What Are Psychotropic Drugs?
Psychotropic drugs are medications prescribed to improve a patient’s mood, perception, behavior and emotions. These may consist of:
- Antipsychotics for the treatment of schizophrenia
- Atypical antipsychotic drugs for bipolar disorders
- Antidepressants like monoamine oxidase inhibitors (MAOIs) such as phenelzine and isocarboxazid
- Selective serotonin reuptake inhibitors (SSRIs) like venlafaxine and paroxetine
- Mood stabilizers like lithium and sodium valproate
These drugs usually act by improving the balance of natural chemicals in the brain known as neurotransmitters and by blocking receptors to which these substances interact.
Side Effects of Psychotropic Drugs Related to Diabetes
Among the side effects related to diabetes noted with the use of psychotropics are:
- Weight gain, elevated body mass index (BMI) and obesity
- Increased blood sugar levels (hyperglycemia)
- Increased insulin levels (hyperinsulinemia)
- Diabetic ketoacidosis
- Elevated total cholesterol and triglycerides
Diabetes-related side effects have been observed to occur rapidly with the use of psychotropic drugs, most especially with typical antipsychotics like clonazepine and olanzapine. The risk for these side effects seem to be less for atypical antipsychotics like risperidone, quetiapine and ziprasidone although there have been fewer studies done on these drugs.
The side effects psychotropic drugs related to diabetes and high blood sugar have been established after observations that these effects start right after the commencement of their intake and the rapid disappearance or improvement of these effects after withdrawal of the drugs or switching to other drugs.
How Do Psychotropic Drugs Increase Blood Sugar Levels?
The mechanisms proposed on how antipsychotics, antidepressants and other mood-altering drugs affect blood sugar levels and lead to diabetes include:
- Weight gain – the onset of type 2 diabetes is often associated with a significant increase in BMI and obesity which occur after the intake of psychotropics
- Insulin resistance – a decrease in glucose utilization by the cells despite elevations of insulin production leads to high blood sugar levels
- Rapid and disproportionate increase in leptin levels (a substance released from fat cells) - leads to an imbalance of hypothalamic hormone regulation; this effect inhibits the normal effect of leptin which is to suppress the appetite and cause the breakdown of fat cells
Management of Diabetes and Psychotropic Drug Intake
Patients who need effective control of symptoms of schizophrenia, bipolar disorders, chronic depression and other behavioral and mood problems usually benefit from the intake of psychotropic drugs which may need several weeks or months to work. However, diabetes-related side effects such as high blood sugar levels, weight gain and high cholesterol levels may occur in these patients. Therefore, management of these patients should include:
- Screening of patients at risk for side effects, namely: age over 45, sedentary habits, family history of diabetes, smoking, ethnicity, BMI greater than 25, base line blood sugar and lipid levels
- Regular monitoring of weight gain, blood sugar and lipid levels
- Proper advice on lifestyle management concerning diet, exercise, smoking, alcohol intake and stress management
- Maintaining adequate blood sugar control by using diabetes medications
- Switching to psychotropic meds with less diabetes-related side effects like risperidone
It is important to note that since high blood sugar levels and obesity are related to high calorie, high carbohydrate diets and sedentary lifestyle these effects are highly preventable even with the intake of medications that are highly recommended for the control of psychiatric symptoms.
Mental Health Reviews, “Diabetes And Psychiatry: The Interface”, https://www.psyplexus.com/excl/diabetes_psychiatry_2.html
Archives of Internal Medicine “Antipsychotic Drugs and Hyperglycemia in Older Patients with Diabetes”, https://archinte.ama-assn.org/cgi/content/short/169/14/1282