Drugs that can Cause Metabolic Syndrome: Part 2 Steroids, Antidepressants, Anti-seizures

Posted on by Jesse Santiano, M.D.

Part 1 of this series mentioned commonly used drugs for hypertension, diabetes, and hypercholesterolemia that can cause metabolic syndrome.

Metabolic syndrome constellates five conditions: hypertension, obesity, high blood sugar, low HDL, and high triglycerides. These five conditions work together in several combinations and bring out many common chronic complicated diseases.

This article talks about drugs for mental health, anti-epilepsy medicines, and immune suppressants and their role in causing metabolic syndrome.

Antipsychotics

Antipsychotics are prescribed to psychiatric patients with depression, bipolar disorders, and schizophrenia, and developmental disorders.

Atypical antipsychotics like Olanzapine, ziprasidone, and aripiprazole are being prescribed in a rising trend in children for off-label indications like attention deficit hyperactivity disorder ADHD.

Patients on antipsychotics are almost twice as likely to develop obesity and diabetes, and hyperlipidemia than the general population.

Clozapine and Olanzapine cause the top weight gainers, followed by risperidone and quetiapine. Ziprasidone and aripiprazole are associated with the least weight gain.

These medicines affect the neurotransmitters in the brain. Neurotransmitters are chemicals that transmit information and allows communication between nerve cells.

Norepinephrine, dopamine, and histamine-H1 receptors are some examples of neurotransmitters that also regulate appetite and satiety.

 

Antidepressants

Tricyclic antidepressants like amitriptyline and monoamine oxidase inhibitors are associated with the most significant weight gain. Fortunately, these drugs are not very popular anymore.

Paroxetine, a selective serotonin reuptake inhibitor or SSRI, is the most likely to induce weight gain among its class. Bupropion is associated with long-term weight reduction.

 Antiseizure

Antiseizure medications are prescribed for epilepsy or seizures and are used for bipolar disorders, migraines, and diabetic neuropathy.

Diabetic neuropathy is a nerve complication of chronic diabetes. It results in abnormal or loss of sensation of the feet and hands. Numbness of the feet commonly results in unnoticed infections that later progress to gangrene and amputations.

Valproate (Depakene, Stavzor, Depacon, Depakote) decreases the metabolic rate. The result is a slower burning of calories and weight gain.

Gabapentin is also indicated for seizures and neuropathic pain. In high doses, it can also cause significant weight gain.

In contrast, topiramate or Topamax is associated with weight loss.

Immunosuppressive medications

Immunosuppressive medications control inflammation present in acute and chronic asthma and chronic obstructive lung diseases like emphysema.

Immunosuppressants are used to prevent the rejection of transplanted organs. Cyclosporine and tacrolimus are examples.

Cyclosporine affects the pancreatic cells that produce insulin in a dose-dependent manner.  Less insulin production leads to high blood sugar levels and potentially diabetes.

Tacrolimus causes high blood sugar and types 2 diabetes more so than cyclosporine.

Steroids like prednisone are used for asthma and chronic lung diseases like emphysema. They are known to elevate blood sugars and can also cause diabetes. Not only that, but they also cause hypertension and increase cholesterol levels.

Take-Away Message

People who take medicines that can cause metabolic syndrome should have their cardiovascular risk profiles regularly checked. Fasting lipid profiles, and fasting blood sugar, and weights should be monitored.

Adopting a healthy lifestyle with intermittent fasting and eating in moderation and plenty of physical activity can prevent or lessen medication dependence.

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