Increased Risk of Metabolic Syndrome in Antidepressants Users: A Mini Review (original) (raw)
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Psychoneuroendocrinology, 2016
To examine longitudinal associations between antidepressant medication use and the metabolic syndrome (MetS). 5014 participants (49.8% were men) from the D.E.S.I.R. cohort study, aged 30-65 years at baseline in 1994-1996, were followed over 9 years at 3-yearly intervals (1997-1999, 2000-2002, and 2003-2005). Antidepressant use and MetS, defined by the National Cholesterol Education Program Adult Treatment Panel III criteria (NCEP-ATP III) and the American Heart Association and the National Heart, Lung and Blood Institute (AHA/NHLBI) criteria, were assessed concurrently at four medical examinations. In fully-adjusted longitudinal logistic regression analyses based on generalized estimating equations, antidepressant users had a 9% (p=0.011) and a 6% (p=0.036) greater annual increase in the odds of having the MetS defined by NCEP-ATP III and AHA/NHLBI criteria respectively. Sex-specific analyses showed that this association was confined to men only. When the different types of antidepr...
Vessel Plus
Depression is one of the most common psychiatric disorders, and has become an epidemic in modern medical practice; notorious for frequently co-occurring with multiple comorbidities, especially cardiovascular disease (CVD), type 2 diabetes mellitus (DM2), and its various risk factors comprised in the metabolic syndrome (MS). Selective serotonin reuptake inhibitors (SSRIs) are the most widely used class of psychotropic drugs in this and many other clinical scenarios; yet their impact on cardiometabolic health has not been elucidated. The objective of this review was to summarize current views on the pharmacology of SSRIs and cardiometabolic risk, as well as available epidemiological evidence regarding its clinical significance. SSRIs appear to intervene in cardiometabolic physiology fundamentally by modulating chronic inflammation, a key pathophysiologic phenomenon in MS, DM2 and CVD. However, the dosing necessary to achieve a beneficial impact in this regard, as well as their clinical correlations, remain controversial. Each SSRI displays a particular profile regarding each of the components of the MS: weight gain seems to be the most common effect of SSRIs, more frequent with paroxetine, followed by citalopram and escitalopram. As a drug class, SSRIs also appear to promote hypercholesterolemia rather uniformly, while fluoxetine and citalopram appear to particularly increase triacylglyceride levels. In contrast, fluvoxamine and paroxetine seem to have the greatest impact on dysglycemia. Lastly, most SSRIs appear to be innocuous or even beneficial regarding blood pressure and high-density lipoprotein cholesterol. Nevertheless, many of these effects may vary significantly upon specific clinical circumstances, especially timing. This topic remains rather unexplored in clinical psychopharmacology, and further, larger-scale epidemiological studies are needed in order to offer improved care in this field.
vessel plus, 2018
Metabolic risk in depression and treatment with selective serotonin reuptake inhibitors: are the metabolic syndrome and an increase in cardiovascular risk unavoidable? Vessel Plus 2018;2:6. http://dx. Abstract Depression is one of the most common psychiatric disorders, and has become an epidemic in modern medical practice; notorious for frequently co-occurring with multiple comorbidities, especially cardiovascular disease (CVD), type 2 diabetes mellitus (DM2), and its various risk factors comprised in the metabolic syndrome (MS). Selective serotonin reuptake inhibitors (SSRIs) are the most widely used class of psychotropic drugs in this and many other clinical scenarios; yet their impact on cardiometabolic health has not been elucidated. The objective of this review was to summarize current views on the pharmacology of SSRIs and cardiometabolic risk, as well as available epidemiological evidence regarding its clinical significance. SSRIs appear to intervene in cardiometabolic physiology fundamentally by modulating chronic inflammation, a key pathophysiologic phenomenon in MS, DM2 and CVD. However, the dosing necessary to