Psychoactive drugs and metabolic disorders
DOI:
https://doi.org/10.25118/2763-9037.2023.v13.439Keywords:
psychotropics, drug-related side effects and adverse reactions, metabolic side effects of drugs and substancesAbstract
Objective: The objective of this article is to promote a literature revision and an overview of evidence of the metabolic impacts of the use of psychotropic drugs on metabolic alterations. Methods: A descriptive review, including articles in English and Portuguese, was conducted in the Google Scholar and PubMed databases, using the following keywords: body weight, dyslipidemia, metabolic syndrome and antipsychotics, mood stabilizers and antidepressants on PubMed, and dyslipidemia, body weight , metabolic syndrome associated with antipsychotics, mood stabilizers and antidepressants on Google Scholar. Results: 46 articles were analyzed and 46 articles were included. The review revealed a large amount of evidence concerning body weight changes under psychotropic drugs use and the impact of antipsychotics on the main metabolic variables. However, controversies and scanty evidence regarding mood stabilizers in glycemic and dyslipidemic alterations, and especially about antidepressants in metabolic alterations, were noticed. Conclusions: It is concluded that the impact of psychotropic drugs on metabolic changes has great clinical relevance and is characterized as a challenge for modern psychopharmacology. These alterations, seen as possible side effects of such drugs, directly affect the patient's quality and life expectancy, therefore, deserving attention for success in psychiatric treatment and in the holistic health context.
Downloads
Metrics
References
Gorenstein C, Scavone C. Avanços em psicofarmacologia: mecanismos de ação de psicofármacos hoje. Rev Bras Psiquiatr. 1999;21(1):64-73. https://doi.org/10.1590/S1516-44461999000100012
Thonnard-Neumann E. Phenothiazines and diabetes in hospitalized women. Am J Psychiatry. 1968;124(7):978-82. https://doi.org/10.1176/ajp.124.7.978 - PMid:5634402
Pedrero LA, Marti A. Effects of antidepressant and antipsychotic use on weight gain: a systematic review. 2019:1-11. https://doi.org/10.1111/obr.12934 - PMid:31524318
Malhi GS, Mitchell PB, Caterson I. "Why getting fat, Doc?" Weight gain and psychotropic medications. Aust N Z J Psychiatry. 2001;35(3):315-21. https://doi.org/10.1046/j.1440-1614.2001.00891.x - PMid:11437804
Garland EJ, Remick RA, Zis AP. Weight gain with antidepressants and lithium. J Clin Psychopharmacol. 1988;8(5):323-330. https://doi.org/10.1097/00004714-198810000-00003 PMid:3053797
Fava M. Weight gain and antidepressants. J Clin Psychiatry. 2000;61(Suppl)1:37-41. https://doi.org/10.4088/JCP.v61n1109 PMid:11105740
Schneider M, Pauwels P, Toto S, Bleich S, Grohmann R, Heinze M, Greiner T. Severe weight gain as an adverse drug reaction of psychotropics: data from the AMSP project between 2001 and 2016. Eur Neuropsychopharmacol. 2020;36:60-71. https://doi.org/10.1016/j.euroneuro.2020.05.001 - PMid:32536570
Zipursky RB, Gu H, Green AI, Perkins DO, Tohen MF, McEvoy JP, Strakowski SM, Sharma T, Kahn RS, Gur RE, Tollefson GD, Lieberman JA. Course and predictors of weight gain in people with first-episode psychosis treated with olanzapine or haloperidol. Br J Psychiatry. 2005;187:537-43. https://doi.org/10.1192/bjp.187.6.537 - PMid:16319406
