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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by zazenducke on July 19, 2012, at 6:32:22
So that's why they call prescribers shrinks!
Original Article | February 2011
Long-term Antipsychotic Treatment and Brain VolumesA Longitudinal Study of First-Episode Schizophrenia FREE
Beng-Choon Ho, MRCPsych; Nancy C. Andreasen, MD, PhD; Steven Ziebell, BS; Ronald Pierson, MS; Vincent Magnotta, PhD
[+] Author Affiliations
Arch Gen Psychiatry. 2011;68(2):128-137. doi:10.1001/archgenpsychiatry.2010.199
Context Progressive brain volume changes in schizophrenia are thought to be due principally to the disease. However, recent animal studies indicate that antipsychotics, the mainstay of treatment for schizophrenia patients, may also contribute to brain tissue volume decrement. Because antipsychotics are prescribed for long periods for schizophrenia patients and have increasingly widespread use in other psychiatric disorders, it is imperative to determine their long-term effects on the human brain.Objective To evaluate relative contributions of 4 potential predictors (illness duration, antipsychotic treatment, illness severity, and substance abuse) of brain volume change.
Design Predictors of brain volume changes were assessed prospectively based on multiple informants.
Setting Data from the Iowa Longitudinal Study.
Patients Two hundred eleven patients with schizophrenia who underwent repeated neuroimaging beginning soon after illness onset, yielding a total of 674 high-resolution magnetic resonance scans. On average, each patient had 3 scans (≥2 and as many as 5) over 7.2 years (up to 14 years).
Main Outcome Measure Brain volumes.
Results During longitudinal follow-up, antipsychotic treatment reflected national prescribing practices in 1991 through 2009. Longer follow-up correlated with smaller brain tissue volumes and larger cerebrospinal fluid volumes. Greater intensity of antipsychotic treatment was associated with indicators of generalized and specific brain tissue reduction after controlling for effects of the other 3 predictors. More antipsychotic treatment was associated with smaller gray matter volumes. Progressive decrement in white matter volume was most evident among patients who received more antipsychotic treatment. Illness severity had relatively modest correlations with tissue volume reduction, and alcohol/illicit drug misuse had no significant associations when effects of the other variables were adjusted.
Conclusions Viewed together with data from animal studies, our study suggests that antipsychotics have a subtle but measurable influence on brain tissue loss over time, suggesting the importance of careful risk-benefit review of dosage and duration of treatment as well as their off-label use.
archpsyc.jamanetwork.com/article.aspx?articleid=211084
Posted by Phillipa on July 19, 2012, at 9:44:13
In reply to Antipsychotics shrink the brain, posted by zazenducke on July 19, 2012, at 6:32:22
I like the play on works. Phillipa
Posted by Phil on July 19, 2012, at 10:03:05
In reply to Antipsychotics shrink the brain, posted by zazenducke on July 19, 2012, at 6:32:22
Some psych drugs shrink other body parts. Man's other brain. :)
I'm 59 and not overly concerned about a shrinking brain. My brain was preshrunk long before meds.
But after hearing that Lamictal can cause cognitive and memory problems above 2oo mg I'm going to talk to my doc about dropping from 400 mg. I need to remember to make a note to do that. And remember to take the note to my next appt. I don't remember when it is. Maybe there's something to this.
Know what's amazing, the DEA is going after ecigs that have helped I would guess hundreds of thousands of people get off cigarettes. I can't understand that in light of pharmaceuticals shrinking brains and nothing is done. Guess it's all about cash flow and misspent energies focusing on trivial when there's an 800 pound pink elephant in the room.
Posted by Willful on July 19, 2012, at 10:34:33
In reply to Antipsychotics shrink the brain, posted by zazenducke on July 19, 2012, at 6:32:22
There is conflicting evidence about the effects of various medications, but it seems strongly indicated the typical antipsychotics do affect brain structure and basal ganglia structure in ways that had not been realized.
This is certainly an important topic for anyone who takes any of these medications.
These articles suggest that the evidence is complex but needs to be researched thoroughly.