achieve a beneficial impact in this regard, as well as their clinical correlations, remain controversial. Each SSRI displays a particular profile regarding each of the components of the MS: weight gain seems to be the most common effect of SSRIs, more frequent with paroxetine, followed by citalopram and escitalopram. As a drug class, SSRIs also appear to promote hypercholesterolemia rather uniformly, while fluoxetine and citalopram appear to particularly increase triacylglyceride levels. In contrast, fluvoxamine and paroxetine seem to have the greatest impact on dysglycemia. Lastly, most SSRIs appear to be innocuous or even beneficial regarding blood pressure and
Metabolic Effects of Antidepressant Treatment
Noro Psikiyatri Arsivi, 2017
Mortality and morbidity are relatively high among patients with severe psychiatric disorders such as schizophrenia, bipolar disorder, and depression compared with those among the general population (1). It is known that patients with severe psychiatric disorders have a shorter life expectancy (2). This decreased life expectancy results from an increased risk for suicide and also medical disorders such as cardiovascular diseases (3). The cardiovascular risk is associated with cardiometabolic risk factors such as diabetes mellitus, smoking, dyslipidemia, and obesity (4). Genetic, lifestyle-related factors, limited access to good quality physical care, the disease itself, and psychopharmacotherapy play a role in the increased risk for cardiovascular diseases (1). Although modifiable cardiometabolic risk factors such as smoking, hyperglycemia, hypertension, dyslipidemia, and obesity are frequently observed in patients with severe psychiatric disorders, they are not sufficiently recognized or are overlooked in these patients (5). Obesity that results from reduced activity and irregular nourishment is one of the most important risk factors in psychiatric patients. Obesity is more frequently observed among psychiatric patients than among the general population (6). There are many reasons for increased obesity in patients with severe psychiatric disorders (7). Lifestyle alterations related to the psychiatric disorder can cause increased food intake and decreased energy expenditure, thus leading to increased fat accumulation (8). In addition, drugs used for treating psychiatric disorders may also play a role in the etiology of obesity in such patients (9). It is known that psychotropic agents, primarily antipsychotics and mood stabilizers, lead to weight gain. Furthermore, weight gain is a serious problem that can compromise adherence to psychotropic drug regimens and lead to symptomatic relapse and medical comorbidity. In this context, antidepressants have attracted lesser attention than anti-psychotic agents and mood stabilizers. However, if there is a higher risk for antidepressant-related weight gain, it is more important because these drugs are more commonly used. There are a few studies regarding antidepressant-related weight change. It was reported that the likelihood and amount of weight gain may vary in tricyclic antidepressants (TCAs), although TCAs, as a class, are considered to generally result in weight gain through anticholinergic activity (10). In contrast to TCAs,
Psychological Medicine
Background Major depressive disorder (MDD) is a complex disorder with a significant public health burden. Depression remission is often associated with weight gain, a major risk factor for metabolic syndrome (MetS). The primary objective of our study was to assess prospectively the impact of response to antidepressant treatment on developing MetS in a sample of MDD patients with a current major depressive episode (MDE) and who are newly initiating their treatment. Methods In the 6-month prospective METADAP cohort, non-overweight patients, body mass index <25 kg/m2, with MDD and a current MDE were assessed for treatment response after 3 months of treatment, and incidence of MetS after 3 and 6 months of treatment. Outcome variables were MetS, number of MetS criteria, and each MetS criterion (high waist circumference, high blood pressure, high triglyceridemia, low high-density lipoprotein-cholesterolemia, and high fasting plasma glucose). Results In total, 98/169 patients (58%) resp...