Sachs G, Bowden C, Calabrese JR, Ketter T, Thompson T, White R, Bentley B. Effects of lamotrigine and lithium on body weight during maintenance treatment of bipolar I disorder. Bipolar Disord. 2006;8(2):175-81. https://doi.org/10.1111/j.1399-5618.2006.00308.x - PMid:16542188
Bond DJ, Kunz M, Torres IJ, Lam RW, Yatham LN. The association of weight gain with mood symptoms and functional outcomes following a first manic episode: prospective 12-month data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM). Bipolar Disord. 2010;12(6):616-26. https://doi.org/10.1111/j.1399-5618.2010.00855.x PMid:20868460
Abosi O, Lopes S, Schmitz S, Fiedorowicz JG. Cardiometabolic effects of psychotropic medications. Horm Mol Biol Clin Investig. 2018;36(1). https://doi.org/10.1515/hmbci-2017-0065 PMid:29320364 - PMCid:PMC6818518
Zimmermann U, Kraus T, Himmerich H, Schuld A, Pollmächer T. Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res. 2003;37(3):193-220. https://doi.org/10.1016/S0022-3956(03)00018-9 - PMid:12650740
Holt RIG, Peveler RC, Byrne CD. Schizophrenia, the metabolic syndrome and diabetes. Diabet Med. 2004;21(6):515-23. https://doi.org/10.1111/j.1464-5491.2004.01199.x PMid:15154933
Wirshing DA. Schizophrenia and obesity: impact of antipsychotic medications. J Clin Psychiatry. 2004;65(Suppl. 18):13-26. https://www.psychiatrist.com/read-pdf/18975/
McIntyre RS, Mancini DA, Basile VS, Srinivasan J, Kennedy SH. Antipsychotic-induced weight gain: bipolar disorder and leptin. J Clin Psychopharmacol. 2003;23(4):323-7. https://doi.org/10.1097/01.jcp.0000085403.08426.f4 PMid:12920406
Teixeira PJR, Rocha FL. Efeitos adversos metabólicos de antipsicóticos e estabilizadores de humor. Rev Psiquiatr do Rio Gd do Sul. 2006;28(2):186-96. https://doi.org/10.1590/S0101-81082006000200011
Arranz B, Rosel P, Ramírez N, Dueñas R, Fernández P, Sanchez JM, Navarro MA, San L. Insulin resistance and increased leptin concentrations in noncompliant schizophrenia patients but not in antipsychotic-naive first-episode schizophrenia patients. J Clin Psychiatry. 2004;65(10):1335-42. https://doi.org/10.4088/JCP.v65n1007 - PMid:15491236
Littrell KH, Petty RG, Hilligoss NM, Kirshner C, Johnson CG. The effect of aripiprazole on insulin resistance in schizophrenia. In: Proceedings of the 157th Annual Meeting of the American Psychiatric Association. New York: APA; 2004.
Vestergaard P, Schou M. Does long-term lithium treatment induce diabetes mellitus? Neuropsychobiology. 1987;17(3):130-2. https://doi.org/10.1159/000118351 - PMid:3683801
McIntyre RS, McElroy SL, Eudicone JM, Forbes RA, Carlson BX, Baker RA. A 52-week, double-blind evaluation of the metabolic effects of aripiprazole and lithium in bipolar I disorder. Prim Care Companion CNS Disord. 2011;13(6). https://doi.org/10.4088/PCC.11m01182
Raeder MB, Bjelland I, Emil Vollset S, Steen VM. Obejity, dyslipidemia, and diabetes with selective serotonin reuptake inhibitors: the Hordaland Health Study. J Clin Psychiatry. 2006;67(12):1974-82. https://doi.org/10.4088/JCP.v67n1219 PMid:17194277
Ijaz S, Bolea B, Davies S, Savović J, Richards A, Sullivan S, Moran P. Antipsychotic polypharmacy and metabolic syndrome in schizophrenia: a review of systematic reviews. BMC Psychiatry. 2018;18(1):275. https://doi.org/10.1176/appi.focus.18307 PMid:33343261 - PMCid:PMC7725149
Monteleone P, Martiadis V, Maj M. Management of Schizophrenia with obesity, metabolic, and endocrinological disorders. Psychiatr Clin North Am. 2009;32(4):775-94. https://dx.doi.org/10.1016/j.psc.2009.08.003 - PMid:19944883
