Do antipsychotic drugs affect brain structure? A systematic and critical review of MRI findings

• Published in: Psychological medicine Vol. 39; no. 11; pp. 1763 - 1777
• Main Authors: Navari, S., Dazzan, P.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.11.2009
• Subjects: Anatomy & physiology; Antipsychotic Agents - adverse effects; Antipsychotic Agents - therapeutic use; Antipsychotic drugs; Basal Ganglia - drug effects; Basal Ganglia - pathology; Biological and medical sciences; Brain; Brain - drug effects; Brain - pathology; Brain structure; Cerebral Cortex - drug effects; Cerebral Cortex - pathology; Cortex; Cross-Sectional Studies; Dominance, Cerebral - drug effects; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug therapy; Gyrus Cinguli - drug effects; Gyrus Cinguli - pathology; Humans; Longitudinal Studies; Magnetic Resonance Imaging; Medical imaging; Medical sciences; Mesencephalon - drug effects; MRI; Neuropharmacology; Neuropsychology; Organ Size - drug effects; Pharmacology. Drug treatments; Psycholeptics: tranquillizer, neuroleptic; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Psychoses; psychosis; Psychotic Disorders - diagnosis; Psychotic Disorders - drug therapy; Psychotic Disorders - pathology; Psychotropic drugs; Reference Values; Schizophrenia; Schizophrenia - diagnosis; Schizophrenia - drug therapy; Schizophrenia - pathology; Subject headings; Systematic review; Thalamus - drug effects; Thalamus - pathology; Antipsychotic drugs; brain; MRI; psychosis; Human; Volumetric analysis; Cerebral cortex; Neuroleptic; Psychotropic; Central nervous system; Pharmacotherapy; Basal ganglion; Review; Nuclear magnetic resonance imaging; Encephalon; Psychosis; Treatment; Medical imagery; Critical study; Thalamus; Biological effect
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291709005315

The potential effects of antipsychotic drugs on brain structure represent a key factor in understanding neuroanatomical changes in psychosis. This review addresses two issues: (1) do antipsychotic medications induce changes in total or regional human brain volumes and (2) do such effects depend on antipsychotic type? A systematic review of studies reporting structural brain magnetic resonance imaging (MRI) measures: (1) directly in association with antipsychotic use; and (2) in patients receiving lifetime treatment with antipsychotics in comparison with drug-naive patients or healthy controls. We searched Medline and EMBASE databases using the medical subject heading terms: 'antipsychotics' AND 'brain' AND (MRI NOT functional). The search included studies published up to 31 January 2007. Wherever possible, we reported the effect size of the difference observed. Thirty-three studies met our inclusion criteria. The results suggest that antipsychotics act regionally rather than globally on the brain. These volumetric changes are of a greater magnitude in association with typical than with atypical antipsychotic use. Indeed, there is evidence of a specific effect of antipsychotic type on the basal ganglia, with typicals specifically increasing the volume of these structures. Differential effects of antipsychotic type may also be present on the thalamus and the cortex, but data on these and other brain areas are more equivocal. Antipsychotic treatment potentially contributes to the brain structural changes observed in psychosis. Future research should take into account these potential effects, and use adequate sample sizes, to allow improved interpretation of neuroimaging findings in these disorders.