tomb in the Republic of Ireland dating from around 3,300 to 2,900 BC For a few days around the Winter Solstice light shines along the central passageway into the heart of the tomb. What makes this notable is not that light shines in the passageway, but that it does not do so through the main entrance. Instead it enters via a hollow box above the main doorway discovered by Michael O'Kelly. It is this roofbox which strongly indicates that the tomb was built with an astronomical aspect in mind. In their discussion of the credibility of archaeoastronomical sites, Cotte and Ruggles gave Newgrange as an example of a Generally accepted site, the highest of their four levels of credibility. Clive Ruggles notes:
Egypt. Since the first modern measurements of the precise cardinal orientations of the Giza pyramids by Flinders Petrie, various astronomical methods have been proposed for the original establishment of these orientations. It was recently proposed that this was done by observing the positions of two stars in the Plough / Big Dipper which was known to Egyptians as the thigh. It is thought that a vertical alignment between these two stars checked with a plumb bob was used to ascertain where north lay. The deviations from true north using this model reflect the accepted dates of construction. Some have argued that the pyramids were laid out as a map of the three stars in the belt of Orion, although this theory has been criticized by reputable astronomers. The site was instead probably governed by a spectacular hierophany which occurs at the summer solstice, when the Sun, viewed from the Sphinx terrace, forms—together with the two giant pyramids—the symbol Akhet, which was also the name of the Great Pyramid. Further, the south east corners of all the three pyramids align towards the temple of Heliopolis, as first discovered by the Egyptologist Mark Lehner.
The astronomical ceiling of the tomb of Senenmut (BC) contains the Celestial Diagram depicting circumpolar constellations in the form of discs. Each disc is divided into 24 sections suggesting a 24-hour time period. Constellations are portrayed as sacred deities of Egypt. The observation of lunar cycles is also evident. El Castillo. El Castillo, also known as Kukulcán's Pyramid, is a Mesoamerican step-pyramid built in the centre of Mayan center of Chichen Itza in Mexico. Several architectural features have suggested astronomical elements. Each of the stairways built into the sides of the pyramid has 91 steps. Along with the extra one for the platform at the top, this totals 365 steps, which is possibly one for each day of the year (365.25) or the number of lunar orbits in 10,000 rotations (365.01).
Stonehenge. Many astronomical alignments have been claimed for Stonehenge, a complex of megaliths and earthworks in the Salisbury Plain of England. The most famous of these is the midsummer alignment, where the Sun rises over the Heel Stone. However, this interpretation has been challenged by some archaeologists who argue that the midwinter alignment, where the viewer is outside Stonehenge and sees the Sun setting in the henge, is the more significant alignment, and the midsummer alignment may be a coincidence due to local topography. In their discussion of the credibility of archaeoastronomical sites, Cotte and Ruggles gave Stonehenge as an example of a Generally accepted site, the highest of their four levels of credibility. As well as solar alignments, there are proposed lunar alignments. The four station stones mark out a rectangle. The short sides point towards the midsummer sunrise and midwinter sunset. The long sides if viewed towards the south-east, face the most southerly rising of the Moon. Anthony Aveni notes that these lunar alignments have never gained the acceptance that the solar alignments have received.
Maeshowe. This is an architecturally outstanding Neolithic chambered tomb on the mainland of Orkney, Scotland—probably dating to the early 3rd millennium BC, and where the setting Sun at midwinter shines down the entrance passage into the central chamber (see Newgrange). In the 1990s further investigations were carried out to discover whether this was an accurate or an approximate solar alignment. Several new aspects of the site were discovered. In the first place the entrance passage faces the hills of the island Hoy, about 10 miles away. Secondly, it consists of two straight lengths, angled at a few degrees to each other. Thirdly, the outer part is aligned towards the midwinter sunset position on a level horizon just to the left of Ward Hill on Hoy. Fourthly the inner part points directly at the Barnhouse standing stone about 400m away and then to the right end of the summit of Ward Hill, just before it dips down to the notch between it at Cuilags to the right. This indicated line points to sunset on the first Sixteenths of the solar year (according to A. Thom) before and after the winter solstice and the notch at the base of the right slope of the Hill is at the same declination. Fourthly a similar 'double sunset' phenomenon is seen at the right end of Cuilags, also on Hoy; here the date is the first Eighth of the year before and after the winter solstice, at the beginning of November and February respectively—the Old Celtic festivals of Samhain and Imbolc. This alignment is not indicated by an artificial structure but gains plausibility from the other two indicated lines. Maeshowe is thus an extremely sophisticated calendar site which must have been positioned carefully in order to use the horizon foresights in the ways described.
Uxmal. Uxmal is a Mayan city in the Puuc Hills of Yucatán Peninsula, Mexico. The Governor's Palace at Uxmal is often used as an exemplar of why it is important to combine ethnographic and alignment data. The palace is aligned with an azimuth of 118° on the pyramid of Cehtzuc. This alignment corresponds approximately to the southernmost rising and, with a much greater precision, to the northernmost setting of Venus; both phenomena occur once every eight years. By itself this would not be sufficient to argue for a meaningful connection between the two events. The palace has to be aligned in one direction or another and why should the rising of Venus be any more important than the rising of the Sun, Moon, other planets, Sirius "et cetera"? The answer given is that not only does the palace point towards significant points of Venus, it is also covered in glyphs which stand for Venus and Mayan zodiacal constellations. Moreover, the great northerly extremes of Venus always occur in late April or early May, coinciding with the onset of the rainy season. The Venus glyphs placed in the cheeks of the Maya rain god Chac, most likely referring to the concomitance of these phenomena, support the west-working orientation scheme.
Chaco Canyon. In Chaco Canyon, the center of the ancient Pueblo culture in the American Southwest, numerous solar and lunar light markings and architectural and road alignments have been documented. These findings date to the 1977 discovery of the Sun Dagger site by Anna Sofaer. Three large stone slabs leaning against a cliff channel light and shadow markings onto two spiral petroglyphs on the cliff wall, marking the solstices, equinoxes and the lunar standstills of the 18.6 year cycle of the moon. Subsequent research by the Solstice Project and others demonstrated that numerous building and interbuilding alignments of the great houses of Chaco Canyon are oriented to solar, lunar and cardinal directions. In addition, research shows that the Great North Road, a thirty-five mile engineered "road", was constructed not for utilitarian purposes but rather to connect the ceremonial center of Chaco Canyon with the direction north. Lascaux Cave.
Fringe archaeoastronomy. Archaeoastronomy owes something of a poor reputation among scholars due to its occasional misuse to advance a range of pseudo-historical accounts. During the 1930s, Otto S. Reuter compiled a study entitled "Germanische Himmelskunde", or "Teutonic Skylore". The astronomical orientations of ancient monuments claimed by Reuter and his followers would place the ancient Germanic peoples ahead of the Ancient Near East in the field of astronomy, demonstrating the intellectual superiority of the "Aryans" (Indo-Europeans) over the Semites. More recently I. J. Gallagher, R. L. Pyle, and B. Fell interpreted inscriptions in West Virginia as a description in Celtic Ogham alphabet of the supposed winter solstitial marker at the site. The controversial translation was supposedly validated by a problematic archaeoastronomical indication in which the winter solstice Sun shone on an inscription of the Sun at the site. Subsequent analyses criticized its cultural inappropriateness, as well as its linguistic and archaeoastronomical claims, to describe it as an example of "cult archaeology".
Archaeoastronomy is sometimes related to the fringe discipline of Archaeocryptography, when its followers attempt to find underlying mathematical orders beneath the proportions, size, and placement of archaeoastronomical sites such as Stonehenge and the Pyramid of Kukulcán at Chichen Itza. India. Since the 19th century, numerous scholars have sought to use archaeoastronomical calculations to demonstrate the antiquity of Ancient Indian Vedic culture, computing the dates of astronomical observations ambiguously described in ancient poetry to as early as 4000 BC. David Pingree, a historian of Indian astronomy, condemned "the scholars who perpetrate wild theories of prehistoric science and call themselves archaeoastronomers". Organisations. There are currently several academic organisations for scholars of archaeoastronomy (including ethnoastronomy and Indigenous astronomy). ISAACthe International Society for Archaeoastronomy and Astronomy in Culturewas founded in 1996 as the global society for the field. It sponsors the Oxford conferences and the Journal of Astronomy in Culture.
SEAC – La Société Européenne pour l'Astronomie dans la Culture was founded in 1992 with a focus on broader Europe. SEAC holds annual conferences in Europe and publishes refereed conference proceedings on an annual basis. SIACLa Sociedad Interamericana de Astronomía en la Cultura was founded in 2003 with a focus on Latin America. SCAAS - The Society for Cultural Astronomy in the American Southwest was founded in 2009 as a regional organisation focusing on the astronomies of the native peoples of the Southwestern United States; it has since held seven meetings and workshops. AAAC – the Australian Association for Astronomy in Culture was founded in 2020 in Australia, focusing on Aboriginal and Torres Strait Islander astronomy. The Romanian Society for Cultural Astronomy was founded in 2019, holding an annual international conference and publishing the first monograph on archaeo- and ethnoastronomy in Romania (2019). SMART – the Society of Māori Astronomy Research and Traditions was founded in Aotearoa/New Zealand in 2013, focusing on Maori astronomy.
Native Skywatchers was founded in 2007 in Minnesota, USA to promote Native American star knowledge, particularly of the Lakota and Ojibwe peoples of the northern US and Canada. Publications. Additionally the "Journal for the History of Astronomy" publishes many archaeoastronomical papers. For twenty-seven volumes (from 1979 to 2002) it published an annual supplement "Archaeoastronomy". The "Journal of Astronomical History and Heritage", "Culture & Cosmos", and the "Journal of Skyscape Archaeology" also publish papers on archaeoastronomy. Academic programs. National projects and university programs including, or dedicated to, cultural astronomy are found globally. They include: The Sophia Centre for Cosmology in Culture at the University of Wales - Trinity Saint David in Lampeter, UK. The Cultural Astronomy Program at the University of Melbourne in Australia. The Tata Institute of Fundamental Research made interesting findings in this field.
Andrzej Sapkowski Andrzej Sapkowski (; born 21 June 1948) is a Polish fantasy writer. He is best known for his series of books "The Witcher", which revolves around the eponymous monster-hunter, Geralt of Rivia. The saga has been popularized through television, stage, comic books, video games and translated into 37 languages making him the second most-translated Polish science fiction and fantasy writer after Stanisław Lem. Described as the "Polish Tolkien", he has written multiple novels and short story collections, selling over 30 million copies worldwide. The influence of Slavic mythology is seen as a characteristic feature of many of his works. He is a five-time recipient of the Zajdel Award, Poland's most popular science fiction and fantasy prize, as well as many other awards and honors including David Gemmell Award, World Fantasy Life Achievement Award and the Gloria Artis Medal for Merit to Culture. Early life. He was born on 21 June 1948 in Łódź, in central Poland. His father served in the Polish People's Army and participated in the Battle of Berlin. After the end of World War II, his parents lived near Nowa Sól before settling in Łódź. He attended the Bolesław Prus High School No. 21. He also studied economics at the University of Łódź, and before turning to writing, he had worked as a senior sales representative for a foreign trade company. He started his literary career as a translator, in particular, of science fiction. Among the first works translated by him was "The Words of Guru" by Cyril M. Kornbluth.
