Psycho-Babble Medication Thread 1111445

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Are antipsychotics neurotoxic?

Posted by NKP on July 29, 2020, at 2:11:24

According to the following study, long-term use of antipsychotics may lead to reduced brain size:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3476840/

Here is commentary of the above study:

https://www.psychiatrictimes.com/view/antipsychotics-and-shrinking-brain

Here is another study that concludes brain shrinkage in monkeys treated with antipsychotics:

https://www.nature.com/articles/1301233

 

Re: Are antipsychotics neurotoxic?

Posted by linkadge on July 29, 2020, at 8:12:43

In reply to Are antipsychotics neurotoxic?, posted by NKP on July 29, 2020, at 2:11:24

Possibly more so with higher doses. Brain volume reduction may be more a consequence of dopamine blockade (dopamine being involved in neurogenesis and plasticity). However, I haven't seen similar studies in humans. I remember reading a study suggesting a volume increase in patients taking olanzapine. If you don't need an antipsychotic, I would recommend not taking one. There are alternatives to taking antipsychotics i.e. for anxiety and/or mood stability. If you need one, take it in the lowest dose needed.

Linkadge


 

Re: Are antipsychotics neurotoxic?

Posted by NKP on August 1, 2020, at 5:17:20

In reply to Re: Are antipsychotics neurotoxic?, posted by linkadge on July 29, 2020, at 8:12:43

I've been doing some more reading on the topic (do a search for "antipsychotic brain shrinkage"). It seems that antipsychotics DO cause some loss of brain volume BUT:

(i) this is not necessarily a bad thing, e.g. pregnancy also causes a transient loss of grey matter volume;
(ii) the loss of brain volume seems not to have any clinical relevance and seems not to cause cognitive deficits;
(iii) it is not neurons as such that die, but rather, dendrites that atrophy, and synapses that shrink;
(iv) the effects appear to be reversible upon discontinuation of the medication;
(v) the effect is observable within two hours of once-off administration of intravenous haloperidol, and reverses soon after the haloperidol leaves the patient's system;
(vi) there is some evidence that, in the short run at least, the effect is more pronounced with typical antipsychotics (some studies conclude that typicals and atypicals cause the same brain shrinkage in the long run);
(vii) the effect is related to dose.

I may have my facts wrong on the above but this is the impression that I got from the literature.

 

Re: Are antipsychotics neurotoxic?

Posted by NKP on August 1, 2020, at 5:54:03

In reply to Re: Are antipsychotics neurotoxic?, posted by linkadge on July 29, 2020, at 8:12:43

> Brain volume reduction may be more a consequence of dopamine blockade (dopamine being involved in neurogenesis and plasticity).

I wonder then if antipsychotics which promote domapinergic activity at low doses, would also cause brain shrinkage?

And what can one do to attenuate the effect? For example, would activities that normally promote good brain health, like reading, socialising, playing a musical instrument, etc., reduce the brain shrinkage?

 

Re: Are antipsychotics neurotoxic?

Posted by rjlockhart37 on August 3, 2020, at 21:09:20

In reply to Are antipsychotics neurotoxic?, posted by NKP on July 29, 2020, at 2:11:24

mostly the older ones were, permanent nerve damage. Parkinson's disease

 

Re: Are antipsychotics neurotoxic?

Posted by Christ_empowered on August 8, 2020, at 23:56:24

In reply to Re: Are antipsychotics neurotoxic?, posted by NKP on August 1, 2020, at 5:54:03

I read somewhere that aripiprazole causes a bit less d2 up regulation than the other tranquilizers. And...

Yeah, the data on brain damage is scary. What to do?

Avoid if possible. Lowest effective dose when needed. Personally, I load up on antioxidants and vitamins, orthomolecular style. And I take aripiprazole. Its...ok, usually.

 

Re: Are antipsychotics neurotoxic?

Posted by NKP on August 11, 2020, at 10:06:51

In reply to Re: Are antipsychotics neurotoxic?, posted by Christ_empowered on August 8, 2020, at 23:56:24

I think that I will stop using Fluanxol. I'm on only 0.5 mg/day, but dynamite comes in small packages. I've now reduced my dose to 0.375 mg/day and will use this for a week or two before going down further.

 

Re: Are antipsychotics neurotoxic?

Posted by NKP on August 13, 2020, at 9:29:02

In reply to Re: Are antipsychotics neurotoxic?, posted by NKP on August 11, 2020, at 10:06:51

I've been on 0.375 mg/day of Fluanxol (down from 0.5 mg/day) for a few days now. There has been a marked deterioration in my mood and functioning. Amazing that such a small dose change can have so great an effect. Last night I only went to bed at 03:00 AM; back to my bad old habits. My sleep routine had become so healthy these last few weeks: I generally went to bed well before midnight each evening. I also felt very negative and sulky yesterday evening, and today, when I felt stressed, I gave in to a bad nervous habit of biting my fingers.

