Do antipsychotics do more good than harm?

According to an international group of experts, the benefits of antipsychotic medications outweigh the risks.

The experts concluded that, for the patients with schizophrenia and related psychotic disorders, antipsychotic medications do not have negative long-term effects on patients' outcomes or the brain. In addition, the benefits of these medications are much greater than their potential side effects.

Jeffrey Lieberman, Lawrence C. Kolb from the Columbia University College of Physicians and Surgeon and colleagues from institutions in the United States, Germany, The Netherlands, Austria, Japan, and China 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.

Lieberman noted that the evidence from randomized clinical trials and neuroimaging studies overwhelmingly suggested 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. Moreover, whatever side effects that these medications might cause are greatly outweighed by their therapeutic benefits.

"Anyone who doubts this conclusion should talk with people whose symptoms have been relieved by treatment and literally given back their lives," Lieberman 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."

And while preclinical studies in rodents suggested that antipsychotic medications can sensitize dopamine receptors, there is no evidence that antipsychotic treatment increases the risk of relapse. While antipsychotic medications can increase the risk for metabolic syndrome, which is linked to heart disease, diabetes, and stroke, the study did not include a risk-benefit analysis.

"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," continued Lieberman.

These findings are published in the American Journal of Psychiatry.