Career. Major works. He says he wrote his first short story, "The Witcher" (1986), ("Wiedźmin", also translated "The Hexer" or "Spellmaker"), on a whim, in order to enter a contest by Polish science fiction and fantasy magazine "Fantastyka". In an interview, he said that being a businessman at the time and thus familiar with marketing, he knew how to sell, and indeed, he won third prize. The story was published in "Fantastyka" in 1986 and was enormously successful both with readers and critics. Sapkowski has created a cycle of tales based on the world of "The Witcher", comprising three collections of short stories and eight novels. This cycle and his other works have made him one of the best-known fantasy authors in Poland in the 1990s. The main character of "The Witcher" is Geralt of Rivia, trained as a monster hunter since childhood. Geralt exists in a morally ambiguous universe, yet manages to maintain his own coherent code of ethics. At the same time cynical and noble, Geralt has been compared to Raymond Chandler's signature character Philip Marlowe. The world in which these adventures take place is heavily influenced by Slavic mythology.
In her review of "Blood of Elves", Alice Wybrew of "Total Sci-Fi" writes that "Moving effortlessly between moments of wrought emotion and staggeringly effective action, to lengthy periods of political discussion and war stratagems, Sapkowski addresses every aspect of a good fantasy novel eloquently and with ease. His style reads as easily as David Gemmel, but hits harder and deeper than his late fantasy comrade. Creating a world that is both familiar and comfortable, it is through his inventive use of character manipulation that he generates a new and realistic experience". Alex Jay of "Polygon" further observes that within Sapkowski's fantasy tales, "there are parallels to the complicated history of ethnic strife and resistance to oppression in Central and Eastern Europe". The depictions of the disputes between nonhumans and humans "echo real-world disputes over territory and citizenship that draw dividing lines according to race, nationality, or ethnicity". In 2001, he published the "Manuscript Found in a Dragon's Cave", an original and personal guide to fantasy literature. It was written in the form of an encyclopaedia and the author discusses in it the history of the literary genre, well-known fantasy heroes, descriptions of magic terminology as well as major works of notable writers including J. R. R. Tolkien's "The Hobbit" and "The Lord of the Rings", Robert E. Howard's "Conan", C. S. Lewis's "The Chronicles of Narnia", Ursula K. Le Guin's "Earthsea", Roger Zelazny's "The Chronicles of Amber", J. K. Rowling's "Harry Potter", and George R. R. Martin's "A Song of Ice and Fire".
Sapkowski's next book series was the "Hussite Trilogy" set in the 15th century at the time of the Hussite Wars with Reinmar of Bielawa as the main protagonist. Mariusz Czubaj writes: Although the "Hussite Trilogy" proved less popular compared to "The Witcher", it has been described as the author's "magnum opus". Published between 2002 and 2006, the series was released as an audiobook in 2019. In August 2023, Sapkowski announced he was working on a new novel from "The Witcher" universe during an on-line meeting with his Ukrainian fans. He added that his work on the book "may take a year, but no longer" giving it a potential expected publication date at some point in 2024. The novel, titled "Rozdroże Kruków", was published in Poland in November 2024, and will release internationally as "Crossroads of Ravens" in September 2025. Legal dispute with CD Projekt. In October 2018, he sent an open letter to CD Projekt demanding 60 million zloty ($16.1 million) in royalty payments from the company for using the Witcher universe in their computer games. The letter was written despite the fact that Sapkowski had sold the video game rights to the Witcher for a single sum, rather than through a royalties contract. Sapkowski and his lawyers based their claims on Article 44 of the Copyright and Related Rights Act.
CD Projekt released a statement claiming that the author's demands are groundless and that the company had legitimately and legally acquired copyright to Sapkowski's works. His decision was criticized by many commentators and gaming journalists including Dmitry Glukhovsky, the author of "Metro 2033", who described him as "an old fool" and noted that without the gaming franchise, the Witcher series "would never get this crazy international readership" and would have remained popular only in Central and Eastern Europe. On 20 December 2019, the writer and the company resolved the dispute with an amicable settlement. The company stated this deal was made in an effort "to maintain good relations with authors of works which have inspired CD Projekt Red's own creations." The details of this arrangement were not made public. Personal life. Sapkowski resides in his hometown of Łódź in central Poland. He had a son named Krzysztof (1972–2019), who was an avid reader of the Polish "Fantastyka" magazine, and for whom he wrote the first "Witcher" story, who has since deceased.
Sapkowski is a member of the Polish Writers Association. In an interview, he mentioned that his favorite writers included Ernest Hemingway, Mikhail Bulgakov, Raymond Chandler and Umberto Eco. In 2005, Stanisław Bereś conducted a lengthy interview with Sapkowski that was eventually published in a book form as "Historia i fantastyka". Translations and adaptations of Sapkowski's works. Sapkowski's books have been translated into Bulgarian, Chinese, Croatian, Czech, Dutch, English, Estonian, Finnish, French, Georgian, German, Greek, Hebrew, Hungarian, Italian, Korean, Lithuanian, Norwegian, Persian, Portuguese, Romanian, Russian, Serbian, Slovak, Spanish, Swedish, Turkish, and Ukrainian. In English, his official debut was from his The Witcher universe that was published in 2000 in a small press anthology "Chosen by Fate". An English translation of "The Last Wish" short story collection was published by Gollancz in 2007. From 2008, the Witcher saga is published by Gollancz. The English translation of Sapkowski's novel "Blood of Elves" won the David Gemmell Legend Award in 2009.
In the years 1993–1995, a six-issue comic book series entitled "The Witcher" was released in the "Komiks" magazine by Prószyński i S-ka publishing house. The comic was written by Maciej Parowski and illustrated by Bogusław Polch. The comics were the first attempt to portray the Witcher universe outside the novels. Since 2014, a comic book series "The Witcher" has been published by the American publisher Dark Horse Comics. The stories presented in the series are mostly originals, written not by Andrzej Sapkowski but by other writers; the exception being volume 2, Fox Children, which adapted a story from the anthology "Season of Storms". In 2001, a television series based on the "Witcher" cycle was released in Poland and internationally, entitled "Wiedźmin" ("The Hexer"). A film by the same title was compiled from excerpts of the television series but both have been critical and box office failures. In 2009, Russian heavy metal band Esse staged "The Road with No Return", a rock opera based on the works by Sapkowski. Yevgeny Pronin is the author of the libretto and the composer of much of the opera's music. The premiere of the opera took place the same year in Rostov-on-Don and was subsequently released as a DVD in 2012.
The Polish game developer, CD Projekt Red, created a role-playing game series based on "The Witcher" universe. The first game, titled simply "The Witcher", was first released in October 2007. The sequel, ' was released in 2011. The third game in the trilogy, ', was released in May 2015. The game shipped over 40 million copies, making it one of the best selling video games of all time. In May 2017, Netflix commissioned "The Witcher", an English-language adaptation of the book series. "The Witcher" television series premiered on Netflix on 20 December 2019. Sapkowski served for a while as a creative consultant on the project. The popularity of the Netflix show led to Sapkowski topping Amazon's list of best-selling authors ahead of J.K. Rowling and Stephen King. A spin-off anime ', produced by Lauren Schmidt Hissrich, premiered in 2021. A second spinoff anime, ', was released on February 11 2025, adapting the short story A Little Sacrifice from the collection "Sword of Destiny". In September 2017, a musical "Wiedźmin" (The Witcher) directed by Wojciech Kościelniak was premiered at the Musical Theatre in Gdynia.
"" is a fantasy miniseries created by Declan de Barra and Lauren Schmidt Hissrich adapted from "The Witcher" book series which serves as a prequel to the Netflix television series. It was released on Netflix in December 2022. Awards and recognition. Sapkowski is a recipient of numerous awards and honours both Polish and foreign including: Bibliography. The Witcher Saga. New book. Shortly before the release of "Rozdroże kruków", in an interview for the Polish weekly periodical "Polityka", Sapkowski announced that it would not be the last book set in the "Witcher" universe. Again, he did not provide more details, saying only that "there'll be a new book" and "if I set the time horizon to three or four years, it'll be without much risk".
Ammeter An ammeter (abbreviation of "ampere meter") is an instrument used to measure the current in a circuit. Electric currents are measured in amperes (A), hence the name. For direct measurement, the ammeter is connected in series with the circuit in which the current is to be measured. An ammeter usually has low resistance so that it does not cause a significant voltage drop in the circuit being measured. Instruments used to measure smaller currents, in the milliampere or microampere range, are designated as "milliammeters" or "microammeters". Early ammeters were laboratory instruments that relied on the Earth's magnetic field for operation. By the late 19th century, improved instruments were designed which could be mounted in any position and allowed accurate measurements in electric power systems. It is generally represented by letter 'A' in a circuit. History. The relation between electric current, magnetic fields and physical forces was first noted by Hans Christian Ørsted in 1820, who observed a compass needle was deflected from pointing North when a current flowed in an adjacent wire. The tangent galvanometer was used to measure currents using this effect, where the restoring force returning the pointer to the zero position was provided by the Earth's magnetic field. This made these instruments usable only when aligned with the Earth's field. Sensitivity of the instrument was increased by using additional turns of wire to multiply the effect – the instruments were called "multipliers".
The word "rheoscope" as a detector of electrical currents was coined by Sir Charles Wheatstone about 1840 but is no longer used to describe electrical instruments. The word makeup is similar to that of "rheostat" (also coined by Wheatstone) which was a device used to adjust the current in a circuit. Rheostat is a historical term for a variable resistance, though unlike rheoscope may still be encountered. Types. Some instruments are "panel meters", meant to be mounted on some sort of control panel. Of these, the flat, horizontal or vertical type is often called an "edgewise meter". Moving-coil. The D'Arsonval galvanometer is a moving coil ammeter. It uses magnetic deflection, where current passing through a coil placed in the magnetic field of a permanent magnet causes the coil to move. The modern form of this instrument was developed by Edward Weston, and uses two spiral springs to provide the restoring force. The uniform air gap between the iron core and the permanent magnet poles make the deflection of the meter linearly proportional to current. These meters have linear scales. Basic meter movements can have full-scale deflection for currents from about 25 microamperes to 10 milliamperes.
