Ebru FINDIKLI, Filiz İZCİ, Mehmet Akif CAMKURT, Ali ÇETİNKAYA, Hüseyin Avni FINDIKLI, Murad ATMACA

The frequency of metabolic syndrome in psychiatric patients using antidepressant medications

Objective: There are limited studies investigating the metabolic syndrome (MS) in patients using antidepressants. This study examines and compares the prevalence of MS and related factors in psychiatric patients taking various antidepressants at an outpatient clinic. Methods: The study comprised a total of 70 patients using fluoxetine, paroxetine, sertralin, citalopram, essitalopram, clomipramine and venlafaxine aged 18- 60 years with depressive and anxiety disorder. MS rates of patients (according to National Cholesterol Education Program-Adult Treatment Panel III-(NCEP III)) who met the study criteria were obtained. Results: In our study metabolic syndrome frequency was 32.8% in total patient groups according to NCEP-III criteria. The higher metabolic syndrome frequency was found in drug groups such as clomipramine, paroxetine and venlafaxine groups. The safest drug for metabolic syndrome was fluoxetine as seen in its relevant group. Conclusion: Conventional antidepressants may cause metabolic syndrome which is important for mortality, morbidity and quality of life of psychiatric patients.

Antidepresan kullanan psikiyatrik hastalarda metabolik sendrom sıklığ

Amaç: Antidepresan kullanan hastalarda metabolik sendrom (MS) varlığını araştıran çalışma sayısı kısıtlıdır. Bu çalışma ile polikliniğe başvuran ve çeşitli antidepresan kullanan psikiyatrik hastalarda MS ve ilişkili faktörlerin oran- larını araştırmak ve karşılaştırmak amaçlanmıştır. Yöntem: Çalışma fluoksetin, paroksetin, sertralin, citalopram, essitalopram, klomipramin, venlafaksin kullanan 18-60 yaş arası depresif ve anksiyete bozukluğuna sahip 70 hasta- dan oluşmuştur. Çalışma ölçütlerine uyan hastaların açlık kan şekerleri, kan trigliserit ve kolesterol düzeyleri, ortala- ma kan basıncı, vücut kitle indeksi, bel çevresi ve Ulusal Kolesterol Eğitim Programı – Erişkin Tedavi Paneli III’e göre (NCEP-III) MS oranları tespit edildi. Sonuç: NCEP-III’e göre tüm hastalardaki MS sıklığı %32,8 idi. En yüksek metabolik sendrom oranları klomipramin, paroksetin ve venlafaksin gruplarında saptandı. Fluoksetin grubu metabo- lik sendrom açısından en güvenli ilaç olarak saptandı. Tartışma: Klasik antidepresanlar metabolik senrom oranlarını artırmaktadır ve bu da psikiyatrik hastaların mortalite, morbidite ve yaşam kalitesini etkilemesi açısından oldukça önemlidir.

PDF

___

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62(6):593-602.
McIntyre RS, Park KY, Law CW, Sultan F, Adams A, Lourenco MT, et al. The association between conventional antidepressants and the metabolic syndrome: a review of the evidence and clinical implications. CNS Drugs 2010; 24(9):741-753.
Cameron AJ, Shaw JE, Zimmet PZ. The metabolic syndrome: prevalence in worldwide populations. Endocrinol Metab Clin North Am 2004; 33(2):351- 375.
Grundy SM. Metabolic syndrome pandemic. Arterioscler Thromb Vasc Biol 2008; 28(4):629-636.
Diminic-Lisica I, Popovic B, Rebic J, Klaric M, Franciskovic T. Outcome of treatment with antidepressants in patients with hypertension and undetected depression. Int J Psychiatry Med 2014; 47(2):115-129.
McIntyre RS, Soczynska JK, Konarski JZ, Kennedy SH. The effect of antidepressants on lipid homeostasis: a cardiac safety concern? Expert Opin Drug Saf 2006; 5(4):523-537.
McIntyre RS, Soczynska JK, Konarski JZ, Kennedy SH. The effect of antidepressants on glucose homeostasis and insulin sensitivity: synthesis and mechanisms. Expert Opin Drug Saf 2006; 5(1):157-168.
Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry 2009; 66(8):848-856.
Virk S, Schwartz TL, Jindal S, Nihalani N, Jones N. Psychiatric medication induced obesity: an aetiologic review. Obes Rev 2004; 5(3):167-170.
Guelfi JD, Ansseau M, Timmerman L, Korsgaard S, Mirtazapine-Venlafaxine Study G. Mirtazapine versus venlafaxine in hospitalized severely depressed patients with melancholic features. J Clin Psychopharmacol 2001; 21(4):425-431.
Derijks HJ, Heerdink ER, Janknegt R, De Koning FH, Olivier B, Loonen AJ, et al. Visualizing pharmacological activities of antidepressants: a novel approach. Open Pharmacol J 2008; 2:54-62.
Levkovitz Y, Ben-shushan G, Hershkovitz A, Isaac R, Gil-Ad I, Shvartsman D, et al. Antidepressants induce cellular insulin resistance by activation of IRS-1 kinases. Mol Cell Neurosci 2007; 36(3):305- 312.
Jensen MD. Role of body fat distribution and the metabolic complications of obesity. J Clin Endocrinol Metab 2008; 93(11 Suppl.1):S57-63.
Yosmaoğlu A, Fıstıkcı N, Keyvan A, Hacyo?lu M, Erten E, Saatçioğlu Ö, et al. Correlation of selective serotonin re-uptake inhibitor use with weight gain and metabolic parameters. Anadolu Psikiyatri Derg 2013; 14(3):245-251.
Canadian Pharmacist Association. Compendium of pharmaceuticals and specialties. Ottawa (ON): Canadian Pharmacist.
Beyazyuz M, Albayrak Y, Egilmez OB, Albayrak N, Beyazyuz E. Relationship between SSRIs and Metabolic Syndrome Abnormalities in Patients with Generalized Anxiety Disorder: A Prospective Study. Psychiatry Investig 2013; 10(2):148-154.
Raeder MB, Bjelland I, Emil Vollset S, Steen VM. Obesity, dyslipidemia, and diabetes with selective serotonin reuptake inhibitors: the Hordaland Health Study. J Clin Psychiatry 2006; 67(12):1974-1982.
Ye Z, Chen L, Yang Z, Li Q, Huang Y, He M, et al. Metabolic effects of fluoxetine in adults with type 2 diabetes mellitus: a meta-analysis of randomized placebo-controlled trials. PloS One 2011; 6(7):e21551.