Metabolic syndrome with the atypical antipsychotics

Curr Opin Endocrinol Diabetes Obes. 2010 Oct;17(5):460-6. doi: 10.1097/MED.0b013e32833de61c.


Purpose of review: Metabolic syndrome and cardiovascular diseases are important causes of morbidity and mortality among patients with severe mental illnesses. Atypical or second-generation antipsychotics (SGAs) are associated with obesity and other components of metabolic syndrome, particularly abnormal glucose and lipid metabolism. This review aims to provide a summary of recent evidence on metabolic risks associated with SGAs, current recommendations for metabolic monitoring, and efficacy of treatment options currently available.

Recent findings: Studies have identified younger, antipsychotic-naive patients with first-episode psychosis as a population vulnerable to adverse metabolic effects from SGAs. These patients gained more weight and developed evident lipid and glucose abnormalities as soon as 8-12 weeks after treatment initiation. Findings are more striking among children and adolescents. The differential effects of various SGAs are well described, with clozapine and olanzapine associated with the highest metabolic risk. In addition to behavioral therapy, emerging data suggest that pharmacological therapy, most notably metformin, is efficacious in the treatment and possibly prevention of SGA-associated metabolic derangements.

Summary: More data have become available on the burden from metabolic complications associated with SGAs. New and effective treatment options are required in the near future to improve cardiovascular health in this susceptible population.

Publication types

  • Review

MeSH terms

  • Antipsychotic Agents / adverse effects*
  • Antipsychotic Agents / therapeutic use
  • Benzodiazepines / adverse effects
  • Benzodiazepines / therapeutic use
  • Cardiovascular Diseases / chemically induced
  • Cardiovascular Diseases / drug therapy
  • Clozapine / adverse effects
  • Clozapine / therapeutic use
  • Humans
  • Metabolic Syndrome / chemically induced*
  • Metabolic Syndrome / drug therapy
  • Metabolic Syndrome / metabolism
  • Metformin / therapeutic use
  • Obesity / chemically induced*
  • Obesity / drug therapy
  • Obesity / metabolism
  • Olanzapine
  • Practice Guidelines as Topic
  • Psychotic Disorders / drug therapy*
  • Psychotic Disorders / metabolism
  • Severity of Illness Index
  • Weight Gain / drug effects


  • Antipsychotic Agents
  • Benzodiazepines
  • Metformin
  • Clozapine
  • Olanzapine