Table 2.
Adverse effects of antipsychotics, antidepressants and mood stabilizers on specific physical health outcomes
| Physical disease/condition | Antipsychotics | Antidepressants | Mood stabilizers |
|---|---|---|---|
| Nutritional and metabolic diseases | |||
| Obesity | 0/+ (haloperidol, lurasidone, ziprasidone, aripiprazole) to +++ (clozapine, olanzapine, low potency FGAs) | − (bupropion) to + (mirtazapine, paroxetine, TCAs) | 0 (lamotrigine) to ++ (valproate, lithium) |
| Dyslipidemia | + to ++ | 0 to + (if weight gain) | − (valproate: cholesterol) to + |
| Endocrine system diseases | |||
| Diabetes | 0/+ (haloperidol, lurasidone, ziprasidone, aripiprazole) to +++ (clozapine and olanzapine > low and mid potency FGAs) | 0 to + | 0 to ++ (valproate) |
| Thyroid disorders | 0 | 0 | 0 to ++ (lithium) |
| Hyponatremia/SIADH | + | + to ++ (SSRIs) | 0 to + |
| Cardiovascular diseases | |||
| Hypertension | 0 to ++ | 0 to + (venlafaxine) | 0 |
| Coronary heart disease and stroke | + to ++ | 0 to + | 0 to + |
| Myocarditis | 0 to + (clozapine) | 0 | 0 |
| QTc prolongation/sudden cardiac death | 0 to + (thioridazine>sertindole > ziprasidone) | 0 to + ? | 0 |
| Respiratory tract diseases | |||
| Pneumonia | + to ++ (clozapine) | 0 | − (lithium) to 0 |
| Gastrointestinal diseases | |||
| Constipation | 0 to ++ (clozapine) | 0 to + (TCAs) | 0 |
| Liver dysfunction | 0 to ++ (often early and transient) | + | 0 to ++ (valproate > carbamazepine) |
| Neoplasms | |||
| Breast cancer | 0 to + ? | 0 | 0 |
| Prolactinoma | 0? | 0 | 0 |
| Musculoskeletal diseases | |||
| Osteoporosis/fractures | 0 to + (prolactin-raising antipsychotics) | + | − (lithium) to 0 |
| Hematologic diseases | |||
| Leucocytopenia/agranulocytosis | + to +++ (clozapine) | 0 to + | 0 to ++ (carbamazepine) |
| Thrombocytopenia | 0 | 0 | 0 to ++ (valproate) |
| Other physical diseases | |||
| Kidney diseases | 0 | 0 | 0 to ++ (lithium) |
| Movement disorders | + to +++ | 0 to + | 0 to + |
| Seizure disorders | + to ++ (clozapine) | 0 to + (TCAs > bupropion) | − to + (lithium toxicity) |
− = reduction; 0 = likely/generally no effect; + = some effect; ++ = moderate effect; +++ = marked effect, ? = questionable
SIADH – syndrome of inadequate antidiuretic hormone secretion, FGAs – first-generation antipsychotics, SSRIs – selective serotonin reuptake inhibitors, TCAs – tricyclic antidepressants