One of the most commonly used drugs to treat mental illnesses has been linked to adverse changes in brain structure. This was discovered in a recent study published in JAMA Psychiatry by Dr. Aristotle Voineskos and his team.
According to the study, olanzapine, a commonly used antipsychotic drug was linked to adverse changes in brain structure, namely a thinning of the cortex. These changes were especially pronounced in older people.
Until the 1990s, antipsychotic drugs were mostly prescribed to people with schizophrenia. Since then, their use has expanded to major depression and a range of pediatric, adult, and geriatric disorders, including anxiety, insomnia, and autism, for which one in five patients are prescribed antipsychotics.
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.
At the same time, however, this new discovery means that health practitioners should consider alternatives where possible before prescribing olanzapine-based antipsychotics.
Dr. Voineskos’ and his team are the first ones to evaluate the effects of this type of medication on the brain using a gold-standard design and advanced brain imaging techniques.
They examined patients with major depression who also experience psychosis who were prescribed 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 first group started exhibiting a thinning of the cortex while the placebo group had no such side-effects. However, many of the participants in the placebo group suffered from relapses due to the lack of olanzapine antipsychotic medications. As a result of that, they suffered other potentially adverse changes to their brain structure caused by the untreated psychosis.
The team’s conclusion was that despite the significant side-effects, the prescription of olanzapine still outweighs the life-threatening effects of untreated psychosis. With over 20 million active cases of schizophrenia around the world, this disease is in the Top 15 leading causes of disability.
However, the researchers recommend a more detailed analysis of each patient’s needs before prescribing antipsychotics as not all participants in the placebo group suffered relapses. Ideally, new treatment models will have to be developed, at least until new side-effect-free medications can be invented.