Metabolic Issues—Side Effects of Antipsychotics

Iqbal, Syed MD
McDeavitt, Kathleen MD
Han, Jin Yong MD
Li, Benjamin T. MD
Beal, Lauren Ludmila MD
Zaidi, Mariam
Shah, Asim A. MD

From Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas (SI, KM, JYH, BTL, LLB, AAS); and Arkansas College of Osteopathic Medicine, Fort Smith, Arkansas (MZ).

Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Syed Iqbal, MD, Menninger Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030; email: [email protected].

Psychiatric Annals 55(1):p e19-e23, January 01, 2025. | DOI: 10.3928/00485713-20250108-02

Chronic mental illnesses need prolonged use of antipsychotic treatment to maintain remission of symptoms. First-generation antipsychotics (FGAs) are mostly associated with extrapyramidal side effects and dyskinetic movement disorders. The second-generation antipsychotics (SGAs) are commonly used, associated with metabolic side effects collectively named metabolic syndrome (MetS), including weight gain, dyslipidemia, hyper-tension, and insulin resistance. MetS increases morbidity and mortality due to cardiovascular complications. Monitoring and prompt treatment are of paramount importance. Patients should be educated about lifestyle modifications. Switching medications precipitates relapse of symptoms and is not be feasible in all cases. Off-label treatment, including metformin or topiramate, can be added to minimize the side effects. [Psychiatr Ann. 2025;55(1):e19–e23.]