Because the magnetic field is polarised, the meter needle acts in opposite directions for each direction of current. A DC ammeter is thus sensitive to which polarity it is connected in; most are marked with a positive terminal, but some have centre-zero mechanisms and can display currents in either direction. A moving coil meter indicates the average (mean) of a varying current through it, which is zero for AC. For this reason, moving-coil meters are only usable directly for DC, not AC. This type of meter movement is extremely common for both ammeters and other meters derived from them, such as voltmeters and ohmmeters. Moving magnet. Moving magnet ammeters operate on essentially the same principle as moving coil, except that the coil is mounted in the meter case, and a permanent magnet moves the needle. Moving magnet Ammeters are able to carry larger currents than moving coil instruments, often several tens of amperes, because the coil can be made of thicker wire and the current does not have to be carried by the hairsprings. Indeed, some Ammeters of this type do not have hairsprings at all, instead using a fixed permanent magnet to provide the restoring force.
Electrodynamic. An electrodynamic ammeter uses an electromagnet instead of the permanent magnet of the d'Arsonval movement. This instrument can respond to both alternating and direct current and also indicates true RMS for AC. See wattmeter for an alternative use for this instrument. Moving-iron. Moving iron ammeters use a piece of iron which moves when acted upon by the electromagnetic force of a fixed coil of wire. The moving-iron meter was invented by Austrian engineer Friedrich Drexler in 1884. This type of meter responds to both direct and alternating currents (as opposed to the moving-coil ammeter, which works on direct current only). The iron element consists of a moving vane attached to a pointer, and a fixed vane, surrounded by a coil. As alternating or direct current flows through the coil and induces a magnetic field in both vanes, the vanes repel each other and the moving vane deflects against the restoring force provided by fine helical springs. The deflection of a moving iron meter is proportional to the square of the current. Consequently, such meters would normally have a nonlinear scale, but the iron parts are usually modified in shape to make the scale fairly linear over most of its range. Moving iron instruments indicate the RMS value of any AC waveform applied. Moving iron ammeters are commonly used to measure current in industrial frequency AC circuits.
Hot-wire. In a hot-wire ammeter, a current passes through a wire which expands as it heats. Although these instruments have slow response time and low accuracy, they were sometimes used in measuring radio-frequency current. These also measure true RMS for an applied AC. Digital. In much the same way as the analogue ammeter formed the basis for a wide variety of derived meters, including voltmeters, the basic mechanism for a digital meter is a digital voltmeter mechanism, and other types of meter are built around this. Digital ammeter designs use a shunt resistor to produce a calibrated voltage proportional to the current flowing. This voltage is then measured by a digital voltmeter, through use of an analog-to-digital converter (ADC); the digital display is calibrated to display the current through the shunt. Such instruments are often calibrated to indicate the RMS value for a sine wave only, but many designs will indicate true RMS within limitations of the wave crest factor. Integrating. There is also a range of devices referred to as integrating ammeters.
In these ammeters the current is summed over time, giving as a result the product of current and time; which is proportional to the electrical charge transferred with that current. These can be used for metering energy (the charge needs to be multiplied by the voltage to give energy) or for estimating the charge of a battery or capacitor. Picoammeter. A picoammeter, or pico ammeter, measures very low electric current, usually from the picoampere range at the lower end to the milliampere range at the upper end. Picoammeters are used where the current being measured is below the limits of sensitivity of other devices, such as multimeters. Most picoammeters use a "virtual short" technique and have several different measurement ranges that must be switched between to cover multiple decades of measurement. Other modern picoammeters use log compression and a "current sink" method that eliminates range switching and associated voltage spikes. Special design and usage considerations must be observed in order to reduce leakage current which may swamp measurements such as special insulators and driven shields. Triaxial cable is often used for probe connections.
Application. Ammeters must be connected in series with the circuit to be measured. For relatively small currents (up to a few amperes), an ammeter may pass the whole of the circuit current. For larger direct currents, a shunt resistor carries most of the circuit current and a small, accurately-known fraction of the current passes through the meter movement. For alternating current circuits, a current transformer may be used to provide a convenient small current to drive an instrument, such as 1 or 5 amperes, while the primary current to be measured is much larger (up to thousands of amperes). The use of a shunt or current transformer also allows convenient location of the indicating meter without the need to run heavy circuit conductors up to the point of observation. In the case of alternating current, the use of a current transformer also isolates the meter from the high voltage of the primary circuit. A shunt provides no such isolation for a direct-current ammeter, but where high voltages are used it may be possible to place the ammeter in the "return" side of the circuit which may be at low potential with respect to earth.
Ammeters must not be connected directly across a voltage source since their internal resistance is very low and excess current would flow. Ammeters are designed for a low voltage drop across their terminals, much less than one volt; the extra circuit losses produced by the ammeter are called its "burden" on the measured circuit(I). Ordinary Weston-type meter movements can measure only milliamperes at most, because the springs and practical coils can carry only limited currents. To measure larger currents, a resistor called a "shunt" is placed in parallel with the meter. The resistances of shunts is in the integer to fractional milliohm range. Nearly all of the current flows through the shunt, and only a small fraction flows through the meter. This allows the meter to measure large currents. Traditionally, the meter used with a shunt has a full-scale deflection (FSD) of , so shunts are typically designed to produce a voltage drop of when carrying their full rated current. To make a multi-range ammeter, a selector switch can be used to connect one of a number of shunts across the meter. It must be a make-before-break switch to avoid damaging current surges through the meter movement when switching ranges.
A better arrangement is the Ayrton shunt or universal shunt, invented by William E. Ayrton, which does not require a make-before-break switch. It also avoids any inaccuracy because of contact resistance. In the figure, assuming for example, a movement with a full-scale voltage of 50 mV and desired current ranges of 10 mA, 100 mA, and 1 A, the resistance values would be: R1 = 4.5 ohms, R2 = 0.45 ohm, R3 = 0.05 ohm. And if the movement resistance is 1000 ohms, for example, R1 must be adjusted to 4.525 ohms. Switched shunts are rarely used for currents above 10 amperes. Zero-center ammeters are used for applications requiring current to be measured with both polarities, common in scientific and industrial equipment. Zero-center ammeters are also commonly placed in series with a battery. In this application, the charging of the battery deflects the needle to one side of the scale (commonly, the right side) and the discharging of the battery deflects the needle to the other side. A special type of zero-center ammeter for testing high currents in cars and trucks has a pivoted bar magnet that moves the pointer, and a fixed bar magnet to keep the pointer centered with no current. The magnetic field around the wire carrying current to be measured deflects the moving magnet.
Since the ammeter shunt has a very low resistance, mistakenly wiring the ammeter in parallel with a voltage source will cause a short circuit, at best blowing a fuse, possibly damaging the instrument and wiring, and exposing an observer to injury. In AC circuits, a current transformer can be used to convert the large current in the main circuit into a smaller current more suited to a meter. Some designs of transformer are able to directly convert the magnetic field around a conductor into a small AC current, typically either or at full rated current, that can be easily read by a meter. In a similar way, accurate AC/DC non-contact ammeters have been constructed using Hall effect magnetic field sensors. A portable hand-held clamp-on ammeter is a common tool for maintenance of industrial and commercial electrical equipment, which is temporarily clipped over a wire to measure current. Some recent types have a parallel pair of magnetically soft probes that are placed on either side of the conductor.
Amanda Hesser Amanda Hesser (born 1971) is an American food writer, editor, cookbook author and entrepreneur. Most notably, she was the food editor of "The New York Times Magazine", the editor of "T Living", a quarterly publication of "The New York Times", author of "The Essential New York Times Cookbook" which was a "New York Times" bestseller, and co-founder and CEO of Food52. Biography. After finishing her first book, in 1997, Hesser was hired as a food reporter for "The New York Times" where she wrote more than 750 stories. While at the "Times," Hesser wrote about the influence of Costco on the wine industry, and how the Farmer Consumer Advisory Committee made decisions for the New York City Greenmarket. She was also among the first to write about Ferran Adrià of El Bulli in a major American publication. Hesser was involved in two cases of conflict of interest while working at the "Times". In 2004, she awarded the restaurant Spice Market a three-star rating without disclosing that the year before, the restaurant's owner, Jean-Georges Vongerichten, had provided a complimentary jacket blurb for her book "Cooking for Mr. Latte". In 2007, Hesser published a favorable review of "Vegetable Harvest" by Patricia Wells without noting that in 1999, Wells had provided a jacket blurb for Hesser's book "The Cook and the Gardener". In both cases, the "Times" subsequently pointed out the conflicts of interest with editors' notes.
While Hesser left the "Times" in March 2008 to focus on the development of Food52, she continued to write the "Recipe Redux" feature for the "Times" magazine until February 27, 2011. As co-founder and CEO of Food52, she has raised two rounds of investment from parties including Lerer Hippeau Ventures and Bertelsmann Digital Media Investments. Food52 has won numerous notable awards, including the James Beard Foundation Award for Publication of the Year (2012) and the International Association of Culinary Professionals Award for Best Website (2013). In February 2017, noting that 92 percent of the company was white, she and her co-founder Merrill Stubbs "issued a statement about the ways in which the company intended to redress a lack of racial equality in its workplace." By the following January, "they published a follow-up letter updating readers on the progress of their efforts, stating that their staff had been reduced to being 76 percent white." Hesser was featured in "Food & Wine"'s "40 under 40" list, was named one of the 50 most influential women in food by "Gourmet" magazine, and had a cameo as herself in the film "Julie & Julia". Hesser lives in Brooklyn Heights with her husband, Tad Friend, a staff writer for "The New Yorker", and their two children.
Anxiolytic An anxiolytic (; also antipanic or anti-anxiety agent) is a medication or other intervention that reduces anxiety. This effect is in contrast to anxiogenic agents which increase anxiety. Anxiolytic medications are used for the treatment of anxiety disorders and their related psychological and physical symptoms. Nature of anxiety. Anxiety is a naturally-occurring emotion and response. When anxiety levels exceed the tolerability of a person, anxiety disorders may occur. People with anxiety disorders can exhibit fear responses, such as defensive behaviors, high levels of alertness, and negative emotions. Those with anxiety disorders may have concurrent psychological disorders, such as depression. Anxiety disorders are classified using six possible clinical assessments: Different types of anxiety disorders will share some general symptoms while having their own distinctive symptoms. This explains why people with different types of anxiety disorders will respond differently to different classes of anti-anxiety medications.
