How anti-psychotics affect your metabolism

Patients who present with psychotic symptoms (e.g. as in those with schizophrenia and bipolar disorder) are usually prescribed with anti-psychotic drugs. These drugs are mostly effective in controlling the symptoms. However, they come with side effects that can be detrimental to physical health.

Previous studies have demonstrated that second generation anti-psychotic drugs can affect glucose and lipid metabolism, leading to problems with body weight and cardiovascular disorders. It is not wonder that the American Diabetes Association (ADA) has recommended monitoring of blood sugar and lipid levels in patients on anti-psychotics.

However, a study survey discovered that actual metabolic monitoring only occurs in about 10% of these patients, a clear indication that the guidelines on monitoring are not being followed by psychiatrists.

According to lead author Dr Dan W Haupt of the Washington University School of Medicine, St Louis, MO

“Possibly many psychiatrists do not feel comfortable performing metabolic monitoring, because they were not trained to consider the effects of mental illness and treatment on the whole patient, and many practice in environments that are physically separated from the rest of the healthcare system… However, this represents a missed opportunity for psychiatrists to reduce the impact of medical comorbidities in their patients”

The said guidelines were endorsed by 4 medical organizations in 2004, namely:

the ADA
the American Psychiatric Association
the American Association of Clinical Endocrinologists
the North American Association for the Study of Obesity

and strongly recommend that all patients receiving second-generation antipsychotics should have fasting blood glucose and lipid levels determined at baseline and after 12 weeks of treatment.

Unfortunately, the study reveals that there is a general tendency among practitioners not to adapt the guidelines. Furthermore, young psychotic patients are the least likely to be screened and monitored.

This is an issue of major concern, considering the increasing incidence of psychotic disorders in adolescents and young adults. In addition, young American patients tended to be on anti-psychotics than their European counterparts. This increases the risks for cardiovascular disease, type 2 diabetes and obesity among the younger generation.

Dr. Haupt continues:

“While the benefit of these medications likely outweighs the risks in many individuals, psychiatrists cannot discuss informed consent meaningfully with patients and families without monitoring patients for any treatment-emergent metabolic side effects.”

Second generation anti-psychotics are helping people manage mental illness. Without proper metabolic monitoring, we may be treating mental illness at the expense of physical health.

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