Mental disorders, such as schizophrenia and bipolar disorder, often necessitate lifelong treatment with antipsychotic drugs, which, while alleviating symptoms, can lead to adverse side effects including metabolic syndrome, type II diabetes and cardiovascular disease. These conditions are closely tied to oxidative stress, which is prevalent in patients with schizophrenia. This study investigated the effects of atypical antipsychotics, aripiprazole (ARI) and olanzapine (OLA), under oxidative stress conditions. We aimed to assess both, the protective and harmful effects of these drugs, focusing on cell viability, apoptotic activity and oxidative stress responses in Fao rat hepatoma cell line, which enables continuous treatment with the drugs. Cells were treated with therapeutically relevant concentrations of ARI and OLA and exposed to oxidative stress via H2O2. We assessed a moderate and severe effect of oxidative stress through two H2O2 concentrations and our findings revealed contrasting effects of ARI and OLA under these conditions. ARI-treated cells exhibited dose-dependent improved survival rates under oxidative stress conditions compared to OLA- treated cells, which exhibited increased vulnerability. ARI also induced a significant antioxidative enzyme response and autophagy, implying a protective role against oxidative damage. However, ARI induced mitochondrial oxidative stress and displayed blunted stress signaling and apoptotic activity, whereas OLA exhibited reduced cell viability in severe oxidative stress conditions but heightened sensitivity to stress activating pathways like MAPK and STAT3, as well as inducing increased proteasomal activity in severe stress conditions. These findings highlight the differential cellular responses to ARI and OLA, underlining the importance of personalized treatment strategies to mitigate side effects while optimizing therapeutic benefits. In addition, our findings highlight the importance of using repeatedly-treated cell models to observe the steady state of antipsychotics and the need for careful monitoring of long-term ARI treatment due to potential pathological outcomes.
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