Antipsychotic drugs have various neuropharmacological properties as a result of their structural diversity. Despite their therapeutic benefits, most of the prescribed atypical
antipsychotics can induce severe side effects, including
weight gain, type II
diabetes mellitus, and
cardiovascular diseases. Among the developed atypical
antipsychotic agents, tetracyclic dibenzodiazepine and thienobenzodiazepine compounds, particularly
clozapine and
olanzapine, are associated with the greatest
weight gain and metabolic disturbances. However, the unique chemical structure of these compounds causes the low risk of side effects reported for typical
antipsychotics (e.g. extrapyramidal symptoms and
tardive dyskinesia). This report reviews the recent discovery of the potential role of the chemical structure of
antipsychotics in their therapeutic properties and metabolic disturbances. By developing structure-activity relationship studies for atypical
antipsychotics, we will improve our understanding of the structural modifications of these chemical classes that lead to reduced
weight gain, which will be an invaluable step toward the discovery of the next generation of atypical
antipsychotics. In this review, we suggest that a novel dibenzodiazepine or thienobenzodiazepine
antipsychotic drug with lower affinity for H(1) receptors may significantly advance
schizophrenia therapy.