A yearlong study of 510 young patients found that some widely used second-generation antipsychotics were associated with changes in cholesterol, blood sugar and triglycerides that could not be explained solely by changes in weight or body fat.
The findings, published Monday in Nature Mental Health, add to concerns about the cardiometabolic effects of medications used to treat severe mental illness in children and adolescents. The researchers said the results support monitoring that looks beyond weight alone.
The study followed patients ages 4 to 17 who were starting, restarting, or switching to second-generation antipsychotics. Most had little or no prior exposure to the drugs, and researchers used plasma concentrations to verify medication adherence. Changes in body composition and markers of glucose and lipid metabolism were assessed repeatedly over 12 months.
Effects Differed Among Medications
After accounting for changes in body composition, the researchers found increases in total cholesterol, fasting glucose and triglycerides. Those associations were most pronounced with olanzapine, appeared to a lesser extent with risperidone, and were less evident with quetiapine and aripiprazole.
Increased insulin resistance, by contrast, was more closely associated with changes in body composition, according to the study.
The distinctions matter because metabolic syndrome is a group of conditions that can include high blood sugar, abnormal cholesterol or triglyceride levels, high blood pressure, and excess abdominal fat. Together, those conditions increase the risk of heart disease, diabetes and stroke.
The risks are also recognized in federal drug information. MedlinePlus warns that olanzapine may increase blood sugar and blood fat levels, and that teenagers taking it are more likely than adults to experience weight gain and elevated blood fats.
Study Does Not Prove Cause and Effect
The research was a naturalistic clinical study, not a trial in which patients were randomly assigned to medications. It can identify associations but cannot, by itself, prove that a particular drug caused every metabolic change.
The results also do not mean that every child taking one of the medications will experience the same effects. The findings describe group-level patterns, while an individual patient’s response can differ based on the medication, dose, underlying condition, and other health factors.
The authors nevertheless concluded that some second-generation antipsychotics may affect metabolism through pathways connected to changes in body composition and through pathways independent of those changes.
Why Weight Alone May Not Be Enough
Weight and body mass index can provide visible signs of metabolic risk, but the study suggests that relying on them alone could miss changes in fasting glucose, cholesterol or triglycerides.
The researchers called for cardiometabolic monitoring beyond weight and for the development of safer treatment alternatives. For families, that may mean asking the prescribing clinician which measurements and laboratory tests are being followed, how often they are checked, and what findings would prompt a change in the treatment plan.
The study does not instruct patients to stop or change medication. MedlinePlus advises patients not to stop taking olanzapine without first talking to their doctor. Parents and patients should discuss concerns, symptoms, or treatment changes with the prescribing medical professional.
Provided by Dallas Express
