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LD-AGE DEPRESSION IS WIDEspread, affecting at least 1 in 6 patients in general medical practice and an even higher percentage in hospitals and nursing homes. 1-3 Depression, especially in later life, has serious health consequences, including increased health care costs, 4 increased mortality related to suicide 5 and medical illness, 6,7 and amplification of disability associated with medical and cognitive disorders. 8 A recent study by the World Health Organization concluded that unipolar major depression and suicide accounted for 5.1% of the total global burden of disease in 1990, making depression the fourth most important cause of global burden of disability. 9 The study also showed that the significance of illness burden attributable to depression increases with age weighting and is projected to grow further by the year 2020, based on demographic shifts toward a greater proportion of aging adults in the population, especially of the very old.

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It is unclear to what degree antipsychotic therapy confounds longitudinal imaging studies and post-mortem studies of subjects with schizophrenia. To investigate this problem, we developed a non-human primate model of chronic antipsychotic exposure. Three groups of six macaque monkeys each were exposed to oral haloperidol, olanzapine or sham for a 17-27 month period. The resulting plasma drug levels were comparable to those seen in subjects with schizophrenia treated with these medications. After the exposure, we observed an 8-11% reduction in mean fresh brain weights as well as left cerebrum fresh weights and volumes in both drug-treated groups compared to sham animals. The differences were observed across all major brain regions (frontal, parietal, temporal, occipital, and cerebellum), but appeared most robust in the frontal and parietal regions. Stereological analysis of the parietal region using Cavalieri's principle revealed similar volume reductions in both gray and white matter. In addition, we assessed the subsequent tissue shrinkage due to standard histological processing and found no evidence of differential shrinkage due to drug exposure. However, we observed a pronounced general shrinkage effect of B20% and a highly significant variation in shrinkage across brain regions. In conclusion, chronic exposure of non-human primates to antipsychotics was associated with reduced brain volume. Antipsychotic medication may confound post-mortem studies and longitudinal imaging studies of subjects with schizophrenia that depend upon volumetric measures.