Antipsychotic Misuse: A Silent but Growing Public Health Hazard

Antipsychotic drugs are essential in the management of schizophrenia, bipolar disorder, and other psychiatric illnesses, but their use is closely linked to cardiometabolic side effects. Cardiometabolic side effects include weight gain, dyslipidemia, glucose intolerance, and increased cardiovascular morbidity and mortality. Mechanisms of cardiometabolic side effects involve disruption of the central nervous system's ability to regulate appetite, peripheral metabolic effects, which are changes in metabolism outside the CNS, and receptor-level interactions, with second-generation antipsychotics generally posing a greater risk than first-generation agents. This review addresses current evidence on the cardiometabolic consequences of antipsychotic therapy, increasing inappropriate off-label use of antipsychotic drugs, particularly those that are atypical, highlights vulnerable populations, and discusses strategies for monitoring and mitigation. A secondary goal is to address the considerable literature gap covering recent trends and costs in the off-label use of atypical antipsychotic drugs.