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Adverse Endocrine and Metabolic Effects of Psychotropic Drugs

Selective Clinical Review

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Abstract

The article critically reviews selected, clinically significant, adverse endocrine and metabolic effects associated with psychotropic drug treatments, including hyperprolactinaemia, hyponatraemia, diabetes insipidus, hypothyroidism, hyperparathyroidism, sexual dysfunction and virilization, weight loss, weight gain and metabolic syndrome (type 2 diabetes mellitus, dyslipidaemia and hypertension). Such effects are prevalent and complex, but can be managed clinically when recognized. They encourage continued critical assessment of benefits versus risks of psychotropic drugs and underscore the importance of close coordination of psychiatric and general medical care to improve long-term health of psychiatric patients. Options for management of hyperprolactinaemia include lowering doses, switching to agents such as aripiprazole, clozapine or quetiapine, managing associated osteoporosis, carefully considering the use of dopamine receptor agonists and ruling out stress, oral contraceptive use and hypothyroidism as contributing factors. Disorders of water homeostasis may include syndrome of inappropriate antidiuretic hormone (SIADH), managed by water restriction or slow replacement by hypertonic saline along with drug discontinuation. Safe management of diabetes insipidus, commonly associated with lithium, involves switching mood stabilizer and consideration of potassium-sparing diuretics. Clinical hypothyroidism may be a more useful marker than absolute cut-offs of hormone values, and may be associated with quetiapine, antidepressant and lithium use, and managed by thyroxine replacement. Hyper-parathyroidism requires comprehensive medical evaluation for occult tumours. Hypocalcaemia, along with multiple other psychiatric and medical causes, may result in decreased bone density and require evaluation and management. Strategies for reducing sexual dysfunction with psychotropics remain largely unsatisfactory. Finally, management strategies for obesity and metabolic syndrome are reviewed in light of the recent expert guidelines, including risk assessment and treatments, such as monoamine transport inhibitors, anticonvulsants and cannabinoid receptor antagonists, as well as lifestyle changes.

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Acknowledgements

Supported, in part, by an American Psychiatric Institute for Research and Education (APIRE)-Janssen Research Scholarship and NIMH Diversity Supplement grant (to CGB) and by a grant from the Bruce J. Anderson Foundation and McLean Private Donors Fund for Psychopharmacology Research (to RJB). Drs John D. Matthews, Theodore A. Stern and Muhamet Yildiz, PhD provided helpful advice.

Dr Bhuvaneswar has received training awards from: Merck, Janssen, Johnson and Johnson, Novartis, Sepracor, Cypress Bio and Infiniti Pharmaceuticals. Dr Baldessarini has recently been a consultant or investigator-initiated research collaborator with: Auritec, Biotrofix, IFA SpA, Janssen, JDS, Lilly, NeuroHealing, Novartis, Solvay and SK-BioPharmaceuticals Corporations. Dr Harsh has no relevant disclosures. Dr Alpert is a consultant or has received research support from: Aspect Medical Systems, Lilly, Forest, Organon, Pamlab, Pfizer and Pharmavite, and honoraria from Organon and Janssen Corportions. No author is a member of pharmaceutical speakers’ bureaus nor do they or family members hold equity positions in biomedical or pharmaceutical corporations.

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  1. Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, Pennsylvania, 19104, USA

    Chaya G. Bhuvaneswar

  2. Departments of Psychiatry, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA

    Ross J. Baldessarini & Jonathan E. Alpert

  3. McLean Hospital, Belmont, Massachusetts, USA

    Ross J. Baldessarini

  4. Behavioral Endocrinology Branch, National Institute of Mental Health, Bethesda, Maryland, USA

    Veronica L. Harsh

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  1. Chaya G. Bhuvaneswar
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Correspondence to Chaya G. Bhuvaneswar.

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Bhuvaneswar, C.G., Baldessarini, R.J., Harsh, V.L. et al. Adverse Endocrine and Metabolic Effects of Psychotropic Drugs. CNS Drugs 23, 1003–1021 (2009). https://doi.org/10.2165/11530020-000000000-00000

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