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The effect of antipsychotics on the brain


Studies show that brain tissue shrinkage due to prolonged antipsychotic drug use might be a cause for concern. 


The practical questions that every drug introduced into the market bring to mind are primarily centred around safety and effectiveness - “How effective is this drug in treating/reducing symptoms of a disorder?” “How safe is this drug for usage?” and “How are the negative side effects? Are they outweighed by the positives?”


Even antipsychotics, owing to the nature of their usage and dosages, have been questioned along these lines time and again, and as effective as they are in treating and reducing symptoms of psychosis and other mental disorders, lesser-known facts about their impact on the brain - both structurally and functionally - can leave patients doubtful while considering their prolonged continual use in considerable doses. 


In disorders like schizophrenia, research has shown that reduction in grey matter and brain volume are seen amongst patients before the introduction of antipsychotics as treatment. These damages are thought to be caused by the disorder itself. However, one study published in the  Archives of General Psychiatry[1] publication of the JAMA Network, headed by psychiatrist and neuroscientist Beng Choon Ho from the University of Iowa in 2011, showed that antipsychotic treatment, based on intensity and duration, led to progressive brain volume reduction, unrelated to the disorder itself. Over a period of 7.2 years, they tested two hundred and eleven patients who were administered an average of 3 magnetic resonance imaging (MRI) scans over the specified period of time. Higher antipsychotic use was related to smaller grey matter volume and a decrease in white matter in the brain over time. 


Although this is not fresh news in science and psychiatry, the physical effects of neuroleptics, especially on the brain, are not common knowledge amongst the general public and possibly, not even among patients prescribed antipsychotics as treatment. Another study published in the publication Neuropsychopharmacology[2] in 2005 conducted on macaque monkeys indicated that when 3 groups were exposed to certain antipsychotics for a seventeen to twenty-seven-month period, significant brain shrinkage had been observed - including reduction of volume in grey and white matter across regions of the brain - indicating that long-term exposure to antipsychotics led to these effects and although monkeys’ brains provide similar brain models to that of humans, that doesn’t directly translate to similar effects, as was discussed in the study. 


While this does not mean that antipsychotic medication needs to be discontinued en masse - as its benefits cannot be overlooked - surely, this side-effect has led to increased stress being placed on non-drug alternatives to treating psychological disorders. 



References:


[1] https://jamanetwork.com/journals/jamapsychiatry/fullarticle/211084 

Beng-Choon Ho, MRCPsych; Nancy C. Andreasen, MD, PhD; Steven Ziebell, BS; Pierson, MS; Vincent Magnotta, PhD

Arch. Gen Psychiatry. 2011;68(2):128-137.doi:10.1001/archgenpsychiatry.2010.199 

 

[2] Dorph-Petersen, K., Pierri, J., Perel, J. et al. The Influence of Chronic Exposure to Antipsychotic Medications on Brain Size before and after Tissue Fixation: A Comparison of Haloperidol and Olanzapine in Macaque Monkeys. Neuropsychopharmacol 30, 1649–1661 (2005). https://doi.org/10.1038/sj.npp.1300710 
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