Metabolic Syndrome and Antipsychotics: Risks, Side Effects, and Management
Though modern antipsychotic drugs are less risky and cause fewer side effects than older ones, they commonly cause weight gain, increased appetite, and sedation. Long-term, these symptoms can develop into metabolic syndrome.[1][2]
While antipsychotic medication is an essential mental health treatment for many, those who take it long-term run the risk of developing metabolic syndrome. Though some will be able to adjust their medications, others need to make lifestyle changes to help manage their side effects.
These lifestyle changes are most sustainable when they are personalized for your unique needs and experiences. This article will explore:
- An overview of antipsychotic medications.
- Antipsychotics’ side effects and long-term psychiatric medication risks.
- How metabolic syndrome develops.
- The connection between antipsychotics and diabetes risk.
- Managing the metabolic effects of antipsychotics with personalized lifestyle changes.
Overview of Antipsychotics
Antipsychotics are the first-line treatment for psychotic disorders and episodes, such as schizophrenia and brief psychotic disorder. They are also effective for treating people with:[1]
- Drug-induced psychosis.
- Mania.
- Delirium.
- The psychotic features of depression and dementia.
These medications are most effective at treating symptoms like delusions, hallucinations, and disorganized thought and behavior. However, they’re less effective for symptoms like lack of energy, emotional bluntness, lack of pleasure, and social withdrawal, which often occur in these mental health conditions.[1]
There is a wide range of antipsychotic medications, each excelling at alleviating certain symptoms but coming with its own specific risk profile. For example, olanzapine is found to be particularly effective at reducing the risk of suicide in people with psychosis, but it is also the antipsychotic most frequently associated with weight gain.[1][2]
Antipsychotics prescribed today tend to be those known as second-generation (or atypical) antipsychotics. These are new medications that are associated with fewer negative side effects. First-generation (or typical) antipsychotics are still prescribed today in some situations, but they generally carry higher health risks than second-generation medications.[2]
As we will explore, however, second-generation antipsychotics often carry a greater risk of weight gain and metabolic syndrome.[2]
Side Effects of Antipsychotic Medications
Medication side effects in mental health treatment require careful consideration and ongoing monitoring. Some degree of side effects is expected with most medications, including antipsychotics. However, these should be secondary to the positive effects of treatment, with medications providing overall benefits for health and well-being.
First-generation antipsychotics most commonly cause side effects that include:[2]
- Dry mouth.
- Constipation.
- Urine retention.
- Sedation.
- Sexual dysfunction.
They are also associated with significant “extrapyramidal” side effects. These include muscle tremors and spasms, restlessness, and muscle rigidity. A long-term psychiatric medication risk is tardive dyskinesia, which causes involuntary movements like lip smacking.[2]
Second-generation antipsychotics carry fewer extrapyramidal side effects, but some do still occur. You may also experience:[2]
- Dizziness.
- Sedation.
- Anxiety.
- Temperature sensitivity.
- Increased appetite.
- Agitation.
- Headaches.
In addition, a significant side effect of second-generation antipsychotics is weight gain, which can be driven by the increase in appetite and sedation. They have also been found to disrupt the way the body breaks down carbohydrates and manages blood sugar levels. This can lead to mild insulin resistance from antipsychotics, as well as type 2 diabetes, and even diabetic ketoacidosis, which is a serious medical emergency.[2][3]
The side effects of both first and second-generation antipsychotic medications can escalate and worsen with continued use, resulting in more serious health complications.
Health Risks of Antipsychotic Medications
Mental health medication risks in adults include both metabolic and neurological concerns, especially when they are taken long-term.
As explained above, extrapyramidal side effects can develop into tardive dyskinesia, an involuntary movement disorder. Other health risks include:[3]
- Loss of bone mineral density (osteoporosis).
- Low white blood cell count (agranulocytosis).
- Heart rhythm irregularities.
While the main focus of this article is the risk of metabolic syndrome with mental health medication, if you are experiencing any side effects that are affecting your life or that are more severe or different from what your prescriber told you to expect, you should tell them straight away. Your treatment plan may need to be adjusted.
Antipsychotic Medications and Metabolic Syndrome
Metabolic health is a major focus of concern in psychiatry and metabolic health monitoring. This means doctors are interested in how your body converts carbohydrates into usable sugar. When metabolic health is good, it means blood pressure, blood sugar, cholesterol, and waist circumference are within the healthy range.
When these health markers are too high, it could signify metabolic syndrome. While there’s no standard definition of this condition, it is typically identified by:[4]
- Weight gain.
- Hypertriglyceridemia (when there is an excess of fat in the blood).
- Increased levels of insulin, glucose, and cholesterol.
Antipsychotic medications can contribute directly and indirectly to these metabolic changes. They can lead to multiple physiological and behavioral symptoms, which cause weight gain, insulin resistance, and altered glucose metabolism with long-term use. People taking antipsychotic medications are at greater risk of this if they already have diabetes or prediabetes.[4]
The physiological and behavioral symptoms that can lead to metabolic syndrome are the side effects described above. Increased appetite and sedation can result in:
- Overeating.
- Lack of satiation from food.
- Less physical activity.