Etiology. The etiology of anxiety disorder remains unknown. There are several contributing factors that are still yet to be proved to cause anxiety disorders. These factors include childhood anxiety, drug induction by central stimulant drugs, metabolic diseases or having depressive disorder. Medications. Anti-anxiety medication is any drug that can be taken or prescribed for the treatment of anxiety disorders, which may be mediated by neurotransmitters like norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA) in the central nervous system. Anti-anxiety medication can be classified into six types according to their different mechanisms: antidepressants, benzodiazepines, azapirones, antiepileptics, antipsychotics, and beta blockers. Antidepressants include selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs). SSRIs are used in all types of anxiety disorders while SNRIs are used for generalized anxiety disorder (GAD). Both of them are considered as first-line anti-anxiety medications. TCAs are second-line treatment as they cause more significant adverse effects when compared to the first-line treatment. Benzodiazepines are effective in emergent and short-term treatment of anxiety disorders due to their fast onset but carry the risk of dependence. Buspirone is indicated for GAD, which has much slower onset but with the advantage of less sedating and withdrawal effects.
History. The first monoamine oxidase inhibitor (MAOI), iproniazid, was discovered accidentally when developing the new antitubercular drug isoniazid. The drug was found to induce euphoria and improve the patient's appetite and sleep quality. The first tricyclic antidepressant, imipramine, was originally developed and studied to be an antihistamine alongside other first-generation antihistamines of the time, such as promethazine. TCAs can increase the level of norepinephrine and serotonin by inhibiting their reuptake transport proteins. The majority of TCAs exert greater effect on norepinephrine, which leads to side effects like drowsiness and memory loss. In order to be more effective on serotonin agonism and avoid anticholinergic and antihistaminergic side effects, selective serotonin reuptake inhibitors (SSRI) were researched and introduced to treat anxiety disorders. The first SSRI, fluoxetine (Prozac), was discovered in 1974 and approved by FDA in 1987. After that, other SSRIs like sertraline (Zoloft), paroxetine (Paxil), and escitalopram (Lexapro) have entered the market.
The first serotonin norepinephrine reuptake inhibitor (SNRI), venlafaxine (Effexor), entered the market in 1993. SNRIs can target serotonin and norepinephrine transporters while avoiding imposing significant effects on other adrenergic (α1, α2, and β), histamine (H1), muscarinic, dopamine, or postsynaptic serotonin receptors. Classifications. There are six groups of anti-anxiety medications available that have been proven to be clinically significant in treatment of anxiety disorders. The groups of medications are as follows. Antidepressants. Medications that are indicated for both anxiety disorders and depression. Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) are new generations of antidepressants. They have a much lower adverse effect profile than older antidepressants like monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants (TCAs). Therefore, SSRIs and SNRIs are now the first-line agent in treating long term anxiety disorders, given their applications and significance in all six types of disorders.
Benzodiazepines. Benzodiazepines are used for acute anxiety and could be added along with current use of SSRIs to stabilize a treatment. Long-term use in treatment plans is not recommended. Different kinds of benzodiazepine will vary in its pharmacological profile, including its strength of effect and time taken for metabolism. The choice of the benzodiazepine will depend on the corresponding profiles. Benzodiazepines are used for emergent or short-term management. They are not recommended as the first-line anti-anxiety drugs, but they can be used in combination with SSRIs/SNRIs during the initial treatment stage. Indications include panic disorder, sleep disorders, seizures, acute behavioral disturbance, muscle spasm and premedication and sedation for procedures. Azapirones. Buspirone can be useful in GAD but not particularly effective in treating phobias, panic disorder or social anxiety disorders. It is a safer option for long-term use as it does not cause dependence like benzodiazepines. Antiepileptics. Antiepileptics are rarely prescribed as an off-label treatment for anxiety disorders and post-traumatic stress disorders. There have been some suggestions that they may help with anxiety symptoms but there is generally a lack of research on its use.
One antiepileptic, pregabalin, has been found to be better at treating GAD than a placebo, and comparable effects to benzodiazepines. It has also been shown be potentially efficient in treating social anxiety disorder. Gabapentin has been prescribed off-label for anxiety despite a lack of research evidence supporting such use, although some studies have indicated that it may relieve anxiety symptoms. The potential anxiolytic effect of tiagabine has been observed in some pre-clinical trials, but its effectiveness has not yet been proved. Similarly, there is a lack of research on valproate for the treatment of anxiety disorders. Antipsychotics. Olanzapine and risperidone are atypical antipsychotics which are also effective in GAD and PTSD treatment. However, there is a higher chance of experiencing adverse effects than the other anti-anxiety medications. Beta-adrenoceptor antagonists. Propranolol is originally used for high blood pressure and heart diseases. It can also be used to treat anxiety with symptoms like tremor or increased heart rate. They work on the nervous system and alleviate the symptoms as a relief. Propranolol is also commonly used for public speaking when one is nervous.
Mechanism of action. SSRIs and SNRIs. Both selective serotonin reuptake inhibitors (SSRI) and serotonin and norepinephrine reuptake inhibitors (SNRI) are reuptake inhibitors of a class of nerve signal transduction chemical called neurotransmitters. Serotonin and norepinephrine are neurotransmitters that are related to nervous control in mood regulation. The level of these neurotransmitters is regulated by the nerve through reuptake to avoid accumulation of the neurotransmitter at the endings of nerve fibers. By reuptaking the neurotransmitter, the level of neuronal activity will go back down and be ready to go back up upon excitation from a new nerve signal. However the neurotransmitter level of patients with anxiety disorders is usually low or the patients’ nerve fibers are insensitive to the neurotransmitters. SSRIs and SNRIs will then block the channel of reuptake and increase the level of the neurotransmitter. The nerve fibers will inhibit further production of neurotransmitters upon the increase. However the prolonged increase will eventually desensitize the nerve about the change in level. Therefore, the action of both SSRIs and SNRIs will take 4–6 weeks to exert their full effect.
Benzodiazepine. Benzodiazepines bind selectively to the GABA receptor, which is the receptor protein found in the nervous system and is in control of the nervous response. Benzodiazepine will increase the entry of chloride ions into the cells by improving the binding between GABA and GABA receptors and then the better opening of the channel for chloride ion passage. The high level of chloride ion inside the nerve cells makes the nerve more difficult to depolarize and inhibit further nerve signal transduction. The excitability of the nerves then reduces and the nervous system slows down. Therefore, the drug can alleviate symptoms of anxiety disorder and make the person less nervous. Clinical use. Selective serotonin reuptake inhibitors. Selective serotonin reuptake inhibitors (SSRIs) are a class of medications used in the treatment of depression, anxiety disorders, OCD and some personality disorders. SSRIs are the first-line anti-anxiety medications. Serotonin is one of the crucial neurotransmitters in mood enhancement, and increasing serotonin level produces an anti-anxiety effect. SSRIs increase the serotonin level in the brain by inhibiting serotonin uptake pumps on serotonergic systems, without interactions with other receptors and ion channels. SSRIs are beneficial in both acute response and long-term maintenance treatment for both depression and anxiety disorder.
SSRIs can increase anxiety initially due to negative feedback through the serotonergic autoreceptors; for this reason a concurrent benzodiazepine can be used until the anxiolytic effect of the SSRI occurs. The SSRIs paroxetine and escitalopram are USFDA approved to treat generalized anxiety disorder. Adverse effect. The common early side effects of SSRIs include nausea and loose stool, which can be solved by discontinuing the treatment. Headache, dizziness, insomnia are the common early side effects as well. Sexual dysfunction, anorgasmia, erectile dysfunction, and reduced libido are common adverse side effects of SSRIs. Sometimes they may persist after the cessation of treatment. Withdrawal symptoms like dizziness, headache and flu-like symptoms (fatigue/myalgia/loose stool) may occur if SSRI is stopped suddenly. The brain is incapable of upregulating the receptors to sufficient levels especially after discontinuation of the drugs with short half life like paroxetine. Both fluoxetine and its active metabolite have a long half life therefore it causes the least withdrawal symptoms.
Serotonin–norepinephrine reuptake inhibitors. Serotonin–norepinephrine reuptake inhibitor (SNRIs) include venlafaxine and duloxetine drugs. Venlafaxine, in extended release form, and duloxetine, are indicated for the treatment of GAD. SNRIs are as effective as SSRIs in the treatment of anxiety disorders. Tricyclic antidepressants. Tricyclic antidepressants (TCAs) have anxiolytic effects; however, side effects are often more troubling or severe and overdose is dangerous. They are considered effective, but have generally been replaced by antidepressants that cause different adverse effects. Examples include imipramine, doxepin, amitriptyline, nortriptyline and desipramine. Contraindication. TCAs may cause drug poisoning in patients with hypotension, cardiovascular diseases and arrhythmias. Tetracyclic antidepressants. Mirtazapine has demonstrated anxiolytic effect comparable to SSRIs while rarely causing or exacerbating anxiety. Mirtazapine's anxiety reduction tends to occur significantly faster than SSRIs. Monoamine oxidase inhibitors.
Monoamine oxidase inhibitors (MAOIs) are first-generation antidepressants effective for anxiety treatment but their dietary restrictions, adverse effect profile and availability of newer medications have limited their use. MAOIs include phenelzine, isocarboxazid and tranylcypromine. Pirlindole is a reversible MAOI that lacks dietary restriction. Barbiturates. Barbiturates are powerful anxiolytics but the risk of abuse and addiction is high. Many experts consider these drugs obsolete for treating anxiety but valuable for the short-term treatment of severe insomnia, though only after benzodiazepines or non-benzodiazepines have failed. Benzodiazepines. Benzodiazepines are prescribed to quell panic attacks. Benzodiazepines are also prescribed in tandem with an antidepressant for the latent period of efficacy associated with many ADs for anxiety disorder. There is risk of benzodiazepine withdrawal and rebound syndrome if BZDs are rapidly discontinued. Tolerance and dependence may occur. The risk of abuse in this class of medication is smaller than in that of barbiturates. Cognitive and behavioral adverse effects are possible.
Benzodiazepines include: alprazolam (Xanax), bromazepam, chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), oxazepam, temazepam, and Triazolam. Adverse effect. Benzodiazepines lead to central nervous system depression, resulting in common adverse effects like drowsiness, oversedation, light-headedness. Memory impairment can be a common adverse effect especially in elderly, hypersalivation, ataxia, slurred speech, psychomotor effects. Sympatholytics. Sympatholytics are a group of anti-hypertensives which inhibit activity of the sympathetic nervous system. Beta blockers reduce anxiety by decreasing heart rate and preventing shaking. Beta blockers include propranolol, oxprenolol, and metoprolol. The alpha-1 antagonist prazosin could be effective for PTSD. The alpha-2 agonists clonidine and guanfacine have demonstrated both anxiolytic and anxiogenic effects. Miscellaneous. Buspirone. Buspirone (Buspar) is a 5-HT1A receptor agonist used to treated generalized anxiety disorder. If an individual has only recently stopped taking benzodiazepines, buspirone will be less effective.
