Atypical antipsychotics are increasingly used to treat psychiatric disorders such as bipolar disorder or schizophrenia.  In spite of the important role they play for many patients in treating serious psychiatric disorders, atypicals have been associated with negative side effects that may worsen a patient’s cardiovascular health profile.  This includes a greater risk for weight gain, glucose dysregulation/diabetes, and dyslipidemia (elevated triglycerides/cholesterol).

Balf et al (2008) describe the need for increased monitoring and treatment of these risk factors in the field of psychiatry.  Recommendations made by the Mount Sinai Conference and the American Diabetes Association (ADA) state that several baseline parameters should be evaluated prior to initiating treatment with an atypical antipsychotic.  This includes: family history of metabolic conditions, weight and height, waist circumference, plasma glucose level, blood pressure, and lipid profile.

After these baseline assessments, it is suggested that weight and body mass be checked every 3 months while taking an atypical.  A body mass index increase of 1 unit, or a weight gain of >7%, is cause for concern.  Similarly, monitoring for diabetes with a fasting plasma glucose test should be performed every 3-4 months.  Fasting glucose levels of 100mg/dL-125mg/dL signify pre-diabetes, and should be closely watched.  A fasting lipid profile (including total cholesterol, LDL cholesterol, high-density lipoprotein cholesterol, and triglycerides) is recommended at baseline and 3 months into treatment with an atypical, and then every 5 years, based on the American Diabetes Association – APA recommendations.  The Mount Sinai guidelines suggest that routine monitoring for lipids be done more frequently, every 2 years.

The Balf et al. review also refers to the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia study, which found that many patients with schizophrenia discontinued their treatment due to weight gain.  Balf et al. suggest that an added bonus to improved monitoring of such side effects is that patients may better adhere to treatment.

We are now enrolling patients in a new study looking at Omega-3 fatty acids for the treatment of high triglyceride and/or high cholesterol levels.  If you are taking an atypical antipsychotic, and have high levels of either triglycerides or cholesterol please contact us for more information.

Marlene P. Freeman, MD
Rachel C.Vanderkruik, BA

American Diabetes Association; American Psychiatric Association; American Association of Clinical Endocrinologists; North American Association for the Study of Obesity.  Consensus development conference on antipsychotic drugs and obesity and diabetes.  Diabetes Care 2004; 27 (2): 596-601.

Balf G., Stewart T., Whitehead R., Baker R. Metabolic Adverse Events in Patients with Mental Illness Treated with Antipsychotics: A Primary Care Perspective.  Prim Care Companion  J Clin Psychiatry 2008; 10(1), 15-24.

Lieberman JA, Stroup TS, McEvoy JP, et al.  Effectiveness of antipsychotic drugs in patients with chronic schizophrenia.  N Engl J Med 2005; 353(12):1209-1223

Marder S, Essock S, Miller A, et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry 2004; 161 (8): 1334-1349.

Related Research Study at the Center for Women’s Mental Health: Omega-3 fatty acids for the treatment of high trigylcerides and cholesterol in men and women using atypical antipsychotics