Brain Volume vs Antipsychotics: Does Size Matter?

We've known for quite some time that there's a long list of side effects associated with taking antipsychotic medications, ranging from uncontrollable movements to diabetes and weight gain.  You can now add loss of brain volume to that list, at least in patients with schizophrenia.

In a study published this week, the authors followed 211 patients with schizophrenia who received on average 3 scans of their brains over the ensuing 7+ years of observation.  They concluded that those who were adherent with their antipsychotic regimen, especially larger doses for longer periods of time, had a notable loss of brain volume, compared to those who were less adherent.

But as the joke goes, does size matter?  We can't be too sure since the authors didn't include cognitive assessment in their study.  Given the option, I'd prefer to maintain my brain size.  What's worrisome to me is the increasing use of antipsychotics beyond schizophrenia and bipolar affective disorder.  New indications include depression unresponsive to traditional antidepressants alone while I've seen too often off-label use as a sedative-hypnotic to treat insomnia.  Even before this study, I wasn't convinced that this class of pharmaceuticals should be used for chronic insomnia.  Now, I'm even less inclined.