Which class of drugs is considered to have the highest risk for extrapyramidal symptoms (EPS)?

Typical antipsychotics are indeed considered to have the highest risk for extrapyramidal symptoms (EPS). These symptoms can include a range of movement disorders such as tremors, rigidity, bradykinesia, and tardive dyskinesia, which are associated with dopamine receptor antagonism, particularly affecting the nigrostriatal pathway in the brain. Since typical antipsychotics primarily target dopamine D2 receptors, their potent blockade leads to a greater likelihood of causing these motor side effects.

In contrast, atypical antipsychotics have a more favorable side effect profile regarding EPS because they often have a more complex mechanism of action that includes serotonin receptor antagonism, which helps mitigate the risk of movement disorders. SSRIs, or selective serotonin reuptake inhibitors, primarily affect serotonin levels and are not associated with EPS. Similarly, stimulants, which primarily increase dopamine and norepinephrine, do not typically lead to EPS, particularly when used in appropriate doses and for their intended purpose. This distinction highlights why typical antipsychotics are singled out as a greater concern for extrapyramidal symptoms.