Have you ever heard of metabolic syndrome? It’s something you should know about if you take antipsychotic medications. All of the antipsychotic medications increase the risk of developing metabolic syndrome. Some do it more than others.

Metabolic syndrome is not a disease, but it’s a set of risk factors that increase your risk of heart disease, diabetes and stroke.

Here are the five risk factors that constitute metabolic syndrome.
1. Increase waist circumference Men greater than 40 inches
Women greater than 35 inches
You get this number by using a tape measure. You start at your hip bone and wrap it around your waist at the level of your navel.

2. Increased blood pressure of greater than 135/85
3. Triglyceride level greater than 150 mg/dL
4. HDL cholesterol less than 40 mg/dL in men
less than 50 mg/dL in women

HDL is considered good because it absorbs excess cholesterol and carries it back to the liver for processing. So high levels of HDL actually lower your risk of heart attack and stroke. This is why having a high total cholesterol isn’t necessarily bad. It depends on how high it is. But if you have a high HDL, it’s going to raise your total cholesterol. LDL cholesterol is considered bad because when you have too much of it, it can deposit itself on your artery walls and create plaques that narrow your arteries. This contributes to heart disease and risk of stroke. So you want to keep you LDL as low as possible.

5. Fasting blood glucose equal or greater than 100mg/dL
This is a measure of how much glucose or sugar you have in your blood when you haven’t eaten anything for at least 8 hours. Insulin is the hormone produced by the pancreas that processes the glucose from the food you eat.

Glucose levels
Normal = Blood glucose under 100mg.
Prediabetes = Blood glucose of 100-125
Diabetes = Blood glucose greater than 126mg/dl

According the American Heart Association, you need 3 out of five of these to be diagnosed with metabolic syndrome.

What makes this happen?
There are medical conditions that can cause metabolic syndrome, and obesity is a common one.

What does it mean to be obese?
Obesity is defined by your body mass index (BMI).
BMI = weight in kilograms/height in meters2

There are handy calculators online that make it easy for you to input your height in feet and inches and your weight in pounds without having to convert to metric units.
BMI Ranges
Normal – 18.5 – 24. 9
Overweight - 25 – 29.9
Obese - 30 or greater

There are many things that can lead to obesity. But in psychiatry, the antipsychotic medications we use can cause a lot of weight gain and lead to metabolic syndrome.

A 2017 article ranked the antipsychotic medications in order of weight gaining tendency.
The three causing the greatest weight gain were:
Clozapine
Olanzapine
Chlorpromazine

References
Douma LG, Gumz ML. Circadian clock-mediated regulation of blood pressure. Free Radic Biol Med. 2018;119:108-114. doi:10.1016/j.freeradbiomed.2017.11.024

Dayabandara M, Hanwella R, Ratnatunga S, Seneviratne S, Suraweera C, de Silva VA. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatr Dis Treat. 2017;13:2231-2241. Published 2017 Aug 22. doi:10.2147/NDT.S113099

Mitchell AJ, Vancampfort D, De Herdt A, Yu W, De Hert M. Is the prevalence of metabolic syndrome and metabolic abnormalities increased in early schizophrenia? A comparative meta-analysis of first episode, untreated and treated patients. Schizophr Bull. 2013 Mar; 39(2):295-305.

Bazo-Alvarez JC, Morris TP, Carpenter JR, Hayes JF, Petersen I. Effects of long-term antipsychotics treatment on body weight: a population-based cohort study [published online November 14, 2019]. J Psychopharmacol. doi:10.1177/0269881119885918

Feingold KR, Grunfeld C. Introduction to Lipids and Lipoproteins. [Updated 2018 Feb 2]. In: Feingold KR, Anawalt B, Boyce A, et al., editors. Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000-. Available from: https://www.ncbi.nlm.nih.gov/books/NB...

Grajales D, Ferreira V, Valverde ÁM. Second-Generation Antipsychotics and Dysregulation of Glucose Metabolism: Beyond Weight Gain. Cells. 2019;8(11):1336. Published 2019 Oct 29. doi:10.3390/cells8111336



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