The Association between Conventional Antidepressants and the Metabolic Syndrome

McIntyre, Roger S.; Park, Ka Young; Law, Candy W. Y.; Sultan, Farah; Adams, Amanda; Lourenço, Maria Helena; Lo, Aaron; Soczynska, Joanna K.; Woldeyohannes, Hanna O.; Alsuwaidan, Mohammad; Yoon, Jinju; Kennedy, Sidney H.

doi:10.2165/11533280-000000000-00000

Cited by 83 publications

(76 citation statements)

References 160 publications

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“…The use of tricyclic antidepressants (TCA) has been associated with metabolic dysregulation, particularly abdominal obesity 10, 23. However, the effects of selective serotonin reuptake inhibitors (SSRIs) on metabolic syndrome components are less clear 24, 25, 26. For instance, SSRI use has been associated with weight gain, loss and no change, as well as both impaired and improved glucose and lipid profiles 23, 26.…”

Section: Introductionmentioning

confidence: 99%

Bidirectional Prospective Associations of Metabolic Syndrome Components With Depression, Anxiety, and Antidepressant Use

et al. 2016

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BackgroundMetabolic syndrome components—waist circumference, high‐density lipoprotein cholesterol (HDL‐C), triglycerides, systolic blood pressure and fasting glucose—are cross‐sectionally associated with depression and anxiety with differing strength. Few studies examine the relationships over time or whether antidepressants have independent effects.MethodsParticipants were from the Netherlands Study of Depression and Anxiety (NESDA; N = 2,776; 18–65 years; 66% female). At baseline, 2‐ and 6‐year follow‐up, participants completed diagnostic interviews, depression and anxiety symptom inventories, antidepressant use assessment, and measurements of the five metabolic syndrome components. Data were analyzed for the consistency of associations between psychopathology indicators and metabolic syndrome components across the three assessment waves, and whether psychopathology or antidepressant use at one assessment predicts metabolic dysregulation at the next and vice versa.ResultsConsistently across waves, psychopathology was associated with generally poorer values of metabolic syndrome components, particularly waist circumference and triglycerides. Stronger associations were observed for psychopathology symptom severity than diagnosis. Antidepressant use was independently associated with higher waist circumference, triglycerides and number of metabolic syndrome abnormalities, and lower HDL‐C. Symptom severity and antidepressant use were associated with subsequently increased number of abnormalities, waist circumference, and glucose after 2 but not 4 years. Conversely, there was little evidence that metabolic syndrome components were associated with subsequent psychopathology outcomes.ConclusionsSymptom severity and antidepressant use were independently associated with metabolic dysregulation consistently over time and also had negative consequences for short‐term metabolic health. This is of concern given the chronicity of depression and anxiety and prevalence of antidepressant treatment.

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Section: Introductionmentioning

confidence: 99%

Bidirectional Prospective Associations of Metabolic Syndrome Components With Depression, Anxiety, and Antidepressant Use

et al. 2016

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“…They are effective, yet current researches indicate that metabolic abnormalities (usually named as metabolic syndrome) may be more frequent in patients treated with antipsychotics (particularly of second-generation) comparing to general population [1]. However, this applies not only to antipsychotics, but also to mood stabilizers [2] and antidepressants [3], so these are common consequences for all major psychopharmacological drugs used nowadays. Therefore, patients with psychiatric disorders may have increased mortality resulting from increased risk of cardiovascular events (e.g.…”

Section: Introductionmentioning

confidence: 99%

Effect of metabolic abnormalities on cognitive performance and clinical symptoms in schizophrenia

