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Psychosis discovery a big leap forward
ANTIDEPRESSANTS could prevent the onset of schizophrenia if prescribed before the first
psychotic episode, a ground-breaking study by a Sydney researcher has found.
The research found that the brains of people who showed early signs of the disorder, such as impaired thinking or reduced social skills, had less of a protein which helps produce and maintain That protein - brain-derived neurotrophic factor - can be regulated by second-generation antidepressants, such as Prozac or Zoloft, preventing the development of full-blown psychosis which can cripple a sufferer's relationships and job prospects. Dr Cyndi Shannon-Weickert, the professorial chair of schizophrenia research at the Prince of Wales
Medical Research Institute, has spent five years studying the neurobiology of schizophrenia and is
excited by what could be the disorder's "first pharmacological change in treatment in 60 years". "This is exciting work because if we have prevented schizophrenia, we have cured it," she said.
Studies on prevention have focused on the prodrome, which is the phase of illness before psychosis.
During that time, which lasts between two and 10 years, people may show changes in the way they process information or deal with others, but not suffer from hallucinations or delusions. "They may be paying less attention at school, have less motivation or be withdrawing socially from their friends," Dr Shannon-Weickert said. It is that window of opportunity she wants doctors to seize, because if the prodromal phase is not recognised and treated, the person will eventually
suffer psychosis and be diagnosed with schizophrenia. Sufferers are usually treated with
antipsychotic medications after they experience their first psychotic episode, but the medications are not well-tolerated due to side effects such as weight gain, lethargy, constipation and blurred vision. In one study of 13 prodromal adolescents who became psychotic, 12 had gone off their medication for one month or longer. Antidepressants were better tolerated because their side effects were milder so the compliance rate was much higher, she said. In post-mortem studies, Dr Shannon-Weickert found the level of brain-derived neurotrophic factor in those on antidepressants was double that of those who were not. Brain-derived neurotrophic factor is found in the hippocampus, cortex and basal forebrain and is vital to learning, memory and higher thinking. Low levels have been linked with depression, obsessive-compulsive disorder, Alzheimer's disease, Huntington's disease and dementia. Mice born without brain-derived neurotrophic factor suffer developmental defects in the brain and the nervoussystem, and usually die soon after birth. "We now know we have this window where we can reverse this disorder so we really need to start focusing on early intervention," she said. "People at risk need to start taking antidepressants as Schizophrenia affects about 200,000 Australians. One in six will take their life.
"Within a decade I think we will see quite a paradigm shift with this disorder," Dr Shannon-Weickert
said. "It won't help the people who currently have schizophrenia, but it stop future generations


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