Adverse Endocrine and Metabolic Effects of Psychotropic Drugs

Abstract

The article critically reviews selected, clinically significant, adverse endocrine and metabolic effects associated with psychotropic drug treatments, including hyperprolactinaemia, hyponatraemia, diabetes insipidus, hypothyroidism, hyperparathyroidism, sexual dysfunction and virilization, weight loss, weight gain and metabolic syndrome (type 2 diabetes mellitus, dyslipidaemia and hypertension). Such effects are prevalent and complex, but can be managed clinically when recognized. They encourage continued critical assessment of benefits versus risks of psychotropic drugs and underscore the importance of close coordination of psychiatric and general medical care to improve long-term health of psychiatric patients. Options for management of hyperprolactinaemia include lowering doses, switching to agents such as aripiprazole, clozapine or quetiapine, managing associated osteoporosis, carefully considering the use of dopamine receptor agonists and ruling out stress, oral contraceptive use and hypothyroidism as contributing factors. Disorders of water homeostasis may include syndrome of inappropriate antidiuretic hormone (SIADH), managed by water restriction or slow replacement by hypertonic saline along with drug discontinuation. Safe management of diabetes insipidus, commonly associated with lithium, involves switching mood stabilizer and consideration of potassium-sparing diuretics. Clinical hypothyroidism may be a more useful marker than absolute cut-offs of hormone values, and may be associated with quetiapine, antidepressant and lithium use, and managed by thyroxine replacement. Hyper-parathyroidism requires comprehensive medical evaluation for occult tumours. Hypocalcaemia, along with multiple other psychiatric and medical causes, may result in decreased bone density and require evaluation and management. Strategies for reducing sexual dysfunction with psychotropics remain largely unsatisfactory. Finally, management strategies for obesity and metabolic syndrome are reviewed in light of the recent expert guidelines, including risk assessment and treatments, such as monoamine transport inhibitors, anticonvulsants and cannabinoid receptor antagonists, as well as lifestyle changes.

Antipsychotic Agents

“…Importantly, some fi rst-and second-generation antipsychotic drugs are associated with weight-gain, with or without the metabolic syndrome of hypertension, hyperlipidemia, and type 2 diabetes mellitus [ 24,61,97,161,163 ] . Such reactions are most closely associated with older neuroleptics of low potency (such as chlorpromazine and thioridazine) and several modern agents (notably, clozapine, olanzapine, and quetiapine).…”

Hiponatremia in the practice of a psychiatrist. Part 1: SIADH syndrome and drug-induced hyponatremia.

“…Hiponatremia polekowa była również obserwowana po zastosowaniu klasycznych leków przeciwpsychotycznych [48]: haloperidolu [49] oraz tiorydazyny [50].…”

Encephalopathy Associated with Psychotropic Drug Therapy

“…It has been demonstrated that lots of psychotropic drugs including antipsychotics, antidepressants, and anticonvulsants, can cause syndrome of inappropriate antidiuretic hormone secretion (SIADH) (Spigset & Hedenmalm, 1995;Bhuvaneswar et al, 2009;Reddy & Mooradian, 2009), and that antipsychotic-induced hyponatremia is most likely a result of SIADH (Meulendijks, 2010). Vieweg et al (1987) also postulated that the syndrome of self-induced water intoxication and psychosis (SIWIP) was a subcategory of SIADH, with hypoosmolality and hyponatremia induced synergistically by polydipsia and released AVP, both of which were stimulated by psychosis.…”

“…Antipsychotics, in particular atypical antipsychotics such as clozapine and olanzapine, are reported to be associated with an increased risk of obesity, diabetes, and metabolic syndrome (Scheen & De Hert, 2007;Smith et al, 2008) and in the worse case it can result in fatal hyperglycemic encephalopathy (Koller & Doraiswamy, 2002;Wehring et al, 2003). Lithium, a widely used mood stabilizer, increases the risk of hypothyroidism, which can range from subclinical to life-threatening myxedema coma (Bhuvaneswar et al, 2009;Thomas et al, 2010). A case of Hashimoto's encephalopathy possibly induced by lithium was also reported (Nagamine et al, 2008).…”