Metabolic side effects of psychopharmacotherapy - well known, but well considered?

Study outline Introduction:

Obesity and medication-induced or -aggravated weight gain are common problems in the context of psychopharmacological treatment. Drugs with a variety of indications, anti-depressants, mood stabiliser as well as antipsychotics, are associated with changes in appetite regulation, additionally, some therapeutics directly lead to alterations of metabolism [1]. Moreover, severe psychiatric disorders are often accompanied by a substantial energy loss resulting in a decrease of physical activity and daily movement, which is aggravated by the sedating and anxiolytic effect of some drugs. Often, these side effects of psychopharmacotherapy lead to a relevant weight gain throughout the treatment with considerable impact on patients’ somatic and mental health condition. Considering the consequence of weight gain for potential comorbidities like diabetes mellitus or cardiovascular diseases, the implications for treatment compliance [2] and the risk of social stigmatisation due to obesity [3], the risk of weight gain should be considered carefully and individually during psychopharmacotherapeutic treatment.

Study aims:

Our study aims at investigating how the prevalence of obesity has developed within the group of inpatients suffering from severe mental illnesses during the analysed period of time. Moreover, we intend to examine to what extent the prevalence of obesity within the study group suffering from severe mental illnesses has increased more strongly than the prevalence of obesity in a comparison group with other less sever psychiatric illnesses. In addition, the study will evaluate whether patients with comorbid obesity receive psychopharmacological treatment that has either favourable or unfavourable effects on further weight development and whether pharmacological co-therapeutics for weight regulation are used to manage weight gain induced or enhanced by psychopharmacotherapy.

Methods:

We currently conduct descriptive analyses using data from the multi-centre drug safety project Pharmaco-Epidemiology and Vigilance (Pharmako-EpiVig), a semi-annual and cross-sectional evaluation of inpatients of up to 25 Bavarian psychiatric hospitals, with a data collection period from 2013 to 2024. Biometrical data, comorbid metabolic disorders like diabetes mellitus and psychopharmacological as well as further pharmacological treatment of patients with severe mental illnesses (including severe episodes of depressive disorders with and without psychotic symptoms, bipolar affective disorders as well as schizophrenic and schizoaffective disorders) are evaluated and psychopharmacological treatment is analysed according to the associated risk of weight gain. Additionally, the concurrent use of co-therapeutics with a favourable impact on weight development is assessed.

Results:

Currently, statistical analyses of the collected data are ongoing and will be presented at the conference. The results of our study are expected shortly.

Conclusion:

Considering side effects of the psychopharmacological treatment on body weight and metabolic health is crucial to optimise treatment outcome and reduce the health burden for patients affected by severe mental illnesses. Broad and practice-focused research is needed to outline the current clinical standart and improve the psychopharmacological treatment of severely ill patients.

References

1. Yang, Y., Wu, R., 2025. Atypical antipsychotic drugs cause abnormal glucose and lipid metabolism independent of weight gain. European Archives of Psychiatry and Clinical Neuroscience. Vol. 275(3):619-627.
2. Weiden, P., Mackell, J., McDonnell, D., 2004. Obesity as a risk factor for antipsychotic noncompliance. Schizophrenia Research. Vol. 66(1):51-57.
3. Westbury, S., Oyebode, O., van Rens, T., Barber, T., 2023. Obesity Stigma: Causes, Consequences, and Potential Solutions. Current Obesity Reports. Vol. 12(1):10-23.