Pregabalin. Pregabalin (Lyrica) produces anxiolytic effect after one week of use comparable to lorazepam, alprazolam, and venlafaxine with more consistent psychic and somatic anxiety reduction. Unlike BZDs, it does not disrupt sleep architecture nor does it cause cognitive or psychomotor impairment. Hydroxyzine. Hydroxyzine (Atarax) is an antihistamine originally approved for clinical use by the FDA in 1956. Hydroxyzine has a calming effect which helps ameliorate anxiety. Hydroxyzine efficacy is comparable to benzodiazepines in the treatment of generalized anxiety disorder. Phenibut. Phenibut (Anvifen, Fenibut, Noofen) is an anxiolytic used in Russia. Phenibut is a GABAB receptor agonist, as well as an antagonist at α2δ subunit-containing voltage-dependent calcium channels (VDCCs), similarly to gabapentinoids like gabapentin and pregabalin. The medication is not approved by the FDA for use in the United States, but is sold online as a supplement. Temgicoluril. Temgicoluril (Mebicar) is an anxiolytic produced in Latvia and used in Eastern Europe. Temgicoluril has an effect on the structure of limbic-reticular activity, particularly on the hypothalamus, as well as on all four basic neuromediator systems – γ aminobutyric acid (GABA), choline, serotonin and adrenergic activity. Temgicoluril decreases noradrenaline, increases serotonin, and exerts no effect on dopamine.
Fabomotizole. Fabomotizole (Afobazole) is an anxiolytic drug launched in Russia in the early 2000s. Its mechanism of action is poorly-defined, with GABAergic, NGF and BDNF release promoting, MT1 receptor agonism, MT3 receptor antagonism, and sigma receptor agonism thought to have some involvement. Bromantane. Bromantane is a stimulant drug with anxiolytic properties developed in Russia during the late 1980s. Bromantane acts mainly by facilitating the biosynthesis of dopamine, through indirect genomic upregulation of relevant enzymes (tyrosine hydroxylase (TH) and aromatic L-amino acid decarboxylase (AAAD)). Emoxypine. Emoxypine is an antioxidant that is also a purported anxiolytic. Its chemical structure resembles that of pyridoxine, a form of vitamin B6. Menthyl isovalerate. Menthyl isovalerate is a flavoring food additive marketed as a sedative and anxiolytic drug in Russia under the name "Validol". Racetams. Some racetam based drugs such as aniracetam can have an antianxiety effect. Alpidem. Alpidem is a nonbenzodiazepine anxiolytic with similar anxiolytic effectiveness as benzodiazepines but reduced sedation and cognitive, memory, and motor impairment. It was marketed briefly in France but was withdrawn from the market due to liver toxicity.
Etifoxine. Etifoxine has similar anxiolytic effects as benzodiazepine drugs, but does not produce the same levels of sedation and ataxia. Further, etifoxine does not affect memory and vigilance, and does not induce rebound anxiety, drug dependence, or withdrawal symptoms. Alcohol. Alcohol is sometimes used as an anxiolytic by self-medication. fMRI can measure the anxiolytic effects of alcohol in the human brain. Alternatives to medication. Cognitive behavioral therapy (CBT) is an effective treatment for panic disorder, social anxiety disorder, generalized anxiety disorder, and obsessive–compulsive disorder, while exposure therapy is the recommended treatment for anxiety related phobias. Healthcare providers can guide those with anxiety disorder by referring them to self-help resources. Sometimes medication is combined with psychotherapy but research has not found a benefit of combined pharmacotherapy and psychotherapy versus monotherapy. If CBT is found ineffective, both the Canadian and American medical associations then suggest the use of medication.
Antipsychotic Antipsychotics, previously known as neuroleptics and major tranquilizers, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of other psychotic disorders. They are also the mainstay, together with mood stabilizers, in the treatment of bipolar disorder. Moreover, they are also used as adjuncts in the treatment of treatment-resistant major depressive disorder. The use of antipsychotics may result in many unwanted side effects such as involuntary movement disorders, gynecomastia, impotence, weight gain and metabolic syndrome. Long-term use can produce adverse effects such as tardive dyskinesia, tardive dystonia, tardive akathisia, and brain tissue volume reduction. First-generation antipsychotics (e.g., chlorpromazine, haloperidol, etc.), known as typical antipsychotics, were first introduced in the 1950s, and others were developed until the early 1970s. Second-generation antipsychotics, known as atypical antipsychotics, arrived with the introduction of clozapine in the early 1970s followed by others (e.g., risperidone, olanzapine, etc.). Both generations of medication block receptors in the brain for dopamine, but atypicals block serotonin receptors as well. Third-generation antipsychotics were introduced in the 2000s and offer partial agonism, rather than blockade, of dopamine receptors. "Neuroleptic", originating from ("neuron") and ("take hold of")—thus meaning "which takes the nerve"—refers to both common neurological effects and side effects.
Medical uses. Antipsychotics are most frequently used for the following conditions: Given the limited options available to treat the behavioral problems associated with dementia, other pharmacological and non-pharmacological interventions are usually attempted before using antipsychotics. A risk-to-benefit analysis is performed to weigh the risk of the adverse effects of antipsychotics versus: the potential benefit, the adverse effects of alternative interventions, and the risk of failing to intervene when a patient's behavior becomes unsafe. The same can be said for insomnia, in which they are not recommended as first-line therapy. There are evidence-based indications for using antipsychotics in children (e.g., tic disorder, bipolar disorder, psychosis), but the use of antipsychotics outside of those contexts (e.g., to treat behavioral problems) warrants significant caution. Antipsychotics are used to treat tics associated with Tourette syndrome. Aripiprazole, an atypical antipsychotic, is used as add-on medication to ameliorate sexual dysfunction as a symptom of selective serotonin reuptake inhibitor (SSRI) antidepressants in women. Quetiapine is used to treat generalized anxiety disorder.
Schizophrenia. Antipsychotic drug treatment is a key component of schizophrenia treatment recommendations by the National Institute of Health and Care Excellence (NICE), the American Psychiatric Association, and the British Society for Psychopharmacology. The main aim of treatment with antipsychotics is to reduce the positive symptoms of psychosis, that include delusions and hallucinations. There is mixed evidence to support a significant impact of antipsychotic use on primary negative symptoms (such as apathy, lack of emotional affect, and lack of interest in social interactions) or on cognitive symptoms (memory impairments, reduced ability to plan and execute tasks). In general, the efficacy of antipsychotic treatment in reducing positive symptoms appears to increase with the severity of baseline symptoms. All antipsychotic medications work relatively the same way: by antagonizing D2 dopamine receptors. However, there are some differences when it comes to typical and atypical antipsychotics. For example, atypical antipsychotic medications have been seen to lower the neurocognitive impairment associated with schizophrenia more than conventional antipsychotics, although the reasoning and mechanics of this are still unclear to researchers.
Applications of antipsychotic drugs in the treatment of schizophrenia include prophylaxis for those showing symptoms that suggest that they are at high risk of developing psychosis; treatment of first-episode psychosis; maintenance therapy (a form of prophylaxis, maintenance therapy aims to maintain therapeutic benefit and prevent symptom relapse); and treatment of recurrent episodes of acute psychosis. A recent 2024 study found that using high doses of antipsychotics for schizophrenia was linked to a higher risk of mortality. Researchers analyzed data from 32,240 individuals aged 17 to 64 diagnosed with schizophrenia between 2002 and 2012 to arrive at this conclusion. Prevention of psychosis and symptom improvement. Test batteries such as the PACE (Personal Assessment and Crisis Evaluation Clinic) and COPS (Criteria of Prodromal Syndromes), which measure low-level psychotic symptoms and cognitive disturbances, are used to evaluate people with early, low-level symptoms of psychosis. Test results are combined with family history information to identify patients in the "high-risk" group; they are considered to have a 20–40% risk of progression to frank psychosis within two years. These patients are often treated with low doses of antipsychotic drugs with the goal of reducing their symptoms and preventing progression to frank psychosis. While generally useful for reducing symptoms, clinical trials to date show little evidence that early use of antipsychotics improves long-term outcomes in those with prodromal symptoms, either alone or in combination with cognitive-behavioral therapy.
First-episode psychosis. First-episode psychosis (FEP) is the first time that psychotic symptoms are presented. NICE recommends that all people presenting with first-episode psychosis be treated with both an antipsychotic drug and cognitive behavioral therapy (CBT). NICE further recommends that those expressing a preference for CBT alone be informed that combination treatment is more effective. A diagnosis of schizophrenia is not made at this time as it takes longer to be determined by both DSM-5 and ICD-11, and only around 60% of those presenting with a first episode of psychosis will later be diagnosed with schizophrenia. The conversion rate for a first episode of drug induced psychosis to bipolar disorder or schizophrenia is lower, with 30% of people converting to either bipolar disorder or schizophrenia. NICE makes no distinction between substance-induced psychosis and any other form of psychosis. The rate of conversion differs for different classes of drugs. Pharmacological options for the specific treatment of FEP have been discussed in recent reviews. The goals of treatment for FEP include reducing symptoms and potentially improving long-term treatment outcomes. Randomized clinical trials have provided evidence for the efficacy of antipsychotic drugs in achieving the former goal, with first-generation and second generation antipsychotics showing about equal efficacy. The evidence that early treatment has a favorable effect on long-term outcomes is equivocal.
Recurrent psychotic episodes. Placebo-controlled trials of both first- and second-generation antipsychotic drugs consistently demonstrate the superiority of active drugs over placebos in suppressing psychotic symptoms. A large meta-analysis of 38 trials of antipsychotic drugs in schizophrenia with acute psychotic episodes showed an effect size of about 0.5. There is little or no difference in efficacy among approved antipsychotic drugs, including both first- and second-generation agents. The efficacy of such drugs is suboptimal. Few patients achieve complete resolution of symptoms. Response rates, calculated using various cutoff values for symptom reduction, are low, and their interpretation is complicated by high placebo response rates and selective publication of clinical trial results. Maintenance therapy. The majority of patients treated with an antipsychotic drug will experience a response within four weeks. The goals of continuing treatment are to maintain suppression of symptoms, prevent relapse, improve quality of life, and support engagement in psychosocial therapy.
Maintenance therapy with antipsychotic drugs is clearly superior to placebo in preventing relapse but is associated with weight gain, movement disorders, and high dropout rates. A 3-year trial following persons receiving maintenance therapy after an acute psychotic episode found that 33% obtained long-lasting symptom reduction, 13% achieved remission, and only 27% experienced satisfactory quality of life. The effect of relapse prevention on long term outcomes is uncertain, as historical studies show little difference in long term outcomes before and after the introduction of antipsychotic drugs. While maintenance therapy clearly reduces the rate of relapses requiring hospitalization, a large observational study in Finland found that, in people that eventually discontinued antipsychotics, the risk of being hospitalized again for a mental health problem or dying increased the longer they were dispensed (and presumably took) antipsychotics prior to stopping therapy. If people did not stop taking antipsychotics, they remained at low risk for relapse and hospitalization compared to those that did. The authors speculated that the difference may be because the people that discontinued treatment after a longer time had more severe mental illness than those that discontinued antipsychotic therapy sooner.
