It’s important to monitor the metabolic effects of psychiatric medications

A column from Dr. Beecroft on this topic appeared in the May-June issue of Hospital and Physician Update. We’re reprinting it here in case you missed it.

Antipsychotic medications, along with antidepressants and mood stabilizers, have significant weight gain associated with them.

The newer medications are better than the first-generation drugs but still have this side effect. Second-generation antipsychotic medications, such as Zyprexa^® and Risperdal, have the most weight gain associated with them. Seroquel, Latuda^®, Abilify^® and Invega^® tend to cause a medium amount of weight gain, while Geodon has the least effect. In fact, some people actually lose weight while on Geodon.

Antidepressants

Antidepressants in the SSRI** class and SNRI** class also can contribute to weight gain. Wellbutrin, an atypical agent, has the least amount of weight gain associated with it; some people lose weight on it. Depakote and lithium have long been associated with weight gain. This side effect contributes to glucose intolerance and may lead to diabetes if unmonitored.

There is some evidence that metformin prevents the weight gain. Likewise, more recent information suggests semaglutide is an effective agent to assist in the prevention of metabolic syndrome and, ultimately, diabetes. Before prescribing any of these medications, doctors should discuss possible side effects with the patient and the role that diet and exercise can play in treating prediabetes.

Monitoring patients who are on antipsychotics or antidepressants

Monitoring for metabolic syndrome as outlined below is the standard of care when patients start on these medications. The American Diabetes Association suggests monitoring the following:

• Personal history (at baseline and annually)
• Weight (at baseline, 4 weeks, 8 weeks, 12 weeks, quarterly and annually)
• Waist circumference (at baseline, 12 weeks and annually)
• Blood pressure (at baseline, 12 weeks and annually)
• Fasting plasma glucose/A1c (at baseline, 12 weeks and annually)
• Fasting lipid profile (LDL, HDL, total cholesterol; at baseline, 12 weeks and annually)

If significant issues develop while the patient is on any of these medications, changing medications may be the best solution. Or if the medication (or medication combination) the patient is on is the only one that works, then treating the resulting metabolic issues aggressively may help enhance the patient’s quality of life and decrease adverse events in the future.

We encourage you to monitor the key areas outlined above, making them part of your follow-up routine with patients who are on these medications. It’s also important to help patients understand the importance of these measures and the role they play in keeping them well. 

**SSRI stands for selective serotonin reuptake inhibitors while SNRI stands for serotonin and norepinephrine reuptake inhibitors.

This content is for informational purposes only and is not intended to be medical advice. This information does not substitute for professional medical advice or a consultation with a healthcare professional.