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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by crabcakebenny on September 5, 2014, at 18:10:32
I'm sure most of you know this subject, but here's one of many articles discussing it if you're in the dark:
http://www.madinamerica.com/2013/06/antipsychotics-and-brain-shrinkage-an-update/Now I have a personal question; would say, taking low-dose antipsychotics to augment SSRIs, not treating any kind of psychosis, still put me at risk for brain damage? I was taking 2.5 mg zyprexa for about this long, and now I'm concerned I might've caused some irreversible deterioration. This really f*ck*ng bites, it's been driving me crazy thinking about it lately. Why do pdocs prescribe these drugs to non-schizophrenics if the risk factor is this f*ck*ng severe?
Posted by crabcakebenny on September 5, 2014, at 18:11:42
In reply to Neuroleptic Brain-shrinkage, posted by crabcakebenny on September 5, 2014, at 18:10:32
taking zyprexa for about 6 months*
woops
Posted by Beckett on September 5, 2014, at 20:51:06
In reply to Neuroleptic Brain-shrinkage, posted by crabcakebenny on September 5, 2014, at 18:10:32
I believe that in Sweden, standard practice is to to treat schizophrenic episodes. Quality of life was found to be better and episodes no more frequent.
I think you are likely alright. The amount of changes mentioned are small, and you have only six months of use. Brain volume can be increased (or is it neural connectivity?) through brain exercises, yes? And certain supplements? Are you tapering off?
I agree that APs are overprescribed, and most doctors advise that they are benign.
Posted by Christ_empowered on September 6, 2014, at 8:19:01
In reply to Re: Neuroleptic Brain-shrinkage, posted by Beckett on September 5, 2014, at 20:51:06
Ideally, neuroleptics (full dose, at least) should be reserved for schizophrenia and severe bipolar I. That said......low doses of neuroleptics probably aren't so bad. I don't know about that brain shrinkage thing, but the available data on TD (dealing mostly with the older drugs) would seem to indicate that its your cumulative exposure to neuroleptics that matters.
So, 2.5mgs/zyprexa per day isn't as big a deal as, say, 20mgs/day used for schizophrenia. Its probably not as bad as moderate-to-high doses of the older drugs. Throw more drugs in, you probably get more brain damage. The old school lithium+haldol combo, for instance, can cause serious brain damage.
All I can think of is a switch to Abilify. I know, I'm like an ad for it, lol. Thing is...over time, neuroleptics "upregulate" D2 receptors. Blocking D2 receptors is what most neuroleptics do. The upregulation can make you more vulnerable to problems once you taper or quit (especially if you stop abruptly). Abilify doesn't cause as much D2 upregulation in adults (kids and adolescents are a different story) as the older atypicals. Zyprexa causes about as much upregulation as Haldol, it just has a more benign neurological side effect profile.
I do Orthomolecular. It helps anxiety and agitation (and allergies, thank God). An added bonus is that high doses of multiple antioxidants plus b vitamins may both prevent TD and help reverse it, especially if you catch TD early.
Since TD is indicative of serious brain damage, my best bet is that the high dose antioxidants and b vitamins help protect the brain from ill effects of the neuroleptics. I seem to recall reading that high doses of taurine may help prevent TD (and exert a calming effect).
Anyway...that's all I can come up with. I know you can get the brain shrinkage without TD, but my best guess is that something that prevents TD probably protects the brain, so you shouldn't get as much brain damage. Hopefully (this is for me), OM prevents "tardive dementia," which I find to be the scariest thing ever.
Good luck!
Posted by linkadge on September 6, 2014, at 11:26:06
In reply to Re: Neuroleptic Brain-shrinkage, posted by Christ_empowered on September 6, 2014, at 8:19:01
Here's my take.
There probably is some effect of the disease itself. But there is also some effect from the antipsychotic.
I don't think the shrinkage is from the drug itself (I,e, olanzapine isn't directly neurotoxic), but rather the molecular effects of the drug.
For instance, using very high doses of antipsychotics are going to produce some cognitive dysfunction, reduced energy and possible glucose imbalances. Also, dopamine (in the right levels) is neurotrophic. So, blocking dopamine function excessively, probably causes certain circuits to atrophy.
In other words, the brain atrophy is probably secondary to the brain dampening effects the drugs can have. Some circuitry is being dampened. (i.e. use it or lose it).
That being said, untreated psychosis, mania, severe depression, anxiety, insomnia etc. are probably also neurotoxic.
There was a study out a few weeks back showing that chronic insomniacs display progressive brain atrophy over time.
I think at 2.5 mg you are probably pretty safe. You might try half of that just to see. In my opinion, you always want to test the lower threshold of your medication doses.
I would think that the AP's with the shorter half life would be less problematic. Also, an antidepressant *may* offset some of the negative effects of the AP. Coffee, might also offset some of the effects.
The real question (in my mind) is has the antipsychotic changed your behavior? Since starting it, are you feeling more or less engaged in life? Is your cognition better or worse? Are you exercising more or less?
