Metabolic Classroom: Metabolic Consequences of Mental Health Medications

Introduction

• Presenter: Professor Ben Bman
• Topics: Metabolic consequences of medications for mental health (antidepressants and anti-anxiety medications)
• Key Point: Mental health disorders like depression and anxiety are linked with metabolic conditions such as insulin resistance and type 2 diabetes.
• Directionality: The relationship is bidirectional - mental health disorders can lead to metabolic disturbances and vice versa.

Key Neurotransmitters

Serotonin

• Roles: Regulates mood, anxiety, and satiety.
• Low Levels: Linked to depression, anxiety, sleep disturbances.
• Metabolic Impact:
  • Regulates appetite (suppresses hunger, particularly carbohydrate cravings)
  • Affects insulin sensitivity in liver, pancreas, and adipose tissue
  • Promotes fat accumulation and inhibits lipolysis
  • Inhibits thermogenesis in brown fat

Dopamine

• Roles: Reward neurotransmitter, impacts motivation, pleasure.
• Imbalances: Associated with disorders like depression, bipolar disorder, schizophrenia.
• Metabolic Impact:
  • Regulates energy expenditure and appetite
  • Low levels linked to overeating and weight gain
  • Affects glucose metabolism and insulin sensitivity
  • Stimulates thermogenesis and lