CNS Drugs

, Volume 23, Issue 12, pp 1003–1021 | Cite as

Adverse Endocrine and Metabolic Effects of Psychotropic Drugs

Selective Clinical Review
  • Chaya G. Bhuvaneswar
  • Ross J. Baldessarini
  • Veronica L. Harsh
  • Jonathan E. Alpert
Review Article


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.


Clozapine Olanzapine Quetiapine Topiramate Aripiprazole 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.

Supplementary material

40263_2012_23121003_MOESM1_ESM.pdf (16 kb)
Supplementary material, approximately 16 KB.


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Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Chaya G. Bhuvaneswar
    • 1
  • Ross J. Baldessarini
    • 2
    • 3
  • Veronica L. Harsh
    • 4
  • Jonathan E. Alpert
    • 2
  1. 1.Department of PsychiatryUniversity of PennsylvaniaPhiladelphiaUSA
  2. 2.Departments of PsychiatryHarvard Medical School and Massachusetts General HospitalBostonUSA
  3. 3.McLean HospitalBelmontUSA
  4. 4.Behavioral Endocrinology BranchNational Institute of Mental HealthBethesdaUSA

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