Approach to Side Effects

As with any medication, the potential benefits must be weighed against potential toxicity or side effects. The Lancet article, said Bauer, “reaches very realistic conclusions” – summarizing what had already been known but “in a very elegant manner.”

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“We know two things: We know people with serious mental illness are at higher risk for cardiovascular disease, for diabetes and for early death – as much as 15 to 25 years sooner than those without serious mental illness,” he observed. “Fact No. 2 is that many of the medications we give to treat mental illness can induce diabetes, obesity and cardiovascular risk.”

However, he added, this also is true of the new anti-psychotics. “And it’s an important point the authors make: Lithium can cause modest levels of weight gain, but not as much as the newer drugs like olanzapine,” he explained.

Other side effects are more easily managed, Bauer pointed out. The study authors reported that thyroid disease occurs in 20%-25% of cases but noted that rates of clinical disease are much lower than those of lab abnormalities. “That is easily handled in most cases by giving thyroid hormones,” he said.

A number of projects under way at VA seek to improve management of patients with mental-health issues. One is MIAMI (MIRECC Initiative on Antipsychotic Management Improvement) project, funded by the VA Office of Mental Health Services Initiative. One of the cornerstones of the MIAMI project is 2009 research by VA's Center for Mental Healthcare and Outcomes Research, which promised development of guidelines to manage antipsychotic metabolic side effects.