A significant challenge in the use of antipsychotic drugs for the prevention of relapse is the poor rate of adherence. In spite of the relatively high rates of adverse effects associated with these drugs, some evidence, including higher dropout rates in placebo arms compared to treatment arms in randomized clinical trials, suggests that most patients who discontinue treatment do so because of suboptimal efficacy. If someone experiences psychotic symptoms due to nonadherence, they may be compelled to receive treatment through a process called involuntary commitment, in which they can be forced to accept treatment (including antipsychotics). A person can also be committed to treatment outside of a hospital, called outpatient commitment. Antipsychotics in long-acting injectable (LAI), or "depot", form have been suggested as a method of decreasing medication nonadherence (sometimes also called non-compliance). NICE advises LAIs be offered to patients when preventing covert, intentional nonadherence is a clinical priority. LAIs are used to ensure adherence in outpatient commitment. A meta-analysis found that LAIs resulted in lower rates of rehospitalization with a hazard ratio of 0.83; however, these results were not statistically significant (the 95% confidence interval was 0.62 to 1.11).
Bipolar disorder. Antipsychotics are routinely used, often in conjunction with mood stabilizers such as lithium/valproate, as a first-line treatment for manic and mixed episodes associated with bipolar disorder. The reason for this combination is the therapeutic delay of the aforementioned mood stabilizers (for valproate therapeutic effects are usually seen around five days after treatment is commenced whereas lithium usually takes at least a week before the full therapeutic effects are seen) and the comparatively rapid antimanic effects of antipsychotic drugs. The antipsychotics have a documented efficacy when used alone in acute mania/mixed episodes. At least five atypical antipsychotics (lumateperone, cariprazine, lurasidone, olanzapine, and quetiapine) have also been found to possess efficacy in the treatment of bipolar depression as a monotherapy, whereas only olanzapine and quetiapine have been proven to be effective broad-spectrum (i.e., against all three types of relapse—manic, mixed and depressive) prophylactic (or "maintenance") treatments in patients with bipolar disorder. A recent Cochrane review also found that olanzapine had a less favourable risk/benefit ratio than lithium as a maintenance treatment for bipolar disorder.
The American Psychiatric Association and the UK National Institute for Health and Care Excellence recommend antipsychotics for managing acute psychotic episodes in schizophrenia or bipolar disorder, and as a longer-term maintenance treatment for reducing the likelihood of further episodes. They state that response to any given antipsychotic can be variable so that trials may be necessary, and that lower doses are to be preferred where possible. A number of studies have looked at levels of "compliance" or "adherence" with antipsychotic regimes and found that discontinuation (stopping taking them) by patients is associated with higher rates of relapse, including hospitalization. Dementia. Psychosis and agitation develop in as many as 80 percent of people living in nursing homes. Despite a lack of FDA approval and black-box warnings, atypical antipsychotics are very often prescribed to people with dementia. An assessment for an underlying cause of behavior is needed before prescribing antipsychotic medication for symptoms of dementia. Antipsychotics in old age dementia showed a modest benefit compared to placebo in managing aggression or psychosis, but this is combined with a fairly large increase in serious adverse events. Thus, antipsychotics should not be used routinely to treat dementia with aggression or psychosis, but may be an option in a few cases where there is severe distress or risk of physical harm to others. Psychosocial interventions may reduce the need for antipsychotics. In 2005, the FDA issued an advisory warning of an increased risk of death when atypical antipsychotics are used in dementia. In the subsequent 5 years, the use of atypical antipsychotics to treat dementia decreased by nearly 50%.
Major depressive disorder. A number of atypical antipsychotics have some benefits when used in addition to other treatments in major depressive disorder. Aripiprazole, quetiapine extended-release, and olanzapine (when used in conjunction with fluoxetine) have received the Food and Drug Administration (FDA) labelling for this indication. There is, however, a greater risk of side effects with their use compared to using traditional antidepressants. The greater risk of serious side effects with antipsychotics is why, e.g., quetiapine was denied approval as monotherapy for major depressive disorder or generalized anxiety disorder, and instead was only approved as an adjunctive treatment in combination with traditional antidepressants. A recent study on the use of antipychotics in unipolar depression concluded that the use of those drugs in addition to antidepressants alone leads to a worse disease outcome. This effect is especially pronounced in younger patients with psychotic unipolar depression. Considering the wide use of such combination therapies, further studies on the side effects of antipychotics as an add-on therapy are warranted.
Other. Global antipsychotic utilization has seen a steady growth since the introduction of atypical (second-generation) antipsychotics and this is ascribed to off-label use for many other unapproved disorders. Besides the above uses antipsychotics may be used for obsessive–compulsive disorder, post-traumatic stress disorder, personality disorders, Tourette syndrome, autism and agitation in those with dementia. Evidence however does not support the use of atypical antipsychotics in eating disorders or personality disorder. The atypical antipsychotic risperidone may be useful for obsessive–compulsive disorder. The use of low doses of antipsychotics for insomnia, while common, is not recommended as there is little evidence of benefit as well as concern regarding adverse effects. Some of the more serious adverse effects may also occur at the low doses used, such as dyslipidemia and neutropenia, and a recent network meta-analysis of 154 double-blind, randomized controlled trials of drug therapies vs. placebo for insomnia in adults found that quetiapine did not demonstrated any short-term benefits in sleep quality. Low dose antipsychotics may also be used in treatment of impulse-behavioural and cognitive-perceptual symptoms of borderline personality disorder. Despite the lack of evidence supporting the benefit of antipsychotics in people with personality disorders, 1 in 4 who do not have a serious mental illness are prescribed them in UK primary care. Many people receive these medication for over a year, contrary to NICE guidelines.
In children they may be used in those with disruptive behavior disorders, mood disorders and pervasive developmental disorders or intellectual disability. Antipsychotics are only weakly recommended for Tourette syndrome, because although they are effective, side effects are common. The situation is similar for those on the autism spectrum. Much of the evidence for the off-label use of antipsychotics (for example, for dementia, OCD, PTSD, personality disorders, Tourette's) was of insufficient scientific quality to support such use, especially as there was strong evidence of increased risks of stroke, tremors, significant weight gain, sedation, and gastrointestinal problems. A UK review of unlicensed usage in children and adolescents reported a similar mixture of findings and concerns. A survey of children with pervasive developmental disorder found that 16.5% were taking an antipsychotic drug, most commonly for irritability, aggression, and agitation. Both risperidone and aripiprazole have been approved by the US FDA for the treatment of irritability in autistic children and adolescents. A review in the UK found that the use of antipsychotics in England doubled between 2000 and 2019. Children were prescribed antipsychotics for conditions for which there is no approval, such as autism.
Aggressive challenging behavior in adults with intellectual disability is often treated with antipsychotic drugs despite lack of an evidence base. A recent randomized controlled trial, however, found no benefit over placebo and recommended that the use of antipsychotics in this way should no longer be regarded as an acceptable routine treatment. Antipsychotics may be an option, together with stimulants, in people with ADHD and aggressive behavior when other treatments have not worked. They have not been found to be useful for the prevention of delirium among those admitted to hospital. Typicals vs atypicals. Aside from reduced extrapyramidal symptoms, and with the clear exception of clozapine, it is unclear whether the atypical (second-generation) antipsychotics offer advantages over older, first generation antipsychotics. Amisulpride, olanzapine, risperidone and clozapine may be more effective but are associated with greater side effects. Typical antipsychotics have equal drop-out and symptom relapse rates to atypicals when used at low to moderate dosages.
Clozapine is an effective treatment for those who respond poorly to other drugs ("treatment-resistant" or "refractory" schizophrenia), but it has the potentially serious side effect of agranulocytosis (lowered white blood cell count) in less than 4% of people. Due to bias in the research the accuracy of comparisons of atypical antipsychotics is a concern. In 2005, a US government body, the National Institute of Mental Health published the results of a major independent study (the CATIE project). No other atypical studied (risperidone, quetiapine, and ziprasidone) did better than the first-generation antipsychotic perphenazine on the measures used, nor did they produce fewer adverse effects than the typical antipsychotic perphenazine, although more patients discontinued perphenazine owing to extrapyramidal effects compared to the atypical agents (8% vs. 2% to 4%). This is significant because any patient with tardive dyskinesia was specifically excluded from randomization to perphenazine; i.e., in the CATIE study the patient cohort randomized to receive perphenazne was at lower risk of having extrapyramidal symptoms.
Atypical antipsychotics do not appear to lead to improved rates of medication adherence compared to typical antipsychotics. Many researchers question the first-line prescribing of atypicals over typicals, and some even question the distinction between the two classes. In contrast, other researchers point to the significantly higher risk of tardive dyskinesia and other extrapyramidal symptoms with the typicals and for this reason alone recommend first-line treatment with the atypicals, notwithstanding a greater propensity for metabolic adverse effects in the latter. The UK government organization NICE recently revised its recommendation favoring atypicals, to advise that the choice should be an individual one based on the particular profiles of the individual drug and on the patient's preferences. The re-evaluation of the evidence has not necessarily slowed the bias toward prescribing the atypicals. Other uses. Antipsychotics, such as risperidone, quetiapine, and olanzapine, have been used as hallucinogen antidotes or "trip killers" to block the effects of serotonergic psychedelics like psilocybin and lysergic acid diethylamide (LSD).
Adverse effects. Generally, more than one antipsychotic drug should not be used at a time because of increased adverse effects. Use of antipsychotics is associated with reductions in brain tissue volumes, including white matter reduction, an effect which is dose-dependent and time-dependent. However, a recent controlled trial suggests that second generation antipsychotics combined with intensive psychosocial therapy may potentially prevent pallidal brain volume loss in first episode psychosis. Some atypicals are associated with considerable weight gain, diabetes and the risk of metabolic syndrome. Unwanted side effects cause people to stop treatment, resulting in relapses. Risperidone (atypical) has a similar rate of extrapyramidal symptoms to haloperidol (typical). A rare but potentially lethal condition of neuroleptic malignant syndrome (NMS) has been associated with the use of antipsychotics. Through its early recognition, and timely intervention rates have declined. However, an awareness of the syndrome is advised to enable intervention. Another less rare condition of tardive dyskinesia can occur due to long-term use of antipsychotics, developing after months or years of use. It is more often reported with use of typical antipsychotics. Very rarely antipsychotics may cause tardive psychosis.
