The Medication ‘Catch 22’
Certain medications that are used to treat depression can increase metabolic risk.
Some types of antidepressants — including tricyclics, mirtazapine (Remeron), and certain selective serotonin reuptake inhibitors (SSRIs) such as escitalopram (Lexapro) and paroxetine (Paxil) — carry the risk of weight gain that can worsen type 2 diabetes outcomes over time. And antipsychotics that are sometimes used to treat depression — in particular, olanzapine (Zyprexa) and quetiapine (Seroquel) — have been associated with weight gain, insulin resistance, and high cholesterol.
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“Discussing the metabolic effects of psychiatric medications with my patients is one of the most sensitive topics,” Goel says. But the metabolic risks of some medications are often outweighed by the dangers of not getting effective treatment for mental health issues, she says. “Untreated depression in diabetics can negatively affect A1C, blood pressure, cardiovascular risk factors, quality of life, and other measures.”
Goel’s approach is to selectively use medications with favorable metabolic profiles, such as bupropion (which may assist with weight control), serotonin and norepinephrine reuptake inhibitors (SNRIs) or other SSRIs like fluoxetine (Prozac) — and monitor weight, fasting glucose, and cholesterol, working closely with the patient’s endocrinologist.
“Patients should ask their psychiatrist about the metabolic profile of any medication they consider, request baseline metabolic labs, and recognize that medication choices vary,” Goel says. “Refusing psychiatric care due to metabolic risks without this thorough discussion is not advised.”