Long-term effects of antipsychotics

What are the possible long-term effects of antipsychotics?

Antipsychotics can effectively reduce the impact of psychotic disorders in many people’s lives, but there is a body of evidence cautioning against the long-term effects of antipsychotic use. These include:

Metabolic syndrome

Some antipsychotic medications are associated with weight gain, changes in blood sugar levels, and increased risk of metabolic conditions like high blood pressure and high cholesterol. ^[2] Metabolic syndrome is the medical term for a combination of some or all these symptoms. ^[2]

If you are diagnosed with metabolic syndrome, you are more likely to develop diabetes, heart disease, or suffer a stroke. ^[2]

Neurodevelopmental issues

While antipsychotics aim to improve cognitive functioning in patients, there is some evidence suggesting that long-term use might have a stunting impact on their brains.

In 2005, a study with macaque monkeys showed that antipsychotics reduced brain matters by roughly 10% over 18 months of treatment. ^[3] Another study carried out on humans in 2010 also indicated that antipsychotics reduced brain matter. It is unclear whether this structural reduction within the brain correlates with a decrease in intellectual capacity, with studies divided on the matter. ^[3]

Tardive dyskinesia

Some antipsychotics, particularly first-generation or typical antipsychotics, can lead to movement disorders such as tardive dyskinesia (TD). ^[4]

Tardive dyskinesia (TD) refers to involuntary, repetitive body movements and is commonly presented by patients who are on long-term treatment with antipsychotics, with 20%-50% of long-term patients affected. ^[4]

TD is often irreversible, and patients can present symptoms long after they’ve stopped using the medication. If you have concerns about TD, consult your doctor for further information. Healthcare providers are responsible for educating themselves and others on the risks associated with antipsychotics and ensuring patients are kept up to date regarding medical developments on the matter. ^[4]

Cardiovascular complications

Some antipsychotics have been linked to an increased risk of cardiovascular issues, including irregular heartbeats and an increased risk of heart disease.

Certain antipsychotics can prolong the QT interval, which is a measure of the electrical activity of the heart. Prolonged QT intervals can lead to potentially life-threatening arrhythmias, such as torsades de pointes. ^[5]

Long-term antipsychotic use, particularly in higher doses, has been associated with an increased risk of sudden cardiac death, especially in older adults and those with pre-existing cardiovascular conditions. ^[5]

It is worth noting that many atypical antipsychotics have side effects which are known to exacerbate cardiovascular problems. Weight gain, blood sugar spikes, and higher cholesterol are all adversely affected by antipsychotic use, further compounding the cardiovascular complications related to their long-term use. ^[5]

Quality of life and social functioning potentially impaired

Whilst antipsychotics can improve symptoms in people suffering from psychotic disorders in the short-term, there is evidence that long-term use may impair their social functioning.

Some people may experience emotional blunting, reduced motivation, and social withdrawal. Other adverse effects such as akathisia (chronic restlessness) may further impair a person’s quality of life. ^[6]

Hormonal effects

One of the most common hormonal effects of antipsychotic medications, particularly first-generation (typical) antipsychotics and some second-generation (atypical) antipsychotics, is an elevation in prolactin levels.

Prolactin is a hormone responsible for milk production in pregnant and breastfeeding women. Increased prolactin levels can lead to a condition called hyperprolactinemia, which can cause symptoms like irregular menstrual periods, breast enlargement (gynecomastia) in males, and decreased sexual desire. ^[7]

Sexual dysfunction

Sexual dysfunction is a common side effect of long-term antipsychotic use. Antipsychotic medications can interfere with the normal functioning of sex hormones, such as estrogen and testosterone. This can lead to changes in sexual desire, menstrual irregularities in females, and sexual dysfunction. ^{[6] [7]}

Risperidone, haloperidol, and olanzapine are considered the antipsychotics most likely to cause sexual dysfunction in patients. ^[8] These medicines are often associated with erectile dysfunction and ejaculatory issues in men; menstrual irregularities, decreased vaginal lubrication and amenorrhea in women. ^[8]

Clozapine, quetiaptine, and aripiprazole are all reported to have a lower impact on sexual dysfunction ^[8]. Although, more research is needed in this area and these medications may still cause erectile and ejaculatory issues in men. ^[8]

What to ask your doctor about long-term antipsychotic use

When discussing the long-term effects of taking antipsychotic medications with your doctor, it's important to ask informed and comprehensive questions to ensure you have a clear understanding of the potential risks and benefits. Here are 10 questions you might consider asking:

1. What are the potential long-term effects of the antipsychotic medication I'm taking?
2. What are the most common long-term effects and how long will they last?
3. Will I be taking this medication for the rest of my life?
4. Are there any food, drinks, supplements,or other drugs that I should abstain from when taking this drug?
5. How common are these long-term effects, and who is most at risk for experiencing them?
6. Are there any specific monitoring or tests I should undergo to track potential long-term effects?
7. What strategies can I use to minimize or manage the potential side effects associated with long-term use?
8. Are there any lifestyle changes I can make to reduce the risk of long-term side effects?
9. Is it possible to periodically review or reassess my medication regimen to ensure it's still the most appropriate option for me?
10. How does my medical history, family history, and current health status affect the potential for long-term effects?

Remember that your doctor is there to provide you with the information you need to make informed decisions about your healthcare. Be open about your concerns and preferences, and don't hesitate to ask for clarification if you don't understand something.

Final thoughts

Antipsychotic medication can prove invaluable in the management of your psychotic disorder, but it’s important to weigh up the risks versus the benefits.

It's crucial for individuals taking antipsychotic medications to work closely with their healthcare providers to monitor and manage potential long-term effects. Regular check-ups, open communication, and mutual decision-making are essential for finding the right balance between symptom management and minimizing side effects.