Side Effects and Metabolic Syndrome Copy
Ask the client about a range of possible side effects. Closely monitor motor side effects, weight gain, sexual dysfunction and sedation. Some side effects can often be dealt with through simple strategies. These include:
| Symptom | Action to be Taken |
| Eyes sensitive to strong sun or light | Wear sunglasses, hat or visor; avoid prolonged exposure |
| Dryness of lips and/or mouth | Increase fluid intake; rinse mouth often with water; keep hard candies or sugarless gum handy |
| Occasional upset stomach | Drink small amounts of clear soda water; eat dry saltines or toast. |
| Occasional constipation | Increase water intake; increase physical exercise; eat leafy green vegetable or bran cereals, etc; drink lemon juice in warm water; occasionally take milk of magnesia or other milk laxative if suggested by your doctor or pharmacist |
| Tiredness | Take a brief rest period during the day; consult with your physician about switching entire daily dosage to bedtime |
| Dryness of skin | Use mild shampoo and soap; use hand and body lotion after bath; wear seasonal protective clothing |
| Mild restlessness, muscle stiffness or feeling slowed down | Exercise, take short walks; stretch muscles; relax to music |
| Weight gain | Increase exercise; watch diet and reduce overeating; monitor weight regularly |
When side effects are persistent or bothersome, this should always prompt a re-evaluation of the current prescribed medication. An appointment should be made with the prescribing physician to review medications and attempt to deal with any side effects that are not easily resolved.
Metabolic Syndrome
A common side effect of antipsychotic medication is weight gain. Of the atypical antipsychotics, clozapine and olanzapine appear to result in the greatest associated weight gain although weight gain with other antipsychotics may still be significant. Other medications may also lead to weight gain such as certain antidepressants and mood stabilizers (for example, paroxetine, valproic acid, mirtazepine and others).
Weight gain has been found to lead to non-compliance with medication as well as to medical complications. The medical complications that may occur with weight gain include abdominal obesity, impaired glucose regulation or type 2 diabetes, insulin resistance, high blood pressure, and high cholesterol. This cluster of symptoms is referred to as “metabolic syndrome” (or “syndrome X”) which is associated with an increased risk for cardiovascular diseases such as heart disease and stroke.
Enquiries about family and personal risk factors for developing metabolic syndrome (such as cardiovascular disease, smoking, diabetes or high cholesterol) should be made before initiating treatment. It may be appropriate to avoid antipsychotics known to cause more weight gain in individuals that are at higher risk for metabolic syndrome. Also prior to commencing treatment with antipsychotic medication, baseline lab work, weight and blood pressure should be taken. These measures should be repeated at regular intervals in order to detect any negative changes as early on as possible.
A sample of a typical tracking sheet for metabolic syndrome is attached here. This sheet incorporates the recommendations for the minimal frequency of assessments and includes targets to aim for (please note that targets for BMI and waist circumference are lower for adolescents and may vary by ethnicity).
It is easier to prevent metabolic syndrome than it is to treat it. Lifestyle changes that can help prevent metabolic syndrome should be discussed with both the client and family at the initiation of antipsychotic treatment. Recommendations for diet and physical activity should be specific and individualized taking into consideration current ability to engage in exercise (e.g., consider current physical fitness, negative symptoms such as avolition, medication side effects such as sedation, etc.). Clients should be encouraged to monitor their own weight (by weighing themselves or checking how their clothes fit) and report any weight gain they notice as early on as possible. It is significantly easier to reverse a weight gain of 2 or 3 kilograms than a weight gain of 10 or 15 kilograms.
Whenever symptoms of metabolic syndrome develop during treatment, lifestyle changes to diet and exercise should be further discussed and specific plans for change agreed upon. If lifestyle changes are not sufficient for improving symptoms and assuming antipsychotic medication withdrawal is not appropriate, then consideration should be given to switching antipsychotic medications or using pharmacological means to reverse changes (e.g., blood pressure medication, lipid-lowering drugs).
Review the medication section on the Mental Health Canada website.
Select one of the atypical antipsychotics and read over the information for that medication including side effect information.