Magazine article Clinical Psychiatry News

Metabolic Assessments Should Precede Atypicals

Magazine article Clinical Psychiatry News

Metabolic Assessments Should Precede Atypicals

Article excerpt

NEW YORK -- With increased use of atypical antipsychotics like olanzapine in managing bipolar disorder has come an increase in insulin resistance, weight gain, and elevated cardiovascular risk.

Over the last decade, it has become clear that antipsychotics can alter insulin sensitivity and glucose metabolism. Data are scant, and no one is sure exactly how common the problem is. But consensus is growing that psychiatrists considering one of these drugs need to make thorough baseline metabolic assessments, and then monitor the patients very carefully once treatment has begun, said Dr. Hugh Brent Solvason at a symposium sponsored by NARSAD, the Mental Health Research Association.

"The atypical antipsychotics have become one of our mainstay treatment strategies for bipolar disorder. Some patients do extremely well on them, but they do increase the risk for insulin resistance, metabolic syndrome, weight gain, and type 2 diabetes. We need to identify who is developing metabolic side effects early on and then define strategies for what to do," said Dr. Solvason, of the department of psychiatry, Stanford (Calif.) University.

Clozapine (Clozaril), olanzapine (Zyprexa), and risperidone (Risperdal) are the antipsychotics most frequently implicated in the development of metabolic side effects. All three have been associated with weight gain. Clozapine and olanzapine can induce adverse changes in lipid profiles and increase the risk of diabetes. Risperidone and quetiapine (Seroquel) can induce weight gain; the available data are equivocal as to whether these two drugs will change lipid levels or increase net risk of diabetes.

The issue warrants careful consideration, given that mood disorders themselves are risk factors for insulin resistance. Many bipolar patients are already obese, or on the fast track toward obesity. Treatment with an agent that induces further insulin resistance will only accelerate that process.

'A psychiatrist is responsible for monitoring blood pressure, body weight, waist circumference, fasting blood glucose, and lipid levels if he or she wants to use one of these drugs," Dr. Solvason said. "People who already have diabetes at baseline need to be monitored very carefully. …

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