The Importance of Metabolic Psychiatry in Clinical Practice

 

Dr. Sarath Panduwawala and Dr. Ruwan M Jayatunge

Metabolic psychiatry is a new field in psychiatry, and it examines mental health issues associated with metabolic dysfunction. Current evidence indicates an association between metabolic dysfunction in the brain and mental illness (Smith, 2024).

Metabolic syndrome also has a huge impact on mental health. The metabolic syndrome, which is connected with abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein, has an impact on mental health parameters. Although metabolic syndrome is associated with the risk of developing cardiovascular disease and type 2 diabetes, it can cause psychiatric morbidity (Bolton et al., 2013).

Clinical evidence indicates that psychiatric conditions have increased risk for metabolic syndrome (Penninx & Lange, 2018). According to Ho and colleagues (2014), the cause of metabolic syndrome in psychiatric patients is likely to be multifactorial, and psychotropic drugs such as second-generation antipsychotics and mood stabilizers are established risk factors. Antipsychotic-induced weight gain is an existing problem in treating psychiatric patients. Mood stabilizers, particularly lithium and sodium valproate, have been associated with metabolic syndrome (Chang et al., 2009). 

Takeuchi and team (2009) state that metabolic syndrome is associated with increased prevalence of depressive disorder and depressive symptoms, and prevalence ranges from 36 to 50%. Tricyclic antidepressants can cause insulin resistance and hypertriglyceridemia, and patients can experience substantial weight gain (Chokka, Tancer & Yeragani, 2006).

The patients with bipolar disorder have a higher risk of metabolic syndrome than the general population (Chi et al., 2013). As described by Kim and team (2007), dysregulation of the HPA axis with subsequent glucocorticoid resistance, impaired glucose tolerance and insulin resistance, dysregulation of the sympathetic nervous system, and increased pro-inflammatory cytokine production across both phases of bipolar disorder could cause significant negative effects on metabolism. 

Schizophrenia is associated with a greater risk of diabetes mellitus (de Hert et al 2009). Metabolic syndrome is common among people with schizophrenia, and the prevalence is around 5 times higher than that in the general population (Ho et al., 2014).

Yaffe and team (2004) elucidate that metabolic syndrome is associated with cognitive decline, Alzheimer’s disease, and vascular dementia, and the effects could be due to neuroinflammation, oxidative stress, impaired glucose metabolism, and impairment of vascular reactivity. Therefore, identifying and treating metabolic dysfunction in psychiatric patients are essential. Promoting healthy lifestyle practices, diet modification, moderate exercise, and weight management are crucial.

Metabolic Psychiatry discusses the ways to evade the risk of premature mortality in psychiatric patients. The metabolic approach to mental health treatment is imperative. According to Greenblatt (2023), metabolic psychiatry focuses on the removal of processed foods and refined carbohydrates, often implementing a ketogenic diet for the metabolic benefits. The brain chemistry can be changed with optimal nutrition. 

 

(Dr. Sarath Panduwawala is a retired Consultant Psychiatrist who served as a visiting psychiatrist of the Sri Lanka Army.  Dr. Ruwan M Jayatunge is a medical doctor and a Psychologist also a member of the (APA) American Psychological Association)

 

 

REFERENCES

 

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Smith, D. (2024).Metabolic Psychiatry – A new paradigm in the management of Mental Health disorder? Retrieved from https://www.swissre.com/reinsurance/insights/metabolic-psychiatry-management-mental-health-disorder.html

Takeuchi, T, Nakao, M, Nomura, K et al (2009) Association of the metabolic syndrome with depression and anxiety in Japanese men: a 1-year cohort study. Diabetes/Metabolism Research and Reviews, 25: 762–7.

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