Do Antipsychotic Drugs For Schizophrenia Shrink The Brain?

Chronic disability due to schizophrenia is a common problem among young adults. This mental illness affects about one percent of the population, and treatment often involves the use of antipsychotic medications, which help reduce schizophrenia symptoms and improve their mental and social functioning. 

Antipsychotic Drugs for Schizophrenia

Schizophrenia is a severe, chronic, disabling mental disorder that affects many young adults. It manifests with symptoms related to bizarre thought processes, impaired mental functioning, and inability to interact or take care of themselves.

Schizophrenia includes symptoms such as hallucinations, delusions, violent outbursts, and substance abuse, which often pose difficult challenges to the patients’ families and the society. Approximately one percent of the American population is affected by this mental disorder, and its burden to society is related to problems in employment, relationships, and personal independence. Aside from these, schizophrenics are also prone to substance abuse, obesity, and other medical problems related to their inability to care for themselves.

These include:

Typical Antipsychotic Drugs:

• Haloperidol (Haldol)

• Chlorpromazine (Thorazine)

• Perphenazine (Trilafon, Etrafon)

• Fluphenazine (Prolixin)

Atypical Antipsychotic Drugs:

• Risperidone (Risperdal)

• Clozapine (Clozaril)

• Olanzapine (Zyprexa)

• Paliperidone (Invega)

• Ziprasidone (Geodon)

• Quetiapine (Seroquel)

• Aripiprazole (Abilify)

These medications reduce the positive symptoms of schizophrenia, which consist of hallucinations, delusions and disorganized behavior and speech. They also help reduce violent or aggressive behavior, suicidal tendencies, and help prevent relapses and hospital re-admission.

Antipsychotic drugs are often given for long-term use and they are believed to improve the quality of life of patients, increase their independence, and enhance their productivity.

Common Side Effects of Antipsychotic Drugs

Typical antipsychotic medications work by blocking so-called dopaminergic receptors, which influence the appearance of symptoms typical of schizophrenia. However, they may also affect other neurotransmitter systems, which lead to undesirable side effects.

Common side effects associated with typical antipsychotics include movement disorders such as tremors, restlessness, and rigidity. Unusual, uncontrollable movements of the body, such as lip-smacking and jerky head movements are severe manifestations of movement problems associated with antipsychotics. Other side effects include dry mouth, problems in urination, constipation, visual disturbances, dizziness, nasal congestion, and disturbances of sexual function.

In addition, antipsychotics may alter hormonal function, leading to cessation of menstruation, spontaneous production of breast milk, and enlargement of male breasts.

Do Antipsychotic Drugs Lead To Loss Of Brain Tissue?

Loss of brain tissue is one characteristic believed to be associated with schizophrenia, along with other structural and chemical changes in the brain. 

Effects on Brain Tissue

Although antipsychotic drug treatments have led to significant reduction of the targeted symptoms of psychosis in schizophrenics, experts are now concerned whether they could also negatively affect brain volumes and function. Previous animal studies showed that long-term treatment with these drugs led to smaller brains in monkeys.

To investigate their effects on human brains, scientists from the University of Iowa Carver College of Medicine, Iowa City, studied more than 200 schizophrenic patients whose brains were repeatedly subjected to magnetic resonance imaging (MRI) scans after the onset of illness and over a period of about seven years of treatment with antipsychotics.

The authors wanted to evaluate the effects of four potential predictors of brain volume change in their schizophrenic patients, including the illness duration, severity of illness, substance abuse, and antipsychotic treatment.

They found that treatment with the drugs was associated with significant measurable brain tissue reductions after controlling for other predictors. 

They also noted that typical antipsychotics like haloperidol were more likely to be associated with smaller brains than were atypical antipsychotics such as olanzapine.

Although their findings support previous studies, the scientists point out that no cause-and-effect relationship has been established between antipsychotic drug therapy and loss of brain tissue. Further studies have to be done to find out if drug treatment can cause deleterious effects on the brain in people being treated for schizophrenia.

Recommendations

Antipsychotics drugs are the first line of treatment for schizophrenia. They reduce frightening symptoms such as hallucinations and aggressive behaviors and can reduce one’s risk for relapse or suicide. However, these drugs are associated with many undesirable side effects.

Although recent studies may suggest that progressive brain tissue loss may be related to intense antipsychotic therapy, experts believe that the benefits of using these drugs outweigh their harmful side effects. They assert that there is no reason why antipsychotic therapy must be withdrawn if they are making patients feel better, work better, and live more fully.

The authors, however, emphasize the need to monitor more closely the benefits and harmful effects of these antipsychotic medications in individual patients. They recommend prescribing minimal doses needed to achieve therapeutic goals for each patient and to consider adding non-pharmacological methods of treatment.  

These include individual psychotherapy, family counseling, vocational counseling, and social skills training, which could help improve treatment outcomes while helping to reduce the need for medications.