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

Published online by Cambridge University Press:  02 April 2009

S. Navari  and
P. Dazzan
S. Navari*
Affiliation:
Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, UK Section of Psychiatry, Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Italy
P. Dazzan
Affiliation:
Division of Psychological Medicine and Psychiatry, Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: S. Navari, M.D., Ph.D., Psychiatrist and Research Associate, Division of Psychological Medicine and Psychiatry, PO Box 63, Institute of Psychiatry, De Crespigny Park, LondonSE 8AF, UK. (Email: [email protected])
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Abstract

Background

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?

Method

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.

Results

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.

Conclusions

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.

Keywords

Antipsychotic drugsbrainMRIpsychosis
Type
Review Article
Information
Psychological Medicine , Volume 39 , Issue 11 , November 2009 , pp. 1763 - 1777
Copyright
Copyright © Cambridge University Press 2009

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