Two examples that I found, to complement zazenducke's information were:
http://www.namigainesville.org/images/antipsychmedshelpbrain.pdf
Summary
Currently, there is growing evidence that atypical
antipsychotics might ameliorate structural changes caused
by the disease process underlying schizophrenia and
effects of typical antipsychotics. Further studies have to
investigate the mechanism leading to these varying effects
on brain structure.and
"The neurotrophic and neuroprotective effects of psychotropic agents" (Joshua Hunsberger, Laboratory of Molecular Pathophysiology and Experimental Therapeutics, Mood and Anxiety Disorders Program, NIMH, NIH, Bethesda, Maryland, USA) :
Accumulating evidence suggests that psychotropic agents such as mood stabilizers, antidepressants, and antipsychotics realize their neurotrophic/neuroprotective effects by activating the mitogen activated protein kinaselextracellular signal-related kinase, PI3-kinase, and winglesslglycogen synthase kinase (GSK) 3 signaling pathways. These agents also upregulate the expression of trophic/protective molecules such as brain-derived neurotrophic factor, nerve growth factor, B-cell lymphoma 2, serine-threonine kinase, and Bcl-2 associated athanogene 1, and inactivate proapoptotic molecules such as GSK-3, They also promote neurogenesis and are protective in models of neurodegenerative diseases and ischemia. Most if not all, of this evidence was collected from animal studies that used clinically relevant treatment regimens. Furthermore, human imaging studies have found that these agents increase the volume and density of brain tissue, as well as levels of N-acetyl aspartate and glutamate in selected brain regions. Taken together, these data suggest that the neurotrophic/neuroprotective effects of these agents have broad therapeutic potential in the treatment, not only of mood disorders and schizophrenia, but also neurodegenerative diseases and ischemia.
---
I hope researchers are focusing on these issues, as the increase/decrease of brain volume in certain areas is an important piece of information that should influence treatment choices.
There may be neuroprotective as well as not understood other less positive brain changes caused by these drugs which are so widely distributed. More nuanced understanding certainly is needed.
Posted by linkadge on July 19, 2012, at 17:56:27
In reply to Antipsychotics shrink the brain, posted by zazenducke on July 19, 2012, at 6:32:22
Yeah, I believe it.
Linkadge
Posted by SLS on July 19, 2012, at 19:35:49
In reply to Re: Antipsychotics shrink the brain, posted by linkadge on July 19, 2012, at 17:56:27
> Yeah, I believe it.
I have no reason not to, although I don't know how to interpret the authors' use of the word "subtle" to describe the changes in brain tissue that they conclude was due to drug exposure.
One thing that I don't see addressed in the medical literature is what are the consequences of this drug-induced reduction in brain tissue. How does it affect mental or somatic functions? If there are no detectable effects into old age, how does this affect the decision-making process of how to treat schizophrenia?
It would be instructive to study brain morphology in schizophrenia in areas of the world that don't treat it with antipsychotic drugs. It would help to resolve how much brain volume reduction is due to the illness itself.
It is not news that antipsychotics carry risks for serious and sometimes irreversible side effects. However, I don't think it makes sense to remove them from the pharmacopeia without first having a substitute in place. Perhaps modulating glutamatergic neurotransmission should be investigated.
- Scott
Posted by papillon2 on July 21, 2012, at 9:02:17
In reply to Re: Antipsychotics shrink the brain, posted by SLS on July 19, 2012, at 19:35:49
The problem I see is that schizophrenia also causes brain damage. This is evident in brain imaging scans.
Rock, hard place, all that.
Posted by Willful on July 22, 2012, at 1:26:41
In reply to Re: Antipsychotics shrink the brain, posted by papillon2 on July 21, 2012, at 9:02:17
No one has reached any solid conclusions about how antipsychotics cause changes in brain volume.
These studies also don't dispute that the disease process of psychosis also affects brain volume.
However, these images studies done longitudinally suggest that more changes occur in the brains of people taking antipsychotic drugs.
Presumably, further research could lead to information about whether certain drugs cause these changes more than others, etc-- and one hopes to less choosing less damaging treatments.
Plus, informed consent would require presumably that people be told that these drugs do cause such changes.
This is the end of the thread.
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