Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU Liège, Liège, Belgium; Division of Clinical Pharmacology, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium.
Ann Endocrinol (Paris). 2023 May;84(3):357-363. doi: 10.1016/j.ando.2023.03.006. Epub 2023 Mar 22.
Psychotropic drugs may be associated with metabolic disorders, often but not only triggered by weight gain. Disorders include dysglycemia and diabetes, atherogenic dyslipidemia and metabolic syndrome. Overall, metabolic risk is lower with antidepressants than with antipsychotics. Among antidepressants, metabolic disorders may occur with both selective serotonin reuptake inhibitors and tricyclics, but with some between-molecule differences in each pharmacological family. Among antipsychotics, the risk is higher with second-generation (atypical) than first-generation agents. Higher risk was reported with clozapine and olanzapine, and lower risk with risperidone and aripiprazole. Weight gain is associated with increased insulin resistance, but impaired insulin secretion was also reported with clozapine and olanzapine. Metabolic disorders may be attenuated by the medication withdrawal and replacement by another safer drug. Besides deleterious effects of medications, the psychiatric population is also exposed to bad lifestyle habits (unhealthy diet and sedentary life), which also increase the risk of metabolic disorders. Management should first reinforce lifestyle measures. If this proves insufficient, specific drugs may be considered to tackle the metabolic disorder on a strategy similar to that applied in the general population.
精神药物可能与代谢紊乱有关，通常但不仅由体重增加引发。这些紊乱包括血糖异常和糖尿病、动脉粥样硬化性血脂异常和代谢综合征。总体而言，抗抑郁药的代谢风险低于抗精神病药。在抗抑郁药中，选择性 5-羟色胺再摄取抑制剂和三环类抗抑郁药都可能出现代谢紊乱，但在每个药理家族中，分子之间存在一些差异。在抗精神病药中，第二代（非典型）药物的风险高于第一代药物。氯氮平和奥氮平的风险较高，利培酮和阿立哌唑的风险较低。体重增加与胰岛素抵抗增加有关，但氯氮平和奥氮平也有胰岛素分泌受损的报道。代谢紊乱可以通过停药和用另一种更安全的药物替代来减轻。除了药物的不良作用外，精神科患者还容易受到不良生活方式（不健康的饮食和久坐不动的生活）的影响，这也会增加代谢紊乱的风险。治疗应首先加强生活方式措施。如果这证明是不够的，可以考虑使用特定的药物来治疗代谢紊乱，采用类似于在一般人群中应用的策略。