Clozapine is associated with side effects that include weight gain, tiredness, and hypersalivation. More serious adverse effects include seizures, NMS, neutropenia, and agranulocytosis (lowered white blood cell count) and its use needs careful monitoring. Clozapine is also associated with thromboembolism (including pulmonary embolism), myocarditis, and cardiomyopathy. A systematic review of clozapine-associated pulmonary embolism indicates that this adverse effect can often be fatal, and that it has an early onset, and is dose-dependent. The findings advised the consideration of using a prevention therapy for venous thromboembolism after starting treatment with clozapine, and continuing this for six months. Constipation is three times more likely to occur with the use of clozapine, and severe cases can lead to ileus and bowel ischemia resulting in many fatalities. Very rare clozapine adverse effects include periorbital edema due to several possible mechanisms (e.g., inhibition of platelet-derived growth factor receptors leading to increased vascular permeability, antagonism of renal dopamine receptors with electrolyte and fluid imbalance and immune-mediated hypersensitivity reactions).
However, the risk of serious adverse effects from clozapine is low, and there are the beneficial effects to be gained of a reduced risk of suicide, and aggression. Typical antipsychotics and atypical risperidone can have a side effect of sexual dysfunction. Clozapine, olanzapine, and quetiapine are associated with beneficial effects on sexual functioning helped by various psychotherapies. By rate. Common (≥ 1% and up to 50% incidence for "most" antipsychotic drugs) adverse effects of antipsychotics include: Rare/Uncommon (<1% incidence for "most" antipsychotic drugs) adverse effects of antipsychotics include: Long-term effects. Antipsychotic use has been linked to a 21x higher incidence of dementia in the United States by age 65. Both atypical and typical antipsychotics have a higher hazard ratio for dementia risk. In 2024 testable hypotheses were proposed for the mechanism responsible for cortical thinning till dementia. Some studies have found decreased life expectancy associated with the use of antipsychotics, and argued that more studies are needed. Antipsychotics may also increase the risk of early death in individuals with dementia. Antipsychotics typically worsen symptoms in people with depersonalisation disorder. Antipsychotic polypharmacy (prescribing two or more antipsychotics at the same time for an individual) is a common practice but not evidence-based or recommended, and there are initiatives to curtail it. Similarly, the use of excessively high doses (often the result of polypharmacy) continues despite clinical guidelines and evidence indicating that it is usually no more effective but is usually more harmful. A meta-analysis of observational studies with over two million individuals has suggested a moderate association of antipsychotic use with breast cancer.
Loss of grey matter and other brain structural changes over time are observed amongst people diagnosed with schizophrenia. Meta-analyses of the effects of antipsychotic treatment on grey matter volume and the brain's structure have reached conflicting conclusions. A 2020 study concluded that atypical antipsychotics are linked to cortical thinning and cognitive decline in the mid (20 months) to long-term. A 2012 meta-analysis concluded that grey matter loss is greater in patients treated with first generation antipsychotics relative to those treated with atypicals, and hypothesized a protective effect of atypicals as one possible explanation. A second 2012 meta-analysis suggested that treatment with antipsychotics was associated with increased grey matter loss. Animal studies found that monkeys exposed to both first- and second-generation antipsychotics experience significant reduction in brain volume, resulting in an 8-11% reduction in brain volume with preserved neuron count and decreased glial cell count over a 17–27 month period.
The National Association of State Mental Health Program Directors said that antipsychotics are not interchangeable, and it recommends including trying at least one weight-neutral treatment for those patients with potential metabolic issues. Subtle, long-lasting forms of akathisia are often overlooked or confused with post-psychotic depression, in particular when they lack the extrapyramidal aspect that psychiatrists have been taught to expect when looking for signs of akathisia. Adverse effect on cognitive function and increased risk of death in people with dementia along with worsening of symptoms has been described in the literature. Antipsychotics, due to acting as dopamine D2 receptor antagonists and thereby stimulating pituitary lactotrophs, may have a risk of prolactinoma with long-term use. This is also responsible for their induction of hyperprolactinemia (high prolactin levels). Discontinuation. The "British National Formulary" recommends a gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse. Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite. Other symptoms may include restlessness, increased sweating, and trouble sleeping. Less commonly there may be a feeling of the world spinning, numbness, or muscle pains. Symptoms generally resolve after a short period of time.
A randomised controlled trial compared maintenance therapy with gradual dose reduction or discontinuation among people with long-term psychosis. At 2 years, people in the reduction group were twice as likely to relapse (25%) as those in the maintenance group (13%). Moreover, those in the reduction group had no improvement in social functioning (a measure combining people’s ability to look after themselves, work, study and take part in family and social activities), side effects, quality of life, symptoms, or bodyweight. There is tentative evidence that discontinuation of antipsychotics can result in psychosis. It may also result in recurrence of the condition that is being treated. Rarely, tardive dyskinesia can occur when the medication is stopped. Unexpected psychotic episodes have been observed in patients withdrawing from clozapine. This is referred to as supersensitivity psychosis, not to be equated with tardive dyskinesia. Tardive dyskinesia may abate during withdrawal from the antipsychotic agent, or it may persist.
Withdrawal effects may also occur when switching a person from one antipsychotic to another, (it is presumed due to variations of potency and receptor activity). Such withdrawal effects can include cholinergic rebound, an activation syndrome, and motor syndromes including dyskinesias. These adverse effects are more likely during rapid changes between antipsychotic agents, so making a gradual change between antipsychotics minimises these withdrawal effects. The "British National Formulary" recommends a gradual dose reduction when discontinuing antipsychotic treatment to avoid acute withdrawal symptoms or rapid relapse. The process of cross-titration involves gradually increasing the dose of the new medication while gradually decreasing the dose of the old medication. City and Hackney Clinical Commissioning Group found more than 1,000 patients in their area in July 2019 who had not had regular medication reviews or health checks because they were not registered as having serious mental illness. On average they had been taking these drugs for six years. If this is typical of practice in England more than 100,000 patients are probably in the same position.
List of agents. Clinically used antipsychotic medications are listed below by drug group. Trade names appear in parentheses. A 2013 review has stated that the division of antipsychotics into first and second generation is perhaps not accurate. Notes: "† indicates drugs that are no longer (or were never) marketed in English-speaking countries. " "‡ denotes drugs that are no longer (or were never to begin with) marketed in the United States. Some antipsychotics are not firmly placed in either first-generation or second-generation classes." "# denotes drugs that have been withdrawn worldwide." Disputed/unknown. This category is for drugs that have been called both first and second-generation, depending on the literature being used. Third-generation. Third generation antipsychotics are recognized as demonstrating D2 receptor partial agonism as opposed to the D2 and 5HT-2A receptor antagonism of second-generation (atypical) antipsychotics and D2 antagonism of first-generation (typical) antipsychotics. Mechanism of action.
Antipsychotic drugs such as haloperidol and chlorpromazine tend to block dopamine D2 receptors in the dopaminergic pathways of the brain. This means that dopamine released in these pathways has less effect. Excess release of dopamine in the mesolimbic pathway has been linked to psychotic experiences. Decreased dopamine release in the prefrontal cortex, and excess dopamine release in other pathways, are associated with psychotic episodes in schizophrenia and bipolar disorder. In addition to the antagonistic effects of dopamine, antipsychotics (in particular atypical antipsychotics) also antagonize 5-HT2A receptors. Different alleles of the 5-HT2A receptor have been associated with schizophrenia and other psychoses, including depression. Higher concentrations of 5-HT2A receptors in cortical and subcortical areas, in particular in the right caudate nucleus have been historically recorded. Typical antipsychotics are not particularly selective and also block dopamine receptors in the mesocortical pathway, tuberoinfundibular pathway, and the nigrostriatal pathway. Blocking D2 receptors in these other pathways is thought to produce some unwanted side effects that the typical antipsychotics can produce (see above). They were commonly classified on a spectrum of low potency to high potency, where potency referred to the ability of the drug to bind to dopamine receptors, and not to the effectiveness of the drug. High-potency antipsychotics such as haloperidol, in general, have doses of a few milligrams and cause less sleepiness and calming effects than low-potency antipsychotics such as chlorpromazine and thioridazine, which have dosages of several hundred milligrams. The latter have a greater degree of anticholinergic and antihistaminergic activity, which can counteract dopamine-related side-effects.
Atypical antipsychotic drugs have a similar blocking effect on D2 receptors; however, most also act on serotonin receptors, especially 5-HT2A and 5-HT2C receptors. Both clozapine and quetiapine appear to bind just long enough to elicit antipsychotic effects but not long enough to induce extrapyramidal side effects and prolactin hypersecretion. 5-HT2A antagonism increases dopaminergic activity in the nigrostriatal pathway, leading to a lowered extrapyramidal side effect liability among the atypical antipsychotics. Xanomeline/trospium chloride was approved for medical use in the United States in September 2024. It was the first antipsychotic to not act on D2 receptors. The mechanism of action instead relies on xanomeline's functional selectivity for the M1 and M4 muscarinic receptors, with trospium chloride, a peripherally selective antimuscarinic added to counteract xanomeline's unwanted peripheral muscarinic effects. Through the ability of most antipsychotics to antagonize 5-HT2A serotonin pathways enabling a sensitisation of postsynaptic serotonin receptors, MDMA exposure can be more intense because it has more excitatory receptors to activate. The same effect can be observed with the D2 antagonizing with normal amphetamine (with this just being hypothetical as there is the fact that antipsychotics sensitize receptors, with exact these postsynaptic receptors (5-HT2A, D2) being flooded by the respective neurotransmitter (serotonin, dopamine) from amphetamine exposure).
History. The original antipsychotic drugs were happened upon largely by chance and then tested for their effectiveness. The first, chlorpromazine, was developed as a surgical anesthetic. It was first used on psychiatric patients because of its powerful calming effect; at the time it was regarded as a non-permanent "pharmacological lobotomy". Lobotomy at the time was used to treat many behavioral disorders, including psychosis, although its effect was to markedly reduce behavior and mental functioning of all types. However, chlorpromazine proved to reduce the effects of psychosis in a more effective and specific manner than lobotomy, even though it was known to be capable of causing severe sedation. The underlying neurochemistry involved has since been studied in detail, and subsequent antipsychotic drugs have been developed by rational drug design. The discovery of chlorpromazine's psychoactive effects in 1952 led to further research that resulted in the development of antidepressants, anxiolytics, and the majority of other drugs now used in the management of psychiatric conditions. In 1952, Henri Laborit described chlorpromazine only as inducing indifference towards what was happening around them in nonpsychotic, nonmanic patients, and Jean Delay and Pierre Deniker described it as controlling manic or psychotic agitation. The former claimed to have discovered a treatment for agitation in anyone, and the latter team claimed to have discovered a treatment for psychotic illness.
