Metabolic Effects Of Second-generation Antipsychotics Research Articles

Real-WorldData on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies.

IntroductionTo assess the risk of occurrence and potential determinants of metabolic disorders in adult patients treated with second-generation antipsychotics (SGAs) under real-world practice conditions.MethodsMEDLINE, EMBASE, and PsycInfo were searched in July 2019 from database inception. We included population-based, longitudinal, comparative studies that report the results of the outcomes of interest for adult participants, including diabetes, ketoacidosis, hyperosmolar hyperglycemic state, weight gain/obesity, dyslipidemia, hypertension, and metabolic syndrome. Two reviewers independently extracted data on the study design, study quality, and study outcomes.ResultsWe included 40 studies. Most studies showed that clozapine and olanzapine were associated with an increased likelihood of developing diabetes, while the results for risperidone and quetiapine were mixed. Although less well studied, ziprasidone and aripiprazole appeared to not be associated with the occurrence of diabetes. Information on antipsychotic-induced weight gain/obesity is extremely scarce. Regarding dyslipidemia, aripiprazole was not associated with an increased likelihood of developing dyslipidemia, clozapine was associated with an increased likelihood of developing dyslipidemia, and risperidone, olanzapine, quetiapine, and ziprasidone showed mixed results. Two studies suggested an association between ziprasidone and the occurrence of hypertension. Several studies found that the occurrence of a metabolic disorder acted as a risk factor for the development of other metabolic disorders. We did not find information on brexpiprazole, cariprazine, or lurasidone, and data on any long-acting SGA were lacking.ConclusionAlthough there are relevant differences among SGAs concerning the risk of metabolic disorders, it appears that none of the SGAs included in our review are fully devoid of these disturbances.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-021-01689-8.

Safety of psychotropic medicines: contribution from observational evidence.

The risks associated with psychotropic drugs use should be accurately documented at the population level in view of the growing number of persons exposed to these drugs. The strengths of observational studies regarding the identification of drug-related harms mirror the limitations of randomised controlled trials and vice-versa. Observational studies can be carried out in large samples of unselected participants treated in real-life conditions and who may be followed up over long periods. Serious adverse effects undetected during pre-marketing clinical trials may be observed only in post-marketing use, such as metabolic effects of second-generation antipsychotics. Observational studies play a key role in the identification of teratogenic risks, such as those induced by prenatal exposure to anticonvulsants. These studies are the main source of information to investigate the long-term effects of drugs, such as the possible increased risk of dementia in benzodiazepine users. They may also contribute to the accurate assessment at population level of risks overestimated by studies carried out in non-representative samples, such as the risk of congenital heart diseases in babies prenatally exposed to lithium. Owing to the lack of random allocation of drugs, confounding by indication or by disease severity are the major sources of biases in observational studies exploring drug safety. An adverse outcome may be wrongly imputed to drug exposure while it is a symptom/outcome of the disease motivating the decision to prescribe. Such a bias may occur in studies investigating the link between exposure to antidepressants and suicidality. As several methods have been developed to lessen the impact of such biases, pharmaco-epidemiological studies based upon stringent methodological designs should be regarded as a valid approach for assessing psychotropic drug safety.

Effect of melatonin in reducing second-generation antipsychotic metabolic effects: A double blind controlled clinical trial

IntroductionThe use of second-generation atypical antipsychotics has an increasing role in the development of metabolic syndrome. However, these medications due to metabolic disorders can lead to an increased risk of cardiovascular disease and subsequently mortality as well as reduced adherence to treatment. The main objective of current study was to determine the ability of melatonin to reduce the metabolic effects of second-generation antipsychotics. MethodsThis double blind controlled clinical trial was conducted on 100 patients aged 18–64 years old were treated with the second-generation antipsychotics for the first time. The patients were divided randomly into two groups of 50. The case group received slow-release melatonin at a dose of 3mg and the control group was given oral placebo at 8 p.m. ResultsThe findings in melatonin group indicated significantly increase of HDL and decreased fasting blood sugar and systolic blood pressure, as well as had statistically significant increase in waist circumference, weight and BMI compared with placebo group. ConclusionAccording to the findings, it can be claimed that the addition of melatonin to atypical antipsychotics has led to a reduction in some of the metabolic effects of these drugs. In this study, HDL level was increased, and the mean systolic blood pressure and FBS were decreased in the melatonin group. Considering that these factors are contributing to cardiovascular disease as a leading cause of mortality in psychiatric patients, so the use of melatonin can reduce some of the medical effects of long-term treatment of atypical antipsychotics.

