Psychopharmaka-induzierte unerwünschte Wirkungen in der Ernährungstherapie

Zusammenfassung

Metabolische Effekte von Psychopharmaka sind sehr häufig – dies gilt insbesondere für appetitsteigernde Wirkungen und die Zunahme von Körpergewicht. Besonders stark mit einer Gewichtszunahme assoziiert sind Antipsychotika (Neuroleptika) und einige Antidepressiva (Mirtazapin, Lithium, Trizyklika). Resultierende metabolische Veränderungen sind häufig klinisch relevant, da sie sich negativ auf die kardiovaskuläre Morbidität und Mortalität auswirken können. Insbesondere bei Patienten unter Therapie mit Antipsychotika sollten regelmäßig Kontrolluntersuchungen durchgeführt werden (Körpergewicht, Blutdruck, Blutzuckerspiegel, Cholesterin, Leber-/Nierenfunktion). Wirkstoffspezifische metabolische Nebenwirkungen können antizipiert und durch geeignete Ernährungs- und Verhaltensinterventionen abgemildert oder verhindert werden. Alternativ sollte ärztlicherseits auch ein Wirkstoffwechsel erwogen werden, falls die Nebenwirkungen die Lebensqualität des Patienten relevant beeinträchtigen. Bei Unwirksamkeit anderer Maßnahmen zur Gewichtskontrolle kann die Anwendung von Orlistat bzw. Metformin (off-label) versucht werden.

Abstract

Metabolic effects of psychotropic drugs are very common – which primarily is the case due to appetite-enhancing and body weight increasing effects. In particular, use of antipsychotics (neuroleptics) and some antidepressants (mirtazapine, lithium, tricyclics) is associated with weight gain. Resulting metabolic changes often are clinically relevant as they may negatively impact cardiovascular morbidity and mortality. Especially in patients receiving antipsychotics, regular checkup should be executed (body weight, blood pressure, blood glucose, cholesterol, hepatic/renal function). A specific metabolic monitoring should be implemented. Drug-specific metabolic side effects can be anticipated and mitigated or prevented by appropriate nutritional and behavioural interventions. Alternatively, the physician should also consider a change in drug, if the side effects impair the quality of life of the patient relevantly. If other measures remain ineffective for weight control, application of orlistat or metformin (off-label) may be tried.

Schlüsselwörter

Psychopharmaka - Antidepressiva - Antipsychotika - unerwünschte Arzneimittelwirkungen - Ernährungstherapie

Keywords

psychotropic drugs - antidepressants - antipsychotics - adverse drug reactions - nutritional therapy

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