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 might make a patient with psychosis and his or her caregivers so concerned about the use of any of these medications, particularly those associated with a higher risk of diabetes, weight gain, or increased lipid levels, that they would prefer to avoid all of them. However, schizophrenia is associated with a relatively high risk for several diseases, including diabetes, that is independent of the risks that are linked to atypical antipsychotic use. Therefore, the clinician who might think, "Why use atypicals if using the typical drugs will escape the problems of monitoring and all the associated effects of diabetes and hyperglycemia?" needs to know that these problems cannot be avoided simply by choosing typical antipsychotics. Clinicians, patients, and concerned family members must balance the significant benefits of atypical antipsychotic treatment-improved cognition, reduced suicidality, and less depression-against the risks of metabolic disturbances and select a course of treatment that includes a realistic monitoring program.