Clinical and Biological Perspectives of Non-antipsychotic Psychotropic Medications and Weight Gain

Abstract

Background: Non-antipsychotic medications are frequently used in psychiatric patients with a variety of disorders. However, there is limited research concerning weight gain and metabolic changes in mentally ill population. Objective: This review aimed to critically describe non-antipsychotic psychotropic (NAP) medications and their impact on weight in the psychiatric population. Also, the biological and psychosocial mechanisms of weight gain or loss attributed to NAP and antipsychotic medications are also described in this paper. Methods: Electronic searches (2000-2018) of PubMed, Medline, Review Articleand Google Scholar were conducted using Boolean operators and keywords. Large numbers of articles were retrieved, and two independent reviewers retained 85 articles published in English peer-reviewed journals. Results: Only a few non-antipsychotic psychotropic medications prescribed to psychiatric population produce overweight and some metabolic changes, but most of them cause minimal weight gain, or they are weight-neutral and weight-loss. Variable results are reported concerning biological mechanisms attributed to genetics, individual vulnerability, diagnosis and pharmacology of antipsychotic and non-antipsychotic psychotropic medications. Conclusion: Unlike antipsychotic medications, non-antipsychotic psychotropic drugs cause the least weight gain mediated by multiple mechanisms, but mostly without meeting salient features of metabolic syndrome. Further studies are needed to explore metabolic changes and underlying mechanisms concerning psychotropic drugs given chiefly to mentally ill patients around the world.

Mechanisms Involved in the Link between Depression, Antidepressant Treatment, and Associated Weight Change

“…Serotonin and norepinephrine reuptake inhibitors (SNRIs) are considered an evolution of previously established SSRI antidepressants, also being able to affect depressiondisrupted norepinephrine metabolism (e.g., in the limbic system). Thus, the activating effect of noradrenaline reuptake inhibition enables a more pronounced early mass-negative effect than that of SSRIs alone and, over the longer term, SNRIs are considered to exert a mass-neutral effect [17,108]. Unlike SSRIs, SNRIs also appear to have a more pronounced dose-dependent effect whereby an increase in dosage increases noradrenaline reuptake inhibition [17].…”

“…Unlike SSRIs, SNRIs also appear to have a more pronounced dose-dependent effect whereby an increase in dosage increases noradrenaline reuptake inhibition [17]. Duloxetine, an SNRI with a more potent serotoninergic action when compared to the rest of the group, is also associated with the most pronounced weight-gaining effect [108,109]. Overall, however, studies examining the effect of SNRIs on body weight are scarce.…”