Putting Metabolic Side Effects Into Perspective: Risks Versus Benefits of Atypical Antipsychotics

The lengthy list of the side effects and morbidity associated with the atypical antipsychotics mightmake a patient with psychosis and his or her caregivers so concerned about the use of any of thesemedications, particularly those associated with a higher risk of diabetes, weight gain, or increasedlipid levels, that they would prefer to avoid all of them. However, schizophrenia is associated with arelatively high risk for several diseases, including diabetes, that is independent of the risks that arelinked to atypical antipsychotic use. Therefore, the clinician who might think, “Why use atypicals ifusing the typical drugs will escape the problems of monitoring and all the associated effects of diabetesand hyperglycemia?” needs to know that these problems cannot be avoided simply by choosingtypical antipsychotics. Clinicians, patients, and concerned family members must balance the significantbenefits of atypical antipsychotic treatment—improved cognition, reduced suicidality, and lessdepression—against the risks of metabolic disturbances and select a course of treatment that includesa realistic monitoring program.