Wysokiński¹,

Dzienniak²,

Kłoszewska³

2013

Arch Psych Psych

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SummaryAim. The objective of this study is to determine whether and how metabolic abnormalities are associated with clinical symptoms and cognitive performance in schizophrenia. Methods. 46 adult patients with schizophrenia taking first-or second generation antipsychotics were included in the study. The following data were collected: BMI, abdominal circumference, lipid panel and blood glucose, blood pressure and treatment of comorbidities. Clinical symptoms were assessed using PANSS, CDSS, CGI and SAS scales. Cognitive performance was assessed using CNS Vital Signs computerized battery of tests: Verbal Memory test, Visual Memory test, Finger Tapping Test, Symbol Digit Coding, Stroop Test, Shifting Attention Test, and Continuous Performance Test. Results. Dyslipidemia, raised LDL and raised blood glucose levels were the best predictors of more severe clinical symptoms (PANSS, PANSS P, PANSS G, CGI) and lower neurocognitive index, worse cognitive flexibility, executive functions, complex attention composite memory, verbal memory, slower reaction time and worse performance in SAT, CPT, ST tests. Obesity was associated with worse results in VBM, VIM, FTT, SDC tests. Raised blood pressure was associated with improvements in all cognitive domains and better performance in SAT, CPT, ST tests. Discussion. There are several weak associations between severity of clinical symptoms and metabolic abnormalities. Most of these were for blood glucose levels and raised blood glucose. Lipids and glucose abnormalities are the best predictors of deteriorated cognitive performance. Contrary to previous observations, raised blood pressure was associated with better results in cognitive tests. Conclusions. These findings indicate that cognitive impairment and metabolic abnormalities may be linked in patients with schizophrenia.

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“…Historically, weight changes have been a hallmark in the side effect profile of most antidepressant classes [59][60][61] . In the case of SSRIs, the specific agent used and the length of therapy may account for the very variable effects these drugs appear to have on body weight [59] .…”

Section: Obesitymentioning

confidence: 99%

“…These factors also appear to be involved in the pathophysiology of depression, and may account for the higher cardiovascular risk observed in this disorder [8,9] . In this context, the pharmacological management of depression presents a clinical conundrum: depression is accompanied by increased risk of MS -and by extension, CVD and DM2 -yet many antidepressant drugs appear to exacerbate these risks as well [10,11] . However, in contrast with antipsychotic drugs, whose clinical relevance in regards to deleterious cardiometabolic effects has been well-characterized [12,13] , the impact of antidepressant drugs in clinical outcomes remains less clear.…”

Section: Introductionmentioning

confidence: 99%

Metabolic risk in depression and treatment with selective serotonin reuptake inhibitors: are the metabolic syndrome and an increase in cardiovascular risk unavoidable?

Chávez-Castillo¹,

Ortega²,

Nava³

et al. 2018

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Depression is one of the most common psychiatric disorders, and has become an epidemic in modern medical practice; notorious for frequently co-occurring with multiple comorbidities, especially cardiovascular disease (CVD), type 2 diabetes mellitus (DM2), and its various risk factors comprised in the metabolic syndrome (MS). Selective serotonin reuptake inhibitors (SSRIs) are the most widely used class of psychotropic drugs in this and many other clinical scenarios; yet their impact on cardiometabolic health has not been elucidated. The objective of this review was to summarize current views on the pharmacology of SSRIs and cardiometabolic risk, as well as available epidemiological evidence regarding its clinical significance. SSRIs appear to intervene in cardiometabolic physiology fundamentally by modulating chronic inflammation, a key pathophysiologic phenomenon in MS, DM2 and CVD. However, the dosing necessary to achieve a beneficial impact in this regard, as well as their clinical correlations, remain controversial. Each SSRI displays a particular profile regarding each of the components of the MS: weight gain seems to be the most common effect of SSRIs, more frequent with paroxetine, followed by citalopram and escitalopram. As a drug class, SSRIs also appear to promote hypercholesterolemia rather uniformly, while fluoxetine and citalopram appear to particularly increase triacylglyceride levels. In contrast, fluvoxamine and paroxetine seem to have the greatest impact on dysglycemia. Lastly, most SSRIs appear to be innocuous or even beneficial regarding blood pressure and high-density lipoprotein cholesterol. Nevertheless, many of these effects may vary significantly upon specific clinical circumstances, especially timing. This topic remains rather unexplored in clinical psychopharmacology, and further, larger-scale epidemiological studies are needed in order to offer improved care in this field.

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The Association between Conventional Antidepressants and the Metabolic Syndrome

Cited by 83 publications

References 160 publications

Bidirectional Prospective Associations of Metabolic Syndrome Components With Depression, Anxiety, and Antidepressant Use

Bidirectional Prospective Associations of Metabolic Syndrome Components With Depression, Anxiety, and Antidepressant Use

Effect of metabolic abnormalities on cognitive performance and clinical symptoms in schizophrenia

Metabolic risk in depression and treatment with selective serotonin reuptake inhibitors: are the metabolic syndrome and an increase in cardiovascular risk unavoidable?

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