Breit Sigrid, Hubl Daniela
Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Psychoneuroendocrinology. 2025 Jun;176:107415. doi: 10.1016/j.psyneuen.2025.107415. Epub 2025 Mar 20.
Mental illnesses and psychotropic drug use are associated with an increased risk of weight gain and metabolic disorders. Growing evidence suggests that agonists of the glucagon-like peptide-1 receptor (GLP-1RAs) might be safe and effective weight loss medications. However, the current evidence for the use of GLP-1RAs in individuals with obesity and mental illness is limited.
Evaluation of the safety and the impact of GLP-1RAs on mental health and psychotropics-induced metabolic disorders such as obesity and type 2 diabetes (T2D).
A literature search from January 1st, 2010 to August 31st, 2024 was conducted using PubMed and Cochrane Library online databases. Studies comprising adults with obesity or/and T2D and mental illness were included. Studies that examined individuals with obesity or/and T2D without mental illness and completed psychiatric questionnaires before and after GLP-1RAs treatment were also included.
From the 36 included studies 18 examined the weight-reducing effect of GLP-1RAs in patients with mental disorders and the other studies examined patients without mental illness. GLP-1RAs lead to a significant weight loss and improvement of glycemic control in patients with mental illness on psychotropics. They showed a beneficial effect on mental health in patients with and without mental disorders and were not associated with a worsening of mental state, suicidality, new-onset mental illness, or increased psychiatric admissions.
GLP-1RAs are safe and effective weight loss treatments for individuals with obesity and mental illness exerting a positive effect on mental state and quality of life. There is a need for RCTs with larger sample sizes, a longer treatment duration and longer follow-up periods to evaluate the long-term effect of GLP-1RAs. It would be of great interest to conduct studies investigating the use of GLP-1RAs with the purpose to treat mental illness in order to directly assess their use in improving mental health.
精神疾病和使用精神药物与体重增加及代谢紊乱风险增加有关。越来越多的证据表明，胰高血糖素样肽-1受体激动剂（GLP-1RAs）可能是安全有效的减肥药物。然而，目前关于GLP-1RAs在肥胖和精神疾病患者中应用的证据有限。
评估GLP-1RAs的安全性及其对心理健康和精神药物所致代谢紊乱（如肥胖和2型糖尿病（T2D））的影响。
使用PubMed和Cochrane图书馆在线数据库对2010年1月1日至2024年8月31日的文献进行检索。纳入了包含肥胖或/和T2D且患有精神疾病的成年人的研究。也纳入了检查无精神疾病的肥胖或/和T2D个体并在GLP-1RAs治疗前后完成精神科问卷的研究。
在纳入的36项研究中，18项研究考察了GLP-1RAs对精神障碍患者的减肥效果，其他研究考察了无精神疾病的患者。GLP-1RAs可使服用精神药物的精神疾病患者显著减重并改善血糖控制。它们对有或无精神障碍的患者的心理健康均显示出有益作用，且与精神状态恶化、自杀倾向、新发精神疾病或精神科住院增加无关。
GLP-1RAs是肥胖和精神疾病患者安全有效的减肥治疗方法，对精神状态和生活质量有积极影响。需要进行样本量更大、治疗持续时间更长和随访期更长的随机对照试验（RCTs）来评估GLP-1RAs的长期效果。开展旨在治疗精神疾病的GLP-1RAs应用研究以直接评估其对改善心理健康的作用将非常有意义。