Until the 1970s there was considerable debate within psychiatry on the most appropriate term to use to describe the new drugs. In the late 1950s the most widely used term was "neuroleptic", followed by "major tranquilizer" and then "ataraxic". The first recorded use of the term tranquilizer dates from the early nineteenth century. In 1953 Frederik F. Yonkman, a chemist at the Swiss-based Cibapharmaceutical company, first used the term tranquilizer to differentiate reserpine from the older sedatives. The word "neuroleptic" was coined in 1955 by Delay and Deniker after their discovery (1952) of the antipsychotic effects of chlorpromazine. It is derived from the ("neuron", originally meaning "sinew" but today referring to the nerves) and "λαμβάνω" ("lambanō", meaning "take hold of"). Thus, the word means "taking hold of one's nerves". It was often taken to refer also to common side effects such as reduced activity in general, as well as lethargy and impaired motor control. Although these effects are unpleasant and in some cases harmful, they were at one time, along with akathisia, considered a reliable sign that the drug was working.
Although these effects are unpleasant and in some cases harmful, they were at one time, along with akathisia, considered a reliable sign that the drug was working. The term "ataraxy" was coined by the neurologist Howard Fabing and the classicist Alister Cameron to describe the observed effect of psychic indifference and detachment in patients treated with chlorpromazine. This term derived from the Greek adjective "ἀτάρακτος" ("ataraktos"), which means "not disturbed, not excited, without confusion, steady, calm". In the use of the terms "tranquilizer" and "ataractic", medical practitioners distinguished between the "major tranquilizers" or "major ataractics", which referred to drugs used to treat psychoses, and the "minor tranquilizers" or "minor ataractics", which referred to drugs used to treat neuroses. While popular during the 1950s, these terms are infrequently used today. They are being abandoned in favor of "antipsychotic", which refers to the drug's desired effects. While popular during the 1950s, these terms are infrequently used today. They are being abandoned in favor of "antipsychotic", which refers to the drug's desired effects. They are potentially addictive sedatives.
Antipsychotics are broadly divided into two groups, the typical or first-generation antipsychotics and the atypical or second-generation antipsychotics. The difference between first- and second-generation antipsychotics is a subject of debate. The second-generation antipsychotics are generally distinguishable by the presence of 5HT2A receptor antagonism and a corresponding lower propensity for extrapyramidal side effects compared to first-generation antipsychotics. Society and culture. Terminology. The term "major tranquilizer" was used for older antipsychotic drugs. The term "neuroleptic" is often used as a synonym for "antipsychotic", even though – strictly speaking – the two terms are not interchangeable. "Antipsychotic" drugs are a subgroup of "neuroleptic" drugs, because the latter have a wider range of effects. Antipsychotics are a type of psychoactive or psychotropic medication. Sales. Antipsychotics were once among the biggest selling and most profitable of all drugs, generating $22 billion in global sales in 2008. By 2003 in the US, an estimated 3.21 million patients received antipsychotics, worth an estimated $2.82 billion. Over 2/3 of prescriptions were for the newer, more expensive atypicals, each costing on average $164 per year, compared to $40 for the older types. By 2008, sales in the US reached $14.6 billion, the biggest selling drugs in the US by therapeutic class.
In the five years since July 2017 the number of antipsychotic medicines dispensed in the community in the United Kingdom has increased by 11.2%. There have also been substantial price rises. Risperidone 6 mg tablets, the largest, increased from £3.09 in July 2017 to £41.16 in June 2022. The NHS is spending an additional £33 million annually on antipsychotics. Haloperidol 500 microgram tablets constituted £14.3 million of this. Overprescription. Antipsychotics in the nursing home population are often overprescribed, often for the purposes of making it easier to handle dementia patients. Federal efforts to reduce the use of antipsychotics in US nursing homes has led to a nationwide decrease in their usage in 2012. Legal. Antipsychotics are sometimes administered as part of compulsory psychiatric treatment via inpatient (hospital) commitment or outpatient commitment. Formulations. They may be administered orally or, in some cases, through long-acting (depot) injections administered in the dorsgluteal, ventrogluteal or deltoid muscle. Short-acting parenteral formulations also exist, which are generally reserved for emergencies or when oral administration is otherwise impossible. The oral formulations include immediate release, extended release, and orally disintegrating products (which are not sublingual, and can help ensure that medications are swallowed instead of "cheeked"). Sublingual products (e.g., asenapine) also exist, which must be held under the tongue for absorption. The first transdermal formulation of an antipsychotic (transdermal asenapine, marketed as Secuado), was FDA-approved in 2019.
Recreational use. Certain second-generation antipsychotics are misused or abused for their sedative, tranquilizing, and (paradoxically) "hallucinogenic" effects. The most commonly implicated second-generation antipsychotic is quetiapine. In case reports, quetiapine has been abused in doses taken by mouth (which is how the drug is available from the manufacturer), but also crushed and insufflated or mixed with water for injection into a vein. Olanzapine, another sedating second-generation antipsychotic, has also been misused for similar reasons. There is no standard treatment for antipsychotic abuse, though switching to a second-generation antipsychotic with less abuse potential (e.g., aripiprazole) has been used. Controversy. Joanna Moncrieff has argued that antipsychotic drug treatment is often undertaken as a means of control rather than to treat specific symptoms experienced by the patient. Use of this class of drugs has a history of criticism in residential care. As the drugs used can make patients calmer and more compliant, critics claim that the drugs can be overused. Outside doctors can feel under pressure from care home staff. In an official review commissioned by UK government ministers it was reported that the needless use of antipsychotic medication in dementia care was widespread and was linked to 1800 deaths per year. In the US, the government has initiated legal action against the pharmaceutical company Johnson & Johnson for allegedly paying kickbacks to Omnicare to promote its antipsychotic risperidone (Risperdal) in nursing homes.
There has also been controversy about the role of pharmaceutical companies in marketing and promoting antipsychotics, including allegations of downplaying or covering up adverse effects, expanding the number of conditions or illegally promoting off-label usage; influencing drug trials (or their publication) to try to show that the expensive and profitable newer atypicals were superior to the older cheaper typicals that were out of patent. Following charges of illegal marketing, settlements by two large pharmaceutical companies in the US set records for the largest criminal fines ever imposed on corporations. One case involved Eli Lilly and Company's antipsychotic Zyprexa, and the other involved Bextra. In the Bextra case, the government also charged Pfizer with illegally marketing another antipsychotic, Geodon. In addition, AstraZeneca faces numerous personal-injury lawsuits from former users of Seroquel (quetiapine), amidst federal investigations of its marketing practices. By expanding the conditions for which they were indicated, Astrazeneca's Seroquel and Eli Lilly's Zyprexa had become the biggest selling antipsychotics in 2008 with global sales of $5.5 billion and $5.4 billion respectively.
Harvard University medical professor Joseph Biederman conducted research on bipolar disorder in children that led to an increase in such diagnoses. A 2008 Senate investigation found that Biederman also received $1.6 million in speaking and consulting fees between 2000 and 2007, some of them undisclosed to Harvard, from companies including makers of antipsychotic drugs prescribed for children with bipolar disorder. Johnson & Johnson gave more than $700,000 to a research center that was headed by Biederman from 2002 to 2005, where research was conducted, in part, on Risperdal, the company's antipsychotic drug. Biederman has responded saying that the money did not influence him and that he did not promote a specific diagnosis or treatment. Pharmaceutical companies have also been accused of attempting to set the mental health agenda through activities such as funding consumer advocacy groups. Special populations. It is recommended that persons with dementia who exhibit behavioral and psychological symptoms should not be given antipsychotics before trying other treatments. When taking antipsychotics this population has increased risk of cerebrovascular effects, parkinsonism or extrapyramidal symptoms, sedation, confusion and other cognitive adverse effects, weight gain, and increased mortality. Physicians and caretakers of persons with dementia should try to address symptoms including agitation, aggression, apathy, anxiety, depression, irritability, and psychosis with alternative treatments whenever antipsychotic use can be replaced or reduced. Elderly persons often have their dementia treated first with antipsychotics and this is not the best management strategy.
Akita is a Japanese name and may refer to:
Archduke Charles, Duke of Teschen Archduke Charles Louis John Joseph Lawrence of Austria, Duke of Teschen (; 5 September 177130 April 1847) was an Austrian field-marshal, the third son of Emperor Leopold II and his wife, Maria Luisa of Spain. He was also the younger brother of Francis II, Holy Roman Emperor. He was epileptic, but achieved respect both as a commander and as a reformer of the Austrian army. He was considered one of Napoleon's most formidable opponents and one of the greatest generals of the French Revolutionary and Napoleonic Wars. He began his career fighting the revolutionary armies of France. Early in the wars of the First Coalition, he saw victory at Neerwinden in 1793, before being defeated at Wattignies in 1793 and Fleurus in 1794. In 1796, as chief of all Austrian forces on the Rhine, Charles defeated Jean-Baptiste Jourdan at Amberg, Würzburg and Limburg, and then won victories at Wetzlar, Emmendingen and Schliengen that forced Jean Victor Marie Moreau to withdraw across the Rhine. He also defeated opponents at Zürich, Ostrach, Stockach, and Mannheim in 1799. He reformed Austria's armies to adopt the nation-at-arms principle. In 1809, he entered the War of the Fifth Coalition and inflicted Napoleon's first major setback at Aspern-Essling, before suffering a defeat at the bloody Battle of Wagram. After Wagram, Charles saw no more significant action in the Napoleonic Wars.
As a military strategist, Charles was able to successfully execute complex and risky manoeuvres of troops. However, his contemporary Carl von Clausewitz criticised his rigidity and adherence to "geographic" strategy. Many Austrians nevertheless remember Charles as a hero of the French Revolutionary and Napoleonic Wars. Youth and early career. Charles was born in Florence, Tuscany. His father, then Grand Duke of Tuscany, generously permitted Charles's childless aunt Archduchess Maria Christina of Austria and her husband Albert of Saxe-Teschen to adopt and raise the boy in Vienna. Charles spent his youth in Tuscany, at Vienna and in the Austrian Netherlands, where he began his career of military service in the wars of the French Revolution. He commanded a brigade at the Battle of Jemappes (1792), and in the campaign of 1793 distinguished himself at the Action of Aldenhoven and the Battle of Neerwinden. In this year he became Governor of the Habsburg Netherlands, an office he lost with the occupation of the Low Countries by the French revolutionaries in 1794. The year he became Governor he also received the army rank of lieutenant field marshal. Shortly thereafter another promotion saw him made "Feldzeugmeister" (equivalent of Lieutenant General). In the remainder of the war in the Low Countries he held high commands, and was present at the Battle of Fleurus (1794).

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