Fluanxol is amazingly strong stuff. I can't imagine what it must be like to use doses like 6 mg/day.

I'll persist for a few more days on 0.375 mg/day however, but I'm wondering which is the greater evil: mild brain shrinkage or negative mood and poor functioning.

 

Re: Are antipsychotics neurotoxic?

Posted by Christ_empowered on August 13, 2020, at 11:33:05

In reply to Re: Are antipsychotics neurotoxic?, posted by NKP on August 13, 2020, at 9:29:02

Maybe buspirone? Less brain damage.

 

Re: Are antipsychotics neurotoxic?

Posted by undopaminergic on August 14, 2020, at 5:16:04

In reply to Re: Are antipsychotics neurotoxic?, posted by NKP on August 13, 2020, at 9:29:02

>
> Fluanxol is amazingly strong stuff. I can't imagine what it must be like to use doses like 6 mg/day.
>

I've tried a dose like that, and the effects are scarcely dramatic. It seemed to cause restless legs.

> I'll persist for a few more days on 0.375 mg/day however, but I'm wondering which is the greater evil: mild brain shrinkage or negative mood and poor functioning.
>

Brain shrinkage is irrelevant if it doesn't have any symptoms. Many people have used antipsychotics for much longer and at higher doses, and there have been no reports (AFAIK) of symptomatic brain shrinkage.

-undopaminergic

 

Re: Are antipsychotics neurotoxic?

Posted by Lamdage22 on August 14, 2020, at 5:37:46

In reply to Re: Are antipsychotics neurotoxic?, posted by undopaminergic on August 14, 2020, at 5:16:04

Probably not more neurotoxic than psychosis?

 

Re: Are antipsychotics neurotoxic?

Posted by undopaminergic on August 14, 2020, at 5:45:43

In reply to Re: Are antipsychotics neurotoxic?, posted by Lamdage22 on August 14, 2020, at 5:37:46

> Probably not more neurotoxic than psychosis?

In my experience, psychosis is the opposite of neurotoxic. I have grown so tremendously since my psychosis, that I'm a whole different person. That is subjective though -- the change may be viewed as harmful if you don't like it.

-undopaminergic

 

Re: Are antipsychotics neurotoxic? undopaminergic

Posted by linkadge on August 22, 2020, at 12:17:51

In reply to Re: Are antipsychotics neurotoxic?, posted by undopaminergic on August 14, 2020, at 5:45:43

>In my experience, psychosis is the opposite of >neurotoxic. I have grown so tremendously since my >psychosis, that I'm a whole different person. That >is subjective though -- the change may be viewed >as harmful if you don't like it.

I would say that this isn't a typical viewpoint. There are a number of studies looking at brain changes associated with chronic, untreated schizophrenia (i.e. alterations in grey matter, ventricle volume, grey matter reductions, white matter reductions, inflammation, cognitive deficits etc).

A brief psychotic episode, isn't necessarily the same thing as schizophrenia however. Drugs or trauma can induce psychotic episodes that can resolve on their own. Schizophrenia, on the other hand, is usually chronic and relapsing.

Linkadge

 

Re: Are antipsychotics neurotoxic?

Posted by undopaminergic on August 23, 2020, at 1:57:56

In reply to Re: Are antipsychotics neurotoxic? undopaminergic, posted by linkadge on August 22, 2020, at 12:17:51

> >In my experience, psychosis is the opposite of >neurotoxic. I have grown so tremendously since my >psychosis, that I'm a whole different person. That >is subjective though -- the change may be viewed >as harmful if you don't like it.
>
> I would say that this isn't a typical viewpoint. There are a number of studies looking at brain changes associated with chronic, untreated schizophrenia (i.e. alterations in grey matter, ventricle volume, grey matter reductions, white matter reductions, inflammation, cognitive deficits etc).
>

I guess YMMV.

> A brief psychotic episode, isn't necessarily the same thing as schizophrenia however. Drugs or trauma can induce psychotic episodes that can resolve on their own. Schizophrenia, on the other hand, is usually chronic and relapsing.
>

I've only had one "real" episode of psychosis, and that was back in 2009. By real, I mean auditory hallucinations and paranoia, which was consistent with paranoid schizophrenia. Except for an episode of erotomania (fully delusional), later "psychotic" episodes consisted merely in certain unscientific ideas. However, soberly, unscientific ideas are not enough to qualify for a diagnosis of "delusions". Therefore, I scarcely have schizophrenia, even though the doctors insist that I do.

I concede that I am on the schizophrenia *spectrum*, because I have traits of schizoid personality disorder (ie. negative schizophrenic symptoms). That said, these symptoms are difficult to distinguish from depression.

-undopaminergic


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