Long-term Effects of Antipsychotics on the Brain — Transcript

Could the antipsychotic medication you're taking to help you with your mental health be doing lasting damage to your brain? In today's video, we are going to be talking about the long-term and potentially irreversible side effects of these drugs that almost no one talks about.

about we're going to be covering things like brain shrinkage irreversible movement disorders and cognitive decline and for those of you who don't know me I'm Dr ysep I'm a physician I used to work at the FDA and I was a drug safety

We're going to be covering things like brain shrinkage, irreversible movement disorders, and cognitive decline. For those of you who don't know me, I'm Dr. Ysep. I'm a physician. I used to work at the FDA, and I was a drug safety expert for a pharmaceutical company.

looked at recently up to 58% of patients on these medications are never even taught about these serious risks such as heart of discinesia so let's jump in and explore these sensitive topics and if you stick around to the end we're going

I make these videos because, honestly, these risks are rarely talked about, and doctors ought to be telling their patients about them so they can make informed decisions about their health. From the statistics I've looked at recently, up to 58% of patients on these medications are never even taught about these serious risks, such as tardive dyskinesia.

include things like halol ridol cakil Latuda alanine Abilify and Geodon and these drugs work by blocking dopamine 2 receptors in the brain and while this can be effective in reducing symptoms of psychosis agitation or even depression in the short term the long-term use of

So let's jump in and explore these sensitive topics. If you stick around to the end, we're going to talk about what you can do if you've developed one of these problems and how you can recover from it.

the brains of patients with schizophrenia looked different from the brains of patients without them and what they found was that the ventricles in patients with schizophrenia appeared larger now a ventricle in a brain is a fluid filled space and these ventricles

So first, what are the antipsychotics? These are drugs that were originally used to treat schizophrenia. Common antipsychotics include things like Haldol, Risperdal, Seroquel, Latuda, Abilify, and Geodon.

of them wondered whether this could actually be an effect of the drug itself they wondered whether the patients with schizophrenia because they were on these antis psychotic medications were experiencing brain shrinkage not because of the schizophrenia but because of the

These drugs work by blocking dopamine 2 receptors in the brain. While this can be effective in reducing symptoms of psychosis, agitation, or even depression in the short term, the long-term use of these medications can be associated with neurological damage.

one unmedicated and one medicated and given the widespread use of these medications it was it's hard to find unmedicated patients but it's also hard to convince patients with schizophrenia and psychotic symptoms to forgo treatments for long periods of time so

Let's jump in and talk about the first type of brain damage that we've seen from these meds, and this is brain shrinkage. For a long time, researchers have wondered why the brains of patients with schizophrenia looked different from the brains of patients without it.

most genetically similar to humans that's what Dolph Peterson and his research team did in 2005 they looked at mcco monkeys treated with alanza pine or hll for anywhere from 17 up to 24 months and what they found was shocking the

What they found was that the ventricles in patients with schizophrenia appeared larger. A ventricle in the brain is a fluid-filled space, and these ventricles will begin to look larger if the brain tissue surrounding them begins to shrink or die off.

areas in the brain that are associated with highlevel thinking strategic planning executive functioning now this finding was very concerning but not all people were fully convinced by these animal studies and some were arguing that we don't know if this is even

For a long time, researchers said this was evidence that schizophrenia is a degenerative brain disease where neurons are dying off. But not all researchers agreed because some wondered whether this could actually be an effect of the drug itself.

looking into this and the next researcher to picked this up was fusar and poly and his research team and they looked into this in 2013 they analyzed more than a thousand patients with schizophrenia on anti psychotic medication over for a period of 72 weeks

They wondered whether the patients with schizophrenia, because they were on these antipsychotic medications, were experiencing brain shrinkage not because of the schizophrenia but because of the drug.

schizophrenic patients on antis psychotics but not in the other patients not on the drug now I know a lot of you are familiar with some of this language but gray matter volume is neurons so when we look at the brain we have gray

They wanted to do some clinical trials to look at this problem, but this is really challenging because one of the challenges in this research is you would need to have two groups of patients with schizophrenia: one unmedicated and one medicated.

brain atrophy or brain damage and when they started to look at these patients with schizophrenia to see what was associated with the most neuronal loss what they found was it was associated with the cumulative exposure to anotic medications meaning the more antis

Given the widespread use of these medications, it is hard to find unmedicated patients. It's also hard to convince patients with schizophrenia and psychotic symptoms to forgo treatments for long periods of time so they could do these MRI studies.

gry matal loss now what that means essentially is it doesn't look like having schizophrenia or having more severe symptoms of schizophrenia was associated with that because that might be a confounding factor that would make it look like that because you could say

Because we can't do these studies in humans, researchers came up with another way of looking at this. They decided to give these medications to healthy monkeys because these are the most genetically similar to humans.

