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World Psychiatry. 2015 Jun;14(2):119-36. doi: 10.1002/wps.20204.

Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder.

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Department of Psychiatry, Zucker Hillside Hospital, North Shore - Long Island Jewish Health System, Glen Oaks, New York, NY, USA.
Department of Psychiatry and Molecular Medicine, Hofstra North Shore LIJ School of Medicine, Hempstead, New York, NY, USA.
Psychiatric Neuroscience Center of Excellence, Feinstein Institute for Medical Research, Manhasset, New York, NY, USA.
Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, New York, NY, USA.
Department of Neurosciences, Catholic University Leuven, B-3070 Kortenberg, Belgium.
Department of Public Health and Primary Care, University of Leuven, B-3000 Leuven, Belgium.


People with severe mental illness have a considerably shorter lifespan than the general population. This excess mortality is mainly due to physical illness. Next to mental illness-related factors, unhealthy lifestyle, and disparities in health care access and utilization, psychotropic medications can contribute to the risk of physical morbidity and mortality. We systematically reviewed the effects of antipsychotics, antidepressants and mood stabilizers on physical health outcomes in people with schizophrenia, depression and bipolar disorder. Updating and expanding our prior systematic review published in this journal, we searched MEDLINE (November 2009 - November 2014), combining the MeSH terms of major physical disease categories (and/or relevant diseases within these categories) with schizophrenia, major depressive disorder and bipolar disorder, and the three major psychotropic classes which received regulatory approval for these disorders, i.e., antipsychotics, antidepressants and mood stabilizers. We gave precedence to results from (systematic) reviews and meta-analyses wherever possible. Antipsychotics, and to a more restricted degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia, diabetes mellitus, thyroid disorders, hyponatremia; cardiovascular, respiratory tract, gastrointestinal, haematological, musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy, and treatment of vulnerable (e.g., old or young) individuals are associated with greater absolute (elderly) and relative (youth) risk for most of these physical diseases. To what degree medication-specific and patient-specific risk factors interact, and how adverse outcomes can be minimized, allowing patients to derive maximum benefits from these medications, requires adequate clinical attention and further research.


Physical illness; antidepressants; antipsychotics; bipolar disorder; cardiovascular; depression; endocrine; gastrointestinal; metabolic; mood stabilizers; respiratory; schizophrenia

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