Prevalence and effective interventions to manage cardiovascular and metabolic side effects in patients using anti‐depressants or antipsychotic medication: a systematic review

Introduction: Cardiovascular diseases have been reported to be a major cause of death in patients with mental health conditions. Prevalence studies indicate that modifiable cardiovascular risk factors such as diabetes, abnormal lipid profile, glycaemic abnormalities and weight gain are highly prevalent in patients with psychotic illness such as schizophrenia and depression. Although the exact underlining cause of cardiovascular complications in patients with mental conditions is not well defined, there is a growing body of evidence, which has addressed the possible association between the use of antipsychotics, antidepressants and the increased incidence of cardiovascular disease (CVD) in people using these medications.[1]

Aim: The aim of the present review was to identify the prevalence of cardiovascular and metabolic side effects and most effective interventions that mitigate the risks amongst the users of antipsychotic and antidepressant drugs. In addition, the study aimed to highlight the potential causes for under‐management of cardiovascular side effects in people using antipsychotic and antidepressant drugs.

Review method: A narrative synthesis approach of quantitative and qualitative evidence was adopted. A systematic literature search was conducted in the following electronic databases: MEDLINE, EMBASE, Cochrane Library and CINAHL covering the period [2003–2018]. Hand searching of key papers was undertaken along with cross referencing search.

Results: The review identified two main utilised approaches that intended to manage cardiovascular side effects of antipsychotic drugs. Pharmacologic interventions based mainly on using drugs that attenuate or reverse side effects of antipsychotic agents such as metformin. Other approaches categorised as non‐pharmacologic interventions that aim to modulate behaviours that associate with negative effects on metabolic parameters. The analysis suggests that effect change favoured the interventions over the control; however, the change was generally small. Pharmacologic approaches mainly adjunctive therapy with metformin and switching antipsychotic drugs have shown to be the most effective in managing metabolic side effects. The review identified several factors that might influence effective implementation of the different approaches to manage the associated side effects. These include healthcare providers’ attitude and awareness towards the side effects of psychotropic drugs primarily the metabolic effects.

Conclusion: Cardiovascular and metabolic side effects remain highly prevalent among people using antipsychotic and antidepressant drugs. There is a need to address the factors that may negatively influence the effective management of the cardiovascular adverse effects associated with antipsychotic drugs. The results of this review will provide information regarding prevalence of cardiovascular and metabolic side effects of antipsychotic and antidepressant drugs. Such results are likely to be of use to clinicians prescribing these agents, patients and guideline development.

References

1. Wu C‐S, Tsai Y‐T, Tsai H‐J. Antipsychotic drugs and the risk of ventricular arrhythmia and/or sudden cardiac death: a nation‐wide case‐crossover study. J Am Heart Assoc [Internet]. 2015 Feb 23 [cited 2018 Jul 11];4(2):e001568. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25713294