An international group of experts has concluded that, for patients with schizophrenia and related psychotic disorders, antipsychotic medications do not have negative long-term effects on patients’ outcomes or the brain.
In fact, the benefits of these medications are much greater than their potential side effects, according to the researchers.
The findings, by Jeffrey Lieberman, M.D., chairman of psychiatry at Columbia University College of Physicians, and colleagues from institutions in the United States, Germany, the Netherlands, Austria, Japan, and China, were published in the American Journal of Psychiatry.
Nearly seven million Americans take antipsychotic medications for the treatment of schizophrenia and related conditions. The medications are prescribed to alleviate the symptoms of psychosis and, longer term, to prevent relapse.
In recent years, however, concerns have been raised that these medications could have toxic effects and negatively impact long-term outcomes. This has the potential to mislead some patients and their families to refuse or discontinue antipsychotic treatment, according to the researchers.
Antipsychotic medications can also increase the risk for metabolic syndrome, which is linked to heart disease, diabetes, and stroke, but the new study did not include a risk-benefit analysis.
Researchers undertook a comprehensive examination of clinical and basic research studies that examined the effects of antipsychotic drug treatment on the clinical outcomes of patients and changes in brain structure.
“The evidence from randomized clinical trials and neuroimaging studies overwhelmingly suggests that the majority of patients with schizophrenia benefit from antipsychotic treatment, both in the initial presentation of the disease and for longer-term maintenance to prevent relapse,” said Lieberman.
Moreover, whatever side effects that these medications might cause are greatly outweighed by their therapeutic benefits, he noted.
“Anyone who doubts this conclusion should talk with people whose symptoms have been relieved by treatment and literally given back their lives,” he added.
The studies also revealed that delaying or withholding treatment has been associated with poorer long-term outcomes.
“While a minority of patients who recover from an initial psychotic episode may maintain their remission without antipsychotic treatment, there is currently no clinical biomarker to identify them, and it is a very small number of patients who may fall into this subgroup,” said Lieberman.
“Consequently, withholding treatment could be detrimental for most patients with schizophrenia.”
While preclinical studies in rodents suggest that antipsychotic medications can sensitize dopamine receptors, there is no evidence that antipsychotic treatment increases the risk of relapse, according to the study’s findings.
“While more research is needed to address these questions, the strong evidence supporting the benefits of antipsychotic medications should be made clear to patients and their families, while at the same time they should be used judiciously,” said Lieberman.