Metabolic syndrome in drug-naïve patients with Depressive Disorders
Indian Journal of Psychological Medicine, 2013
INTRODuCTION Metabolic Syndrome (MS) is a cluster of abnormalities that predispose a person to develop type 2 diabetes mellitus and cardiovascular disease. [1,2] People with MS are twice as likely to die from, and three times as likely to develop myocardial infarction (MI) or stroke compared to people without MS. [3] Most of the studies which have evaluated the prevalence of MS in patients of depression have emerged from the West. Studies which have studied the relationship of MS with depression can be broadly be understood as: studies which have evaluated the prevalence of MS in depressed patients and as studies which have evaluated the prevalence of MS in patients attending general hospitals or the community-based population. In the latter studies, depression has been studied as a covariate which can predict the development of MS. Studies which have evaluated the prevalence of MS in depressed patients, of sample size varying between 60 and 230, have reported that prevalence rates vary from 25 to 41%. [4-6] In contrast, the studies which have evaluated the prevalence of MS and depression (as a disorder or as subsyndromal depression) in patients attending general hospitals or the community-based Background: The prevalence of metabolic syndrome (MS) is found to be higher in patients with depression than in the general population. As there is lack of data from India, this study aimed to assess the prevalence of MS in patients with depression who had never been treated with antidepressants for their depressive disorder and compare the same with a matched group of healthy controls. Materials and Methods: Forty-three drug-naïve patients with depressive disorders and 43 age-and gender-matched healthy controls were assessed for the prevalence of MS as per the consensus definition. Results: The prevalence of MS in patients with depression was 37.2% and was significantly higher than that seen in the healthy controls (16.3%). Increased waist circumference was the most common abnormality in both the study groups. Compared to healthy controls, a significantly higher proportion of patients with depression had abnormal waist circumference, systolic blood pressure, or high blood pressure. Besides 16 patients with depressive disorders having MS, another 53.5% of patients fulfilled one or two criteria of MS. None of the sociodemographic variables was associated with development of MS in patients with depression. Conclusions: Slightly more than one-third of depressed patients who are drug-naïve have MS and this prevalence rate is significantly higher than in healthy controls.
Metabolic Effects of Antidepressants: Results of a Randomized Study’s Interim Analysis
Cureus
Background and objectives: Individuals with major depressive disorder exhibit a dysregulated metabolic profile. There are few studies on how vilazodone, escitalopram, and vortioxetine alter metabolic parameters. Our study aimed to determine the change in plasma glucose, HbA 1c , serum cholesterol, triglyceride, and creatinine at 12 weeks. Methods: An ongoing randomized, open-label, three-arm study's interim analysis is portrayed here. The participants were assessed at baseline, 4, 8, and 12 weeks after receiving oral tablets of either vilazodone (20-40mg/d), escitalopram (10-20mg/d), or vortioxetine (5-20mg/d). This study is CTRI-registered (2022/07/043808). Results: Of 71 recruited participants, 49 (69%) completed the 12-week visit. The median Hamilton Depression Rating Scale (HDRS) scores of the participants in vilazodone, escitalopram, and vortioxetine groups were 30.0, 29.5, and 29.0 at baseline (p=0.76) and 19.5, 19.5, and 18.0 (p=0.18) at 12 weeks, respectively. The median fasting blood sugar (FBS) values were 98.5, 105.5, and 98.0 at baseline (p=0.07) and 94.0, 99.5, and 96.0 (p=0.19) at 12 weeks, for vilazodone, escitalopram, and vortioxetine groups, respectively. The post hoc analysis did not yield statistically significant differences regarding any parameters. Conclusion: According to this interim study, the HDRS scores declined after 12 weeks of therapy. The subjects' metabolic parameters did not significantly change. It is essential to perform further investigation regarding these impacts.
Metabolic Syndrome with Different Antipsychotics: A Multicentre Cross-Sectional Study
~ Objective: High prevalence of Metabolic Syndrome (MS) and related metabolic disturbances in patients with schizophrenia and bipolar affective disorder have been in main focus of interest in recent years since the introduction of second-generation antipsychotics. This study aims to examine these questions: 1) Is there a relation between antipsychotic treatment and MS prevalence? 2) Which antipsychotic users have higher MS prevalence? 3) Do patients on antipsychotic polytherapy have higher rates of MS than patients on antipsychotic monotherapy? 4) Which metabolic parameters are considerably disturbed on which antipsychotic users? Methods: 242 Patients with schizophre-nia, schizoaffective disorder and bipolar disorder without any other psychiatric comorbidity according to DSM-IV and using the same antipsychotic(s) and/or mood stabilizers at least for the last 6 months included to the final assesment. Results: The sample was divided into 7 drug groups. The MS prevalence was highest in the combined antipsychotic (AA) group (48.1%) according to ATP III criteria. According to IDF criteria clozapine (C) group had the highest MS prevalence (74%). Conclusions: When metabolic parameters evaluated overall, metabolic risk with antipsychotics is found to be highest in clozapine group, followed by combined AP group. Olanzapine and risperidone have intermediate risk while zuclopentixole has lowest. Psychopharmacology Bulletin.