Rationale
Multiple drugs are known to induce metabolic malfunctions, among them second-generation antipsychotics (SGAs). The pathogenesis of such adverse effects is of multifactorial origin.
Objectives
We investigated whether SGAs drive dysbiosis, assessed whether gut microbiota alterations affect body weight and metabolic outcomes, and looked for the possible mechanism of metabolic disturbances secondary to SGA treatment in animal and human studies.
Methods
A systematic literature search (PubMed/Medline/Embase/ClinicalTrials.gov/PsychInfo) was conducted from database inception until 03 July 2018 for studies that reported the microbiome and weight alterations in SGA-treated subjects.
Results
Seven articles reporting studies in mice (experimentsâ=â8) and rats (experimentsâ=â3) were included. Olanzapine was used in five and risperidone in six experiments. Only three articles (experimentsâ=â4) in humans fit our criteria of using risperidone and mixed SGAs. The results confirmed microbiome alterations directly (rodent experimentsâ=â5, human experimentsâ=â4) or indirectly (rodent experimentsâ=â4) with predominantly increased
Firmicutes
abundance relative to
Bacteroidetes
, as well as weight gain in rodents (experimentsâ=â8) and humans (experimentsâ=â4). Additionally, olanzapine administration was found to induce both metabolic alterations (adiposity, lipogenesis, plasma free fatty acid, and acetate levels increase) (experimentsâ=â3) and inflammation (experimentsâ=â2) in rodents, whereas risperidone suppressed the resting metabolic rate in rodents (experimentsâ=â5) and elevated fasting blood glucose, triglycerides, LDL, hs-CRP, antioxidant superoxide dismutase, and HOMA-IR in humans (experimentâ=â1). One rodent study suggested a gender-dependent effect of dysbiosis on body weight.
Conclusions
Antipsychotic treatment-related microbiome alterations potentially result in body weight gain and metabolic disturbances. Inflammation and resting metabolic rate suppression seem to play crucial roles in the development of metabolic disorders.
Electronic supplementary material
The online version of this article (10.1007/s00213-018-5102-6) contains supplementary material, which is available to authorized users.