By Antipsychotics are drugs with the potential to induce really important changes in the metabolism of different substances in our body. Now, what are their consequences? In this article we will tell you!
These drugs can have very undesirable effects on health, and can even be life-threatening. However, they are the core of the treatment of psychosis, as they help both to control the symptoms of the acute psychotic episode and to prevent new ones from occurring.
A general rule when prescribing these drugs is to consider their side effects (Burchinski, 2023). This is because the therapeutic effect of each antipsychotic is, in general terms, similar. Furthermore, since pharmacotherapy with antipsychotics is long and often lasts for years, a recent study has sought to analyze their metabolic effects.
Some metabolic effects of antipsychotics
One of the first metabolic effects is weight gain. This increase may 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 factors for morbidity and death, such as cardiovascular disease, in particular heart attack and stroke . Furthermore, subjects with increased weight as a result of pharmacotherapy experience a lower quality of life (Burchinski, 2023).
“There is evidence supporting increased insulin resistance, hyperglycemia and diabetes mellitus in patients taking antipsychotics, which could reduce their life expectancy.”
-Benjamin Cortes-
These effects often result in the patient discontinuing the antipsychotic. As a result, the treatment stops working and psychotic symptoms reappear. Drugs such as risperidone or brexpiprazole can lead to weight gains of up to two kilograms per patient.
In this regard, drugs that have been associated with a greater increase in weight often induce more intense changes in the usual lipid and glucose profiles. Among the drugs that most produce these metabolic side effects we can mention chlorpromazine, olanzapine and ziprasidone (Burchinski, 2023).
This is usually labelled as metabolic syndrome . This syndrome, in addition to the above, includes a predisposition to the development of blood clots and inflammation. The latter is due to the effect of the antipsychotic on the increase in blood levels of a protein known as C-reactive protein (Cortés, 2011). Thus, this syndrome has been found in almost 40 out of every 100 patients undergoing antipsychotic treatment.
«The emergence of metabolic syndrome is becoming one of the main public health problems of the 21st century, as it has been shown to increase the prevalence of cardiovascular disease by three times.»
-Benjamin Cortes-
What do these metabolic changes translate into?
Current evidence suggests that for every kilogram gained as a result of taking antipsychotics, the likelihood of developing cardiovascular disease increases by about three percentage points. In fact, the more pronounced the weight gain as a result of taking antipsychotics, the more altered the lipid and glucose profiles will be.
On the other hand, once the peak in weight gain occurs , it tends to stabilize. For example, the study mentions that men who took five or more milligrams of olanzapine daily gained almost five kilograms after six weeks of treatment, and then stabilized and gained just under one and a half kilograms during follow-up.
That is, it seems that the metabolic effects of antipsychotics tend to normalize in the long term . In this sense, chlorpromazine could be the antipsychotic that produces the most spectacular weight gains. Furthermore, as we have noted, it seems that the drugs that most destabilize the weight of patients are those that most interfere with glucose and lipid profiles, which would point to chlorpromazine as a drug with potential metabolic side effects.
More research is needed , especially since it is well known that there are other variables that depend on the person when assessing susceptibility to weight gain, such as diet, level of activity or sedentary lifestyle, or the level of quality of medical care that patients receive.
Psychiatry professionals are therefore aware of all of the above and of the new advances in research that occur every day. Therefore, they know how to recognise the warning signs and act accordingly so that the impact of metabolic effects is as small as possible.
-Angelica Burchinski-
“Since schizophrenia is often a chronic disorder, these findings should be considered more than short-term data when choosing drugs.”