The Other Obesity Epidemic—Of Drugs and Bugs

Abstract

Chronic psychiatric patients with schizophrenia and related disorders are frequently treatment-resistant and may require higher doses of psychotropic drugs to remain stable. Prolonged exposure to these agents increases the risk of weight gain and cardiometabolic disorders, leading to poorer outcomes and higher medical cost. It is well-established that obesity has reached epidemic proportions throughout the world, however it is less known that its rates are two to three times higher in mentally ill patients compared to the general population. Psychotropic drugs have emerged as a major cause of weight gain, pointing to an urgent need for novel interventions to attenuate this unintended consequence. Recently, the gut microbial community has been linked to psychotropic drugs-induced obesity as these agents were found to possess antimicrobial properties and trigger intestinal dysbiosis, depleting Bacteroidetes phylum. Since germ-free animals exposed to psychotropics have not demonstrated weight gain, altered commensal flora composition is believed to be necessary and sufficient to induce dysmetabolism. Conversely, not only do psychotropics disrupt the composition of gut microbiota but the later alter the metabolism of the former. Here we review the role of gut bacterial community in psychotropic drugs metabolism and dysbiosis. We discuss potential biomarkers reflecting the status of Bacteroidetes phylum and take a closer look at nutritional interventions, fecal microbiota transplantation, and transcranial magnetic stimulation, strategies that may lower obesity rates in chronic psychiatric patients.

Weight development from childhood to motherhood—embodied experiences in women with pre-pregnancy obesity: a qualitative study

“…Further, side effects of drugs such as psychotropics were highlighted by the women in the Danish study as significant turning points in their weight history [ 32 ]. Drug-induced obesity is a well-known phenomenon primarily related to the use of psychopharmaceuticals or steroids, which also affected several of the women in our study [ 10 , 57 ].…”

Multi-probiotic consumption sex-dependently interferes with MSG-induced obesity and concomitant phagocyte pro-inflammatory polarization in rats: Food for thought about personalized nutrition

“…Epidemic scope, which obesity has reached in many countries, necessitates shifting the emphasis in medicine from traditional reaction to personalized prevention [ 16 , 65 ]. Constantly growing number of literature data convincingly proves the effect of sex at cellular and molecular levels on obesity in morbidity, pathophysiology, comorbidity, outcomes and treatment efficacy [ 4 , 5 ] Understanding biomedical scientific findings concerning obesity in the context of sex differences can facilitate applying research-derived knowledge in personalized approaches to the management and prophylaxis of this pathologic state.…”

Administration of All-Trans Retinoic Acid to Pregnant Sows Alters Gut Bacterial Community of Neonatal Piglets With Different Hoxa1 Genotypes

“…Decreasing the numbers of Firmicutes, Lactobacillus , Veillonella , Rothia , and Clostridium_sensu_stricto_1 will increase the growth and colonization of bacterial pathogens ( Kim et al, 2017 ; Vitetta et al, 2017 ) and weaken gastrointestinal digestion, development, and immune functions ( Edwards et al, 2017 ; Granja-Salcedo et al, 2017 ). The increased relative abundance of Bacteroidetes can generate more propionate, and the surplus of propionate can lower food intake, increase energy expenditures ( Chambers et al, 2015 , 2018 ), and facilitate the absorption of iron ( Sfera et al, 2020 ); chronic iron overload increases the risk of reactive oxygen species and DNA damage ( Sfera et al, 2020 ) and decreases weight gain ( Calarge et al, 2016 ).…”