Galling B, Roldán A, Rietschel L, Hagi K, Walyzada F, Zheng W, Cao X-L, Xiang Y-T, Kane JM, Correll CU. Safety and tolerability of antipsychotic co-treatment in patients with schizophrenia: results from a systematic review and meta-analysis of randomized controlled trials. Expert Opin Drug Saf. 2016;15(5):591-612. https://doi.org/10.1517/14740338.2016.1165668 - PMid:26967126
Mizuno Y, Suzuki T, Nakagawa A, Yoshida K, Mimura M, Fleischhacker WW, Uchida H. Pharmacological strategies to counteract antipsychotic-induced weight gain and metabolic adverse effects in schizophrenia: a systematic review and meta-analysis. Schizophr Bull. 2014;40(6):1385-403. https://doi.org/10.1093/schbul/sbu030 PMid:24636967 PMCid:PMC4193713
Ardizzone TD, Bradley RJ, Freeman AM 3rd, Dwyer DS. Inhibition of glucose transport in PC12 cells by the atypical antipsychotic drugs risperidone and clozapine, and structural analogs of clozapine. Brain Res. 2001;923(1-2):82-90. https://doi.org/10.1016/S0006-8993(01)03026-8 - PMid:11743975
Gallego JA, Nielsen J, De Hert M, Kane JM, Correll CU. Safety and tolerability of antipsychotic polypharmacy. Expert Opin Drug Saf. 2012;11(4):527-42. https://doi.org/10.1517/14740338.2012.683523 PMid:22563628 PMCid:PMC3384511
Srisurapanont M, Suttajit S, Maneeton N, Maneeton B. Efficacy and safety of aripiprazole augmentation of clozapine in schizophrenia: a systematic review and meta-analysis of randomized-controlled trials. J Psychiatr Res. 2015;62:38-47. https://doi.org/10.1016/j.jpsychires.2015.01.004 - PMid:25619176
Heldenberg D, Harel S, Holtzman M, Levtow O, Tamir I. The effect of chronic anticonvulsant therapy on serum lipids and lipoproteins in epileptic children. Neurology. 1983;33(4):510. https://doi.org/10.1212/WNL.33.4.510 - PMid:6403892
Bowden CL, Mosolov S, Hranov L, Chen E, Habil H, Kongsakon R, Manfredi R, Hsin-Nanh L. Efficacy of valproate versus lithium in mania or mixed mania: a randomized, open 12-week trial. Int Clin Psychopharmacol. 2010;25(2):60-7. https://doi.org/10.1097/YIC.0b013e328333ac1b - PMid:20101186
Carman CL, Leung NM, Gnberman AH. Weight gain in epileptic patients during treatment with valproic acid: a retrospective study. Can J Neurol Sci. 1997;24(3):240-4. https://doi.org/10.1017/S0317167100021879 - PMid:9276111
Verrotti A, D'Egidio C, Mohn A, Coppola G, Chiarelli F. Weight gain following treatment with valproic acid: pathogenetic mechanisms and clinical implications. Obes Rev. 2011;12(5):e32-e43. https://doi.org/10.1111/j.1467-789X.2010.00800.x PMid:20880119
Franzoni E, Govoni M, D'Addato S, Gualandi S, Sangiorgi Z, Descovich GC, Salvioli GP. Total cholesterol, high‐density lipoprotein cholesterol, and triglycerides in children receiving antiepileptic drugs. Epilepsia. 1992;33(5):932-5. https://doi.org/10.1111/j.1528-1157.1992.tb02203.x PMid:1396438
Mahmoudi-Gharaei J, Shahrivar Z, Faghihi T, Mohammadi MR, Tehrani-Doost M, Alaghband-Rad J, Ghaeli P. Topiramate versus valproate sodium as adjunctive therapies to a combination of lithium and risperidone for adolescents with bipolar I disorder: effects on weight and serum lipid profiles. Iran J Psychiatry. 2012;7(1):1-10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395968/
Mackle M, Kocsis J. Effects on body weight of the SSRI citalopram. In: 37th annual meeting of the American College of Neuropsychopharmacology. 1998.
Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010;71(10):1259-72. https://doi.org/10.4088/JCP.09r05346blu PMid:21062615
Michelson D, Amsterdam JD, Quitkin FM, Reimherr FW, Rosenbaum JF, Zajecka J, Sundell KL, Kim Y, Beasley Jr CM. Changes in weight during a 1-year trial of fluoxetine. Am J Psychiatry. 1999;156(8):1170-6. https://doi.org/10.1176/ajp.156.8.1170 - PMid:10450256
Aronne LJ, Segal KR. Weight gain in the treatment of mood disorders. J Clin Psychiatry. 2003;64(Suppl 8):22-9. - PMID:12892538
Li H, Fang M, Xu M, Li S, Du J, Li W, Chen H. Chronic olanzapine treatment induces disorders of plasma fatty acid profile in Balb/c Mice: a potential mechanism for olanzapine-induced insulin resistance. PLoS One. 2016;11(12):e0167930. https://doi.org/10.1371/journal.pone.0167930 PMid:27973621 - PMCid:PMC5156395
Eker ÖO, Özsoy S, Eker B, Doğan H. Metabolic effects of antidepressant treatment. 2017;(10):49-56. https://doi.org/10.5152/npa.2016.12373 - PMid:28566959 - PMCid:PMC5439472
Gramaglia C, Gambaro E, Bartolomei G, Camera P, Chiarelli-serra M, Lorenzini L, Zeppegno P. Increased risk of metabolic syndrome in antidepressants users: a mini review. Front. Psychiatry. Sec. Psychological Therapy and Psychosomatics. 2018;9. https://doi.org/10.3389/fpsyt.2018.00621 PMid:30546325 - PMCid:PMC6279880
Allison DB, Mentore JL, Heo M, Chandler LP, Cappelleri JC, Infante MC, Weiden PJ. Antipsychotic-induced weight gain: a comprehensive research synthesis. 1999;156(11):1686-1696. https://doi.org/10.1176/ajp.156.11.1686 - PMid:10553730
CORDÁS TA, KACHANI AT. Nutrição em Psiquiatria. Barueri: MNOLE; 2005. 415 p.
Second-generation NJ. Second-generation (atypical) antipsychotics and metabolic effects: a comprehensive literature review. CNS Drugs. 2005;19(Suppl. 1):1-93. https://doi.org/10.2165/00023210-200519001-00001 - PMid:15998156
Elman I, Goldstein DS, Eisenhofer G, Folio J, Malhotra AK, Adler CM, Pickar D, Breier A. Mechanism of peripheral noradrenergic stimulation by clozapine. Neuropsychopharmacol. 1999;20(1):29-34. https://doi.org/10.1016/S0893-133X(98)00047-5 PMid:9885782
Correll CU, Agarwal V, De Hert M, Manu P P, Cohen D, Nielsen J. Selective effects of individual antipsychotic cotreatments on cardiometabolic and hormonal risk status: results from a systematic review and meta-analysis. Schizophrenia Bulletin. U.S. Dept. of Health, Education and Welfare, Public Health Service, Alcohol, Drug Abuse and Mental Health Administration; 2013. lirias1768552. https://kuleuven.limo.libis.be/discovery/fulldisplay?docid=lirias1768552&context=SearchWebhook&vid=32KUL_KUL:Lirias&lang=en&search_scope=lirias_profile&adaptor=SearchWebhook&tab=LIRIAS&query=any,contains,lirias1768552&offset=0
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Tainá Patrícia Teixeira Bezerra, Alba Inêz Celestino Rezende Fabrício, Alfredo José Minervino, Roberto Mendes dos Santos
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Debates em Psiquiatria allows the author (s) to keep their copyrights unrestricted. Allows the author (s) to retain their publication rights without restriction. Authors should ensure that the article is an original work without fabrication, fraud or plagiarism; does not infringe any copyright or right of ownership of any third party. Authors should also ensure that each one complies with the authorship requirements as recommended by the ICMJE and understand that if the article or part of it is flawed or fraudulent, each author shares responsibility.
Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) - Debates em Psiquiatria is governed by the licencse CC-By-NC
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material
The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes.
No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