Before developing into metabolic syndrome, these symptoms can initially cause obesity and insulin resistance, which is why they’re so often the focus of lifestyle interventions.[4][5] Metabolic monitoring in psychiatry is essential for catching these changes early.
Not everyone who takes mental health medication will develop metabolic syndrome because genetics and environment also play a part. Furthermore, psychiatric medication weight gain varies between drugs.[4]
For example, research finds that people who took clozapine and olanzapine gained the most weight, while those taking risperidone, haloperidol, and sertindole gained less.[4]
Adjusting your antipsychotic medication may help with diabetes risk, but metabolic health psychiatry indicates that lifestyle changes are important for risk prevention.
Managing Metabolic Syndrome With Lifestyle Psychiatry
Lifestyle psychiatry interventions are key to managing side effects of antipsychotics when medication can’t be significantly changed. This approach complements traditional medical treatment, with a focus on how daily habits can help shape health.
Lifestyle psychiatry can support your metabolic health through lifestyle optimization interventions. These are interventions that encourage a healthy diet and exercise. Weight gain caused by antidepressants and antipsychotic medications can often be addressed through these approaches.
Typically, the advice you’ll find for managing metabolic syndrome will be generic guidance for eating healthily, preventing weight gain, and promoting weight loss. You’ll usually be told to:[6]
- Eat a well-balanced diet.
- Exercise regularly.
- Avoid smoking and alcohol.
While this is excellent advice, it’s often easier said than done. Eating less and being active can feel counterintuitive when antipsychotic medications make you feel hungrier and more lethargic.
One way this can be made easier is by following a plan that is personalized to your food and exercise preferences. Healthy living is more sustainable when you make changes that fit your lifestyle rather than adopting drastic habits that feel impossible to maintain.[6][7]
Personalized lifestyle changes take your preferences, routines, and beliefs into account. This can improve health outcomes because it will be easier to commit to certain changes and appreciate their benefits.[8]
Personalizing Nutrition and Exercise Habits
With personalization in mind, here’s how you can implement healthier lifestyle changes and manage the side effects of your medication in a way that suits you:[7][9]
- If you live with someone, ask them if they want to make lifestyle changes together. If they’re also on board with new food choices and physical activities, you can keep each other accountable and enjoy the experiences together. Support groups can also fulfill the same role.
- Instead of generic healthy advice, specific strategies are usually more helpful for each side effect. For example, to tackle a high appetite caused by medication, eating foods high in protein and fiber can keep you fuller for longer.
- To help with cravings throughout the day, ensure you’ve already got enough healthy snacks at home. Planning your meals and meal times can also help reduce impulsive food choices throughout the day.
- Identifying your specific barriers can make healthy choices easier. For example, it may be easier to stick to a certain diet if there is minimal food preparation time.
Similarly, it may also help if all your food options are visible on your kitchen counter or if you have a set of pre-decided meals for the week. - Identifying more personalized benefits can be a real motivator. Instead of thinking “I’m doing this to lose weight”, try focusing on the daily gains. For instance, healthy behaviors will give you:
- Steadier energy levels throughout the day.
- Fewer intense hunger spikes.
- A longer feeling of fullness.
- Higher-quality sleep. These daily benefits are more tangible than long-term goals and may make it easier to stay motivated.
- Celebrating small gains and accepting you’ll have bad days are part of the journey. Small steps, like going for 10-minute walks outdoors, can still be beneficial and add up gradually.
Balancing Medication and Lifestyle Approaches
The health risks associated with medications can understandably discourage people from taking them and lead them to want to stop treatment entirely.
While mental health medications carry risks, adults can see a large improvement in their quality of life with the right prescription. Furthermore, going without medication entirely increases other health risks. The risks and benefits should be carefully balanced so that your treatment is genuinely improving your life.[4]
Treatment planning for antipsychotic side effects should always involve your prescriber. If you’re worried about adverse health effects, speak to them about your concerns. They should be able to tell you about:
- Alternative medications.
- Lower dosages.
- The different side effects you can expect.
You should never stop taking antipsychotic medication abruptly without consulting a physician.
Traditional medicine can coexist effectively with the lifestyle approach promoted in this article. Medical and lifestyle approaches can work together effectively, especially when care is personalized and considers the whole person.[8]
Mission Connection is here to help you or your loved one take the next steps towards an improved mental well-being.
Gain Support for Your Mind and Body With Mission Connection
At Mission Connection, traditional and holistic approaches are combined to treat each person individually. We offer a wide range of therapeutic approaches to suit your preferences and work with the understanding that well-being must be nurtured comprehensively.
This means that if you come for support for antipsychotic side effects like weight gain, treatment planning could include psychotherapy, lifestyle psychiatry guidance, group work, and more.
Our outpatient treatment is delivered in various ways, including in-person at our locations in California, Virginia, and Washington, virtually by telehealth, and as a hybrid program that combines in-person and virtual care. We accept insurance and are in-network with most major providers.
If you want to find out more about your mental health, you can take one of our free self-assessment quizzes. To speak with a caring member of our team, call 866-833-1822 or reach out to us online. We’re here to support you and help you find the treatment that’s right for your needs.
