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Re: Antipsychotics and brain volume

Posted by linkadge on December 3, 2022, at 12:11:02

In reply to Antipsychotics and brain volume, posted by NKP on December 3, 2022, at 4:39:47

Antipsychotics do have an impact on brain volume. For instance, animals chronically given antipsychotics show reductions in brain volume. The typical antipsychotics are probably worse in this regard than atypicals (possibly due to higher D2 binding and less binding to other protective receptors - like 5-ht1a). The newer partial agonist drugs may also have advantages in that they seem to do more to stabilize dopamine firing rather than strict blockade. Although, some of the newer ones can dysregulate glucose, which probably isn't great for the brain either.

Dose is likely a factor. Nutrition, exercise and lifestyle are also likely factors. Some of the animal models suggest that antioxidants (vitamin C and E) were protective against antipsychotic induced atrophy. Lithium too, in general has been shown to improve brain structure and grey matter volume in bipolar patients. It also seems to reduce dopamine supersensitivity and offset some of the alterations resulting from other psychiatric drug use.

As you mention too, psychotic (and manic) episodes are linked to a progressive loss of grey matter, so keeping stable is also important for protecting the brain. So, it's not a simple equation.

There are complimentary treatments for schizohprenia, which, by themselves, are generally not effective, but have been shown to augment the effects of antipsychotics.

For example, one study showed that 1/2 dose risperidone + vitamin C was as effective as full dose risperidone. Some studies show that melatonin can enhance the effect of antipsychotics. Melatonin tends to be anti-dopaminergic and also sensitizes the 5-ht1a receptor, which may make 5-ht1a active drugs more effective (i.e. abilify, seroquel, rexulti, etc). You might also talk to your doctor about a low dose of lithium (especially if schizoaffective is present). It tends to stabilize the dopamine system (via inhibition of GSK3). In some patients it has antipsychotic effects in its own right.

If psychotic depression is present, then adding some fluvoxamine may be beneficial. It is an SSRI with potent sigma-1 receptor agonist properties. This action may be responsible for its increased effectiveness in psychotic depression and may produce pro-cognitive effects.

If metabolic effects are at all present, then speak to your doctor about metformin. This has neuroprotective properties and can offset brain insulin resistance.

A recent study suggested too that multivitamin supplementation preserved brain volume (in older age individuals) compared to a cocoa supplement.





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