Provide better physical health support with psychiatric medications

Patients taking prescribed psychiatric medication, such as antidepressants and mood stabilisers, need better ongoing physical health monitoring and support, say doctors writing in a new Lancet Commission.

The findings provide an updated and practical guide for clinicians on how to reduce the burden of side effects such as diabetes and weight gain caused by psychiatric medications.

Full physical health assessment when treatment is first prescribed

The recommendations include new monitoring and management measures such as a full physical health assessment when treatment is first prescribed, early monitoring such as weight checks within four weeks, and ongoing tracking of cardiometabolic markers, including blood sugar, cholesterol, and blood pressure to prevent conditions such as diabetes and other cardiometabolic conditions.

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The report is one of two papers published in the Lancet Psychiatry Physical Health Commission which look at monitoring the physical health of people prescribed psychiatric medication and lifestyle interventions in mental health care.

The work highlights the need for mental health patients to have holistic rather than fragmented health care provision and could lead to improved quality of life for many individuals prescribed antipsychotic medications.

Medications, including antipsychotics, mood stabilisers, and antidepressants, which are essential in the treatment of many mental health conditions, can cause significant physical side effects that often go unnoticed in routine care.

Weight gain can contribute to diabetes

Many patients taking psychotropic medications put on weight which contributes to the development of metabolic conditions such as diabetes.

The new work warns that the side effects can impact physical health and quality of life, and may trigger some patients to stop taking their medication, compromising the associated benefits of treatment.

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The Commission, co-led by experts from King’s College London, the University of Oxford, and the University of Queensland, conducted a systematic review of the available evidence, covering 11 key areas of side effects, including metabolic, cardiovascular, renal, sexual, and neurological complications.

The report outlines practical steps for healthcare providers, calling for proactive prevention, shared decision-making and better coordination of care to help clinicians act quickly and consistently to protect patients’ physical health. It also includes feedback from service users, who say that while advice on diet and exercise is common, putting it into practice is often difficult without support. Patients cite barriers such as severe depression and the lethargy or sedation caused by many medications.

Dr Toby Pillinger, Academic Clinical Lecturer at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London, and a senior author on the Commission, said: ‘Psychiatric medications save lives and help people regain stability in their daily lives – but they can also cause serious physical side effects. Too often, these are seen as the cost of treatment, or worse, ignored altogether.

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‘This Commission is about saying that patients deserve better. With simple monitoring and timely interventions, we hope to reduce the burden of side effects and improve long-term outcomes.’