Impact of atypical antipsychotic therapy on leptin, ghrelin, and adiponectin
Hua Jin1, Jonathan M Meyer, Sunder Mudaliar
1Department of Psychiatry, University of California at San Diego, USA. hjin@ucsd.edu
Background:
Many adverse effects of atypical antipsychotic treatment are associated with antagonism of monoamine receptors; however, data indicate that important metabolic effects, such as hypertriglyceridemia and impairment in glucose/insulin homeostasis, may not be related to these mechanisms, leading investigators to explore alternative hypotheses. Promising candidates include a possible impact of antipsychotics on peptide hormonal regulators of metabolic control such as leptin, ghrelin, and adiponectin. The purpose of this review is to summarize recent data on changes in these hormones during atypical antipsychotic treatment.
Methods:
A Medline search was performed for papers published from January 1999 to January 2007 using key words antipsychotic, atypical antipsychotic, and individual atypical antipsychotic drug names cross-referenced with leptin, ghrelin, and adiponectin.
Results:
The bulk of the published work focused on changes in body weight and serum leptin, with far less data on ghrelin, and adiponectin, and nonweight metabolic changes. Leptin changes were directly related to a medication's weight gain liability, with no added antipsychotic effects on leptin signaling. Conflicting results emerged for the other markers, but all three long-term studies on ghrelin showed increased levels in patients on atypical antipsychotics with weight gain liabilities.
Conclusions:
Leptin increases during antipsychotic treatment are a result of weight gain rather than a direct impact of atypical antipsychotics on leptin physiology. Preliminary long-term data show increased ghrelin levels, but this finding must be replicated. The association with antipsychotic effects on glucose and lipid metabolism and these hormones remains virtually unstudied. Future research should indicate whether ghrelin and other peptide hormones may be useful predictors of weight gain or metabolic changes in patients on antipsychotics.
Insights
Atypical antipsychotic drugs may affect metabolic hormones like leptin and ghrelin. While leptin changes are linked to weight gain, ghrelin may increase, warranting further study for predicting metabolic side effects.
Area of Science:
- Endocrinology
- Pharmacology
- Metabolic Syndrome
Background:
- Atypical antipsychotics (APs) cause adverse effects, potentially via non-monoamine receptor mechanisms.
- Metabolic changes like hypertriglyceridemia and glucose/insulin issues are key concerns.
- Peptide hormones (leptin, ghrelin, adiponectin) are explored as potential mediators of AP-induced metabolic effects.
Purpose of the Study:
- To review current research on the impact of AP treatment on leptin, ghrelin, and adiponectin levels.
- To understand the relationship between APs, hormonal changes, and metabolic disturbances.
Main Methods:
- Conducted a Medline search (1999-2007) for studies on APs and metabolic hormones.
- Keywords included "antipsychotic," "atypical antipsychotic," and specific drug names cross-referenced with "leptin," "ghrelin," and "adiponectin."
Main Results:
- Most studies focused on body weight and leptin; data on ghrelin and adiponectin were limited.
- Leptin increases correlated with medication weight gain liability, not direct AP effects.
- Preliminary data suggest increased ghrelin levels in patients gaining weight on APs.
Conclusions:
- Leptin elevation during AP treatment is primarily due to weight gain.
- Increased ghrelin levels require replication and further investigation.
- The link between APs, hormones, and metabolic changes (glucose/lipids) needs more research.
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