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.