were looking at these associations the duration or the severity of the schizophrenia was not associated with the level of neuronal degeneration it was just the cumulative exposure to anti psychotic treatment and so for me having looked at this evidence now what's

That's what Dolph Peterson and his research team did in 2005. They looked at macaque monkeys treated with olanzapine or haloperidol for anywhere from 17 up to 24 months. What they found was shocking.

brain injury from antic psychotics I want to talk about is fet discinesia now this is a complicated word but it essentially describes the type of movement disorder caused by these medications and it's characterized by involuntary repetitive movements of

The healthy monkeys who were given Haldol or olanzapine experienced an 8 to 11% reduction in their brain weight compared to the healthy controls. Most of the neuronal loss was in the frontal lobe.

unfortunately this can be a permanent side effect and researchers and clinicians studying this have noticed that for many patients it can be irreversible even after coming off the medication and this suggests that this side effect has been caused by direct

These are the areas in the brain associated with high-level thinking, strategic planning, and executive functioning. This finding was very concerning, but not all people were fully convinced by these animal studies.

one out of 20 patients on these medications will develop T of discinesia per year and for patients who have been on these drugs for several years it's quite often that you see 20 to 30% of the patients have tarada discinesia and

Some argued that we don't know if this is even relevant to humans. Maybe humans are more resilient. While I think that's unlikely because I would already be concerned if we were seeing this in monkeys, I think there is some merit to this argument.

patients and so they're more likely to get this side effect and from what I've seen reading the medical literature the group at the highest risk of having these side effects are women over age 65 one of the saddest things about t of

Researchers kept looking into this. The next researcher to pick this up was Fusar-Poli and his research team. In 2013, they analyzed more than a thousand patients with schizophrenia on antipsychotic medication over a period of 72 weeks, about 17 months.

or because of their psychotic illness it just didn't really matter to them that couldn't be further from the truth because in a recent survey of our patients with heart of discinesia 70 to 80% of them were aware of this movement

They compared them to healthy controls without schizophrenia. What they found was eye-opening. Over time, there was a progressive decrease in gray matter volume and enlargement in the lateral ventricles in the schizophrenic patients on antipsychotics, but not in the other patients not on the drug.

fact a lot of patients experiencing this really don't like it and it has a big impact in their life which can potentially be permanent now the final piece of cognitive damage that I want to talk to you about is actually the link

I know a lot of you are familiar with some of this language, but gray matter volume refers to neurons. When we look at the brain, we have gray matter and white matter. White matter is a lot of the connections between neurons, but gray matter is the neuronal cell bodies.

many doctors think that the neuronal damage is only confined to the areas of the brain responsible for movement however I think this is really wishful thinking because why would this damage only affect one area especially when both human and animal studies are

What that means is they're seeing reductions in neurons. You could say this is brain atrophy or brain damage. When they looked at these patients with schizophrenia to see what was associated with the most neuronal loss, they found it was associated with cumulative exposure to antipsychotic medications.

cognitive decline appear to be going hand inand with many patients which is suggesting that there may also be some permanent cognitive decline in these patients and so when researchers have looked at this and they looked at 206 patients with schizophrenia the patients

Meaning the more antipsychotic you had taken over a long period of time, the more likely you were to have neuronal cell loss. Interestingly, they did not find that the duration or severity of the patient's schizophrenia was associated with the gray matter loss.

for assessing the symptoms of schizophrenia and the negative symptoms are the ones such as low motivation you know not talking being withdrawn not socializing those were all of those areas where patients were performing worse if they had cardo discinesia in

What that means essentially is it doesn't look like having schizophrenia or having more severe symptoms of schizophrenia was associated with that. That might be a confounding factor that would make it look like that because you could say something like, "Well, the patients on more antipsychotic had worse schizophrenia, and because of that, you would say it's not the antipsychotic medication, it's actually because they just had worse schizophrenia."

animal studies where we found that a lot of the frontal cortex and even some of the parietal loes were the spaces that were most affected by this and if you know a little bit about neuroanatomy you'll know the frontal lobe is

But that's not what they found when looking at these associations. The duration or severity of schizophrenia was not associated with the level of neuronal degeneration. It was just the cumulative exposure to antipsychotic treatment.

declines are going hand inand with TD I worry that these may be potentially irreversible because that's what we're seeing with some patients with TD and unfortunately I think a lot of doctors miss this and they don't warn their

For me, having looked at this evidence, what's happened to the monkeys, and what we're seeing in humans on this medication, I would say that's quite compelling evidence that antipsychotic medications, when used long-term, may be associated with some brain shrinkage or neuronal damage.

for a doctor to just say it's part of your underlying illness we see some cognitive dysfunction in these things and I think this is potentially completely overlooked and that is a bad thing because it needs to be acknowledged because everyone should be

