In a recent study published in JAMA Psychiatry, researchers found that a commonly used antipsychotic drug olanzapine was linked to adverse changes in brain structure.
The adverse changes in brain structure are an important consideration for prescribing for psychiatric conditions where alternatives are possible.
It is the first study that evaluates the effects of this type of medication on the human brain.
The research was done by a team from The Centre for Addiction and Mental Health in Canada. One author is Dr. Aristotle Voineskos.
Before the 1990s, antipsychotic medications were primarily given to people with schizophrenia.
But since then their use has expanded to major depression and anxiety, insomnia, and autism, for which one in five patients are prescribed anti-psychotics.
Because it is believed that antipsychotics protect against the harmful effects of untreated psychosis in the brain, they remain the foundation of treatment for schizophrenia.
In the study, the team examined patients with major depression who also experience psychosis who were prescribed antipsychotic medications olanzapine and sertraline for 12 to 20 weeks.
For those who went into remission, one group continued with both medications and the other was given a placebo instead of olanzapine.
Magnetic Resonance Imaging (MRI) scans were taken before and after the placebo was introduced.
The team found evidence that the use of olanzapine was linked to adverse changes in brain structure, namely a thinning of the cortex.
These changes were even more prominent in elderly study participants.
But participants who experienced a relapse of psychotic symptoms also had potentially adverse changes in brain structure, emphasizing the essential role antipsychotics play in treating disorders where psychosis is present.
The team says when psychosis is present, the life-threatening effects of untreated illness outweigh any adverse effects on brain structure.
Future studies could provide a predictive model for which patients need long-term antipsychotic treatment and which patients can safely discontinue them.
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