Monitoring and Treatment of Weight Gain in Children and Adolescents Treated with Second Generation Antipsychotics (SGAs)

ABSTRACT The use of second generation antipsychotics (SGAs) for the treatment of psychiatric illnesses in children and adolescents is increasing. Adverse effects of SGAs include weight gain, dyslipidemia, insulin resistance, and glucose intolerance that can subsequently progress to diabetes. Data suggest that the metabolic effects of SGAs may be more severe in children and adolescents than in adults. The mechanism of SGA-related weight gain is not fully understood and almost certainly due to a combination of factors. A vital first step to minimize risk and long-term adverse outcomes from SGA treatment is to implement consistent metabolic monitoring.

Age-Dependent Metabolic Effects of Second-Generation Antipsychotics in Second-Generation Antipsychotic-Naïve French Canadian Patients

Patients receiving second-generation antipsychotics (SGAs) may experience secondary metabolic effects such as weight gain, as well as changes in lipid and glucose metabolism. These effects are well documented in adults; however, fewer studies are available concerning their occurrence and their evolution in children and adolescents. The aim of this study was to determine if there is an age-dependent variation in the metabolic effects of SGAs in a drug-naïve population. Charts of 232 French Canadian patients participating in a program monitoring the metabolic effects of SGAs were retrospectively reviewed. A total of 85 SGA-naïve patients were selected, including 58 youths and 27 adults. Changes, relative to baseline, in weight, body mass index, lipid metabolism (total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglyceride), and fasting blood glucose were assessed, with follow-up at 3, 6, 12, and 24 months. With respect to weight gain, in both the youth and adult groups, body mass index significantly increased from baseline at 3 months (10.1% [p < 0.0001] and 12.2% [p < 0.0001], respectively) and 6 months (11.8% [p < 0.0001] and 13.1% [p < 0.0001], respectively). With respect to lipid metabolism, in the youth group, there was no significant change. In the adult group, there was a significant increase at 3 and 6 months in total cholesterol (24.0% [p = 0.004] and 24.1% [p = 0.0006], respectively), low-density lipoprotein (26.8% [p = 0.019] and 30.1% [p = 0.010], respectively), and high-density lipoprotein (10.2% [p = 0.04] and 17.1% [p = 0.005], respectively). There was no significant change in triglyceride and glucose metabolism in both groups. Our results confirm the age-independent effects of SGA on weight gain. However, more data are needed to explore the age effect on glucose and lipid metabolism.

When Essential Medications Provoke New Health Problems: The Metabolic Effects of Second-Generation Antipsychotics

When Essential Medications Provoke New Health Problems: The Metabolic Effects of Second-Generation Antipsychotics

Metabolic effects of second‐generation antipsychotics in bipolar youth: comparison with other psychotic and nonpsychotic diagnoses

Despite known metabolic effects of second-generation antipsychotics (SGAs) on children and adolescents, comparative effects in youth with different diagnoses remain underreported. We compared differences in metabolic changes three months after starting treatment with SGAs in youth with bipolar disorder and with other psychotic and nonpsychotic disorders. Weight and metabolic differences among diagnostic groups before and three months after starting treatment with SGAs were compared in a naturalistic cohort of children and adolescents (14.9 +/- 3.0 years) diagnosed with bipolar disorder (n = 31), other psychotic disorders (n = 29), and other nonpsychotic disorders (n = 30), with no (35.6%) or very little (6.6 +/- 9.0 days) previous exposure to antipsychotics. Composite measurements of significant weight gain [weight increase > or = 5% at three months or increase > or = 0.5 in body mass index (BMI) z-score] and 'risk for adverse health outcome' (> or = 95(th) BMI percentile, or > or = 85(th) BMI percentile plus presence of one other obesity-related complication) were included. SGAs (risperidone, olanzapine, and quetiapine) were prescribed in comparable proportion among groups. Baseline weight and metabolic indices were not significantly different among diagnoses. Three months after starting treatment with SGAs, more than 70% patients had significant weight gain, BMI z-score increased in all diagnostic groups (p < 0.001 for all comparisons), total cholesterol increased in the bipolar (p = 0.02) and psychotic (p = 0.01) disorder groups, low-density lipoprotein cholesterol increased in the bipolar group (p = 0.02), and free T4 decreased in the psychotic disorder group (p = 0.05). More patients with bipolar disorder presented overweight plus > or = 1 obesity-related complication at follow-up. There are early weight gain and metabolic changes across diagnoses in youth treated with SGAs.