Metabolic side effects of antipsychotic medication

Abstract

The use of second-generation antipsychotics (SGAs) is associated with metabolic side effects including weight gain, diabetes mellitus and an atherogenic lipid profile. These adverse effects are not only the risk factors for cardiovascular disease, insulin resistance and diabetes mellitus leading to increased morbidity and mortality but may also impair the patient's adherence to treatment. SGAs in particular are associated with significant weight gain with clozapine and olanzapine carrying the highest risk, whereas newer agents, such as risperidone and aripiprazole, are considered to be less prone to cause weight gain. Consequently, a consensus development conference convened issuing recommendations on patient monitoring when treated with SGAs. The metabolic effects of antipsychotic drugs should be of concern when planning a patient's treatment strategy. Baseline screening and regular follow-up monitoring whose intervals should depend on the individual predisposition are advised. Possible therapeutical strategies for the management of drug-induced obesity include therapeutic approaches, such as life style change and pharmaceutical intervention. Drugs with a weight reducing effect become more important because of the lack of compliance with behavioural intervention. Topiramate, histamine-antagonists, dopaminergic- and serotoninergic agents have shown positive results in the management of psychotropic medication induced weight gain. However, further trials are required to support a specific therapeutical approach as well as studies to investigate the underlying mechanisms for future drug development.

Association between Short Sleep Duration and High Incidence of Metabolic Syndrome in Midlife Women

“…Some medications (e.g. antipsychotic drugs, glucocorticoids) have metabolic effects (on weight gain, lipid abnormalities, and glucose metabolism) (Tschoner et al 2007), and some medications (e.g. sleep medication and antidepressant drugs) have been shown to interfere with sleep characteristics (particularly sleep architecture) (Foral et al 2011).…”

A cross-sectional evaluation of adiponectin plasma levels in patients with schizophrenia and schizoaffective disorder

“…An emerging literature suggests an association of certain antipsychotics with the development of metabolic abnormalities (Allison and Casey, 2001 ;Jin et al, 2004;Dufresne, 2007;Meyer and Koro, 2004;Newcomer, 2005Newcomer, , 2007a. These metabolic abnormalities may in turn contribute to the higher risk of cardiovascular disease in patients with schizophrenia (Casey, 2005;De Nayer et al, 2005;Haupt and Newcomer, 2001;Hennekens et al, 2005;Jin et al, 2002Jin et al, , 2004Newcomer, 2005;Newcomer, 2007a;De Hert, 2005, 2007;Tschoner et al, 2007). However, the mechanism underlying antipsychotic-induced metabolic dysregulation is still unclear.…”

Metabolic, endocrinologic and cardiac effects of amisulpride: a 24-week follow-up study

“…There are very few data available on metabolic effects of amisulpride. Recent reviews concluded that amisulpride is associated with minimal weight change, ranging between 0.2 and 1.4 kg over varying treatment durations [Russell and Mackell, 2001;Tschoner et al 2007]. Amisulpride appears to have less risk of treatmentemergent dyslipidemia in compari son with olanzapine and clozapine [Newcomer, 2005;Rettenbacher et al 2007].…”