Antipsychotics are drugs that can potentially induce important changes in the metabolism of some substances in our body. What are the consequences? We talk about it in this article.
These drugs can have very undesirable metabolic effects on your health, even managing to seriously endanger our lives. However, they are the mainstay of the treatment of psychoses, as they help both to control the symptoms of the acute psychotic episode and to prevent new ones from occurring.
A general rule of thumb when prescribing these drugs is to consider their side effects (Burchinski, 2023). This is because the therapeutic effect of each antipsychotic is substantially similar. Furthermore, since pharmacotherapy with antipsychotics is long and often lasts for years, a recent study aimed to analyze their metabolic effects.
Some metabolic effects of antipsychotics
One of the first metabolic effects is weight gain. This increase could be due to drug-induced changes in the way the body metabolizes cholesterol and triglycerides. This metabolic effect is called dyslipidemia. In addition, alterations in the normal balance of sugar or glucose in the blood also occur as a result of the alterations that occur in insulin.
This has been associated with risk elements of morbidity and death, such as cardiovascular disease. In particular, with heart attack and stroke. On the other hand, subjects who gain weight following pharmacotherapy experience a lower quality of life (Burchinski, 2023).
“There is evidence to support increased insulin resistance, hyperglycemia and diabetes mellitus in patients taking antipsychotics, which could shorten their life expectancy.”
-Benjamín Cortés-
Often these effects translate into a fact: the patient abandons the antipsychotic. As a result, the treatment stops working and the psychotic symptoms reappear. Thus, drugs such as risperidone or brexpiprazole induce increases of up to two kilograms per patient.
In this sense, drugs that have been associated with greater weight gain often induce more dramatic changes in normal lipid and glycemic profiles. Among the drugs that mostly produce these secondary metabolic effects we can mention chlorpromazine, olanzapine and ziprasidone (Burchinski, 2023).
This is typically labeled metabolic syndrome. This syndrome, in addition to the above, includes a predisposition to the development of thrombi and inflammation. The latter due to the effect of the antipsychotic on the blood increase of a protein known as C-reactive protein (Cortés, 2011). Thus, this syndrome was found in nearly 40 out of 100 patients receiving antipsychotic treatment.
“The emergence of metabolic syndrome is becoming a major public health problem of the 21st century, as it has been shown to increase the prevalence of cardiovascular disease three-fold.”
-Benjamín Cortés-
What do these metabolic effects translate into?
Current evidence indicates that for every kilogram gained from taking antipsychotics, the likelihood of developing cardiovascular disease increases by about three percentage points. In fact, the more marked the weight gain due to the antipsychotic, the more altered the lipid and glycemic profiles will be.
On the other hand, once the peak of weight gain occurs, it tends to level off. For example, in said study it is mentioned that men who took five or more milligrams of olanzapine per day gained nearly five kilograms after six weeks of treatment, and then stabilized and gained just under one and a half kilograms in the follow-up.
In other words, it appears that the metabolic effects of antipsychotics tend to normalize in the long term. In this sense, chlorpromazine may be the antipsychotic that produces the most spectacular weight gains. Furthermore, as we have outlined, it appears that the drugs that most destabilize patients’ weight are those that most interfere with glycemic and lipid profiles, which would indicate chlorpromazine as a drug with potential metabolic side effects.
More research is needed. Especially since it is known that there are other variables that depend on the person in assessing susceptibility to weight gain, such as diet, degree of activation or sedentary style, or the level of quality of medical care received by patients.
Therefore, psychiatry professionals are aware of all of the above and the new advances in research that are happening day by day. This is why they know how to recognize the warning signs and act accordingly so that the impact of the metabolic effects is as minimal as possible.
“Because schizophrenia is often a chronic disorder, these findings should be given more consideration than short-term data when selecting medications.”
-Angelica Burchinski-
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