Doctors often prescribe AP's for the sleep enhancing effects. You might get the same benefit from a drug like remeron, trazodone or doxepin. These drugs are more selective to the 5-ht2a receptor and *may* result in less cognitive interference.
Linakdge
Posted by SLS on September 6, 2014, at 12:13:49
In reply to Re: Neuroleptic Brain-shrinkage, posted by Christ_empowered on September 6, 2014, at 8:19:01
Tissue loss is often seen in the first-episode of schizophrenia before drugs are introduced (drug-naive). It is difficult to determine whether the tissue loss seen in neuroleptic-treated cases is the result of drug exposure or a natural progression of the disease. There is much debate on this issue. However, it is difficult to ignore the reports of larger decreases in brain tissue following treatment with the older first-generation typical antipsychotics than with the newer atypical drugs. One could argue that this is an artifact of illness severity, but I found this:
- Scott------------------------------------------------
Antipsychotic drug effects on brain morphology in
first-episode psychosisYear: 2005
Source title: Archives of General Psychiatry
Volume: 62
Issue: 4
Page : 361-370Abstract:
Background: Pathomorphologic brain changes occurring as early as first-episode schizophrenia
have been extensively described. Longitudinal studies have demonstrated that these changes may be
progressive and associated with clinical outcome. This raises the possibility that antipsychotics might alter
such pathomorphologic progression in early-stage schizophrenia.Objective: To test a priori hypotheses that
olanzapine-treated patients have less change over time in whole brain gray matter volumes and lateral
ventricle volumes than haloperidol-treated patients and that gray matter and lateral ventricle volume changes
are associated with changes in psychopathology and neurocognition.Design: Longitudinal, randomized,
controlled, multisite, double-blind study. Patients treated and followed up for up to 104 weeks.
Neurocognitive and magnetic resonance imaging (MRI) assessments performed at weeks 0 (baseline), 12,
24, 52, and 104. Mixed-models analyses with time-dependent covariates evaluated treatment effects on MRI
end points and explored relationships between MRI, psychopathologic, and neurocognitive outcomes.
Setting: Fourteen academic medical centers (United States, 11; Canada, 1; Netherlands, 1; England, 1).
Participants: Patients with first-episode psychosis (DSM-IV) and healthy volunteers. Interventions: Random
allocation to a conventional antipsychotic, haloperidol (2-20 mg/d), or an atypical antipsychotic, olanzapine
(5-20 mg/d). Main Outcome Measures: Brain volume changes assessed by MRI.Results: Of 263 randomized patients, 161 had baseline and at least 1 postbaseline MRI evaluation. Haloperidol-treated
patients exhibited significant decreases in gray matter volume, whereas olanzapine-treated patients did not.
A matched sample of healthy volunteers (n=58) examined contemporaneously showed no change in gray
matter volume.Conclusions: Patients with first-episode psychosis exhibited a significant between-treatment
difference in MRI volume changes. Haloperidol was associated with significant reductions in gray matter
volume, whereas olanzapine was not. Post hoc analyses suggested that treatment effects on brain volume
and psychopathology of schizophrenia may be associated. The differential treatment effects on brain
morphology could be due to haloperidol-associated toxicity or greater therapeutic effects of olanzapine.
Posted by SLS on September 6, 2014, at 12:15:30
In reply to Re: Neuroleptic Brain-shrinkage, posted by linkadge on September 6, 2014, at 11:26:06
I tend to agree with Linkadge's synopsis.
- Scott
Posted by linkadge on September 6, 2014, at 14:26:13
In reply to Re: Neuroleptic Brain-shrinkage, posted by SLS on September 6, 2014, at 12:13:49
I would tend to agree with you, but there is the issue of neuroleptics supposedly leading to brain atrophy in animal tests.
Linkadge
Posted by crabcakebenny on September 19, 2014, at 16:46:06
In reply to Re: Neuroleptic Brain-shrinkage, posted by linkadge on September 6, 2014, at 11:26:06
bleh, I forgot about this thread. I hope I get responses, I'll try to respond to all of you.
@linkadge I've long since been off them (3 months?). Let me preface this by stating I'm pretty biased concerning this matter, but I view antipsychotics as mental poison now. For one, I had the zombification/blunting and possessed no clarity, but I also felt like it negatively altered my behavior. I became really impulsive but apathetic; my driving became reckless, I didn't know when to respect somber situations(f*ck*d around and joked all the time) while on the drug. I feel like my executive function is back while being off zyprexa, I've lost 30 pounds, I work out daily, my intellect seems to have returned. I'm just concerned those dopamine circuits, or whatever intricate system it might've f*ck*d up, will be damaged forever. I won't feel the same way I did before the drug, for the rest of my life.
To be fair, this has turned into a unhealthy obsession/paranoia all its own recently. I can't stop thinking about it. It's making me depressed.
This is the end of the thread.
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