The next sign of brain injury from antipsychotics I want to talk about is tardive dyskinesia. This is a complicated word, but it essentially describes the type of movement disorder caused by these medications.

dose but if you look at the cakil label it says it right there in plain English T discinesia can occur even at low doses after using the drug for a brief period of time and I don't think anyone would

It is characterized by involuntary, repetitive movements of muscles. Typically, this starts around the mouth, and you'll have lip movements or your tongue will be moving. Sometimes it can progress to the rest of your body, and you could start to have writhing of your shoulders or even your torso.

theory is is that prolonged dopamine suppression actually causes oxidative stress and this leads to an imbalance between the free radicals and the antioxidants in the brain and this imbalance can go on to damage the neurons so now that we understand a

Unfortunately, this can be a permanent side effect. Researchers and clinicians studying this have noticed that for many patients, it can be irreversible even after coming off the medication.

other safer drugs again thinking about cakil and insomnia another area where you may want to avoid them is for things like depression that isn't severe or causing Suicidal Thoughts because let's think about it if you're someone that's depressed and you get on one of these

This suggests that this side effect has been caused by direct neuronal damage which has not healed even after the drug is removed. Studies that look into this to try and estimate how frequent this risk is have found that this occurs in about 4 to 5% of patients annually.

careful about using these medications for depression especially in the long term you also want to be really cautious about using these meds if you're a woman and if you're over age 65 because that's the highest risk of T of discinesia and

That means about one out of 20 patients on these medications will develop tardive dyskinesia per year. For patients who have been on these drugs for several years, it's quite common to see 20 to 30% of the patients have tardive dyskinesia.

as soon as you're well and only use them when it's absolutely necessary and if you do need to take this medication long term aim for the lowest possible dose and remember to stay engaged and proactive in your treatment make

This risk continues to increase the older you...

dietary changes have had a massive impact on some of my patients another thing that you may want want to do is to do a comprehensive functional medicine workup this panel will look at things that most doctors will miss it can look

at heavy metals it can look at mold can look at nutritional deficits for a long time I thought this stuff was completely overblown and it wasn't that useful having been in this space for a while and talking to a lot of patients these

things have actually helped them feel better now by doing these things like the diet and the proper workup and all of that that that may just reduce your Reliance on these medications and so you can bring the amount that you use down

and so always stay proactive in your treatment and look for non-drug ways to manage your depression or psychosis one thing I want to add is that this actually groups so if you have a psychotic illness and you want to avoid

taking anti psychotics you want to look into groups like the hearing voices Network this is a community of people who are living with psychotic illness and they're trying to avoid the medications or take them at the lowest possible dose and they do a whole range

of groups and they have lots of resources so that may be of interest to you the next thing I want to talk to you about is supplements now there are several supplements out there that have shown promise in mitigating the risk of

TD by reducing that oxidative stress and so vitamin E is one of them this is a powerful antioxidant that may help prevent TD in high-risk patients you can also take drugs like Knack or glutathione which also reduce free

radical damage there's things like co-enzyme Q10 which is a powerful antioxidant that can reduce oxidative stress and you also want to take things like omega-3 fatty ashes and fishales as these have strong anti-inflammatory and neuroprotective effects if you are

taking these medications long term you may be interested in taking some of these supplements now finally specifically for things like T of discinesia there are some pharmaceutical options out there and these are drugs such as valbenazine or ingresa or D

tetrabenazine or OST these are vmat Inhibitors that reduce dopamine release and they've been shown in clinical trials to reduce the symptoms of of discinesia however what I will say is they come with a lot of side effects things like worsening depression

Suicidal Thoughts hypers sensitivity reactions they can be very sedating as well they can cause some cardiac arrhythmias also and they put you at a higher risk for nms which can be a life-threatening adverse reaction and they can also cause signs of

parkinsonism now not everyone is going to get these side effects obviously but I bring these things up because I want you to know this is a powerful drug and from my experience working with my patients after they've already been

harmed by a drug and they've developed something like TD they're usually pretty worry about getting on another Pharmaceutical especially if it has serious side effects like this another thing I'll mention about these drugs is they are really inexpensive and they can

sometimes cost thousands of dollars per month to be on so from my perspective they're not really a great option so that's my deep dive on the neurological effects of anti psychotics that no one is talking about I wish I could end this

video on a more positive note and say that recovery from TD and these neurological things happens in everyone but unfortunately that's not always the case and while many patients will improve once they come off the medications others continue to suffer

from these symptoms long term and that's why I think this message is so important people need to know these things before they get on the drugs in the first place now I know we've been talking about antis psychotics today but if you're

interested in learning more about the causes of psychotic illnesses like schizophrenia the rational use of antis psychotic medication in this condition and also tapering be sure to check out this interview with a world-renowned schizophrenia researcher Dr John Reed