The Effects of Psychotropic Drugs on the Regulation of Glucose Metabolism

Abstract

Psychotropic drugs, like antipsychotics and antidepressants, are often associated with metabolic side effects such as weight gain and an increased risk of the development of diabetes and an atherogenic lipid profile. These adverse effects not only bear a high cardiovascular risk and lead to higher morbidity and mortality, but are an additional burden to mentally ill patients and can be a decisive factor for the compliance and, consequently, the success of the therapy. Second generation antipsychotics (SGAs), in particular, clozapine and olanzapine, lead to significant weight gain and impair glucose metabolism. Despite the availability of newer SGAs, such as aripiprazole, which are considered to be less prone to cause metabolic side effects, olanzapine is still one of the most prescribed SGAs worldwide. Antidepressant drugs may also induce weight again and diabetes even though the literature is contradictory, probably due to different receptor affinities. This review aims to provide an overview of the metabolic side effects caused by commonly used psychotropic drugs and give insight into underlying mechanisms.

A randomized, controlled trial of a stress management intervention for Latinos with type 2 diabetes delivered by community health workers: Outcomes for psychological wellbeing, glycemic control, and cortisol

“…In the U.S., those patients who do not speak English (or speak it as a second language) and those who lack adequate insurance for psychotherapy may be less likely to be prescribed non-pharmacological treatments. Pharmacotherapy may not be accepted by patients [27], nor properly implemented, and may cause side effects such as weight gain and problems with glucose and lipid metabolism [28] which are the very targets of medical management of diabetes. Finally, many patients who face significant life stressors and could benefit from intervention do not necessarily go on to develop a psychiatric disorder or need pharmacotherapy or treatment by a mental health provider per se.…”

Diabetes mellitus onset in geriatric patients: does long‐term atypical antipsychotic exposure increase risk?

“…Certain antidepressants, especially mirtazapine, have been associated with weight gain, an important risk factor for DM. 25 Similarly, depression itself has been previously shown to be linked with hyperglycemia. 26 However, it should be noted that in our main analysis, our patients had no previous or current exposure to hypoglycaemic medications whereas most studies look at diabetic patients, who may have had exposure to oral hypoglycemics.…”

“…Nonetheless, the finding that cholinesterase inhibitors, valproate, and antidepressants – including those other than mirtazapine – predict an increase in glucose levels over time is of potential concern to all physicians. Certain antidepressants, especially mirtazapine, have been associated with weight gain, an important risk factor for DM . Similarly, depression itself has been previously shown to be linked with hyperglycemia .…”

Andere spezifische Diabetesformen

“…4). Neben den aus den Endokrinopathien abzuleitenden Hormon-Präparaten sind in den letzten Jahren insbesondere die häufig mit einer sehr raschen und erheblichen Gewichtszunahme verbundenen atypischen Antipsychotika [7] zu erwähnen, aber auch die nach Organ-Transplantation zum Einsatz kommenden Immunsuppressiva [8]. Auch Statine wurden als Ursache für das vermehrte Auftreten von Diabetes identifiziert, das Risiko der Diabetes-Manifestation wird jedoch durch die benefiziellen Wirkungen der Statine bei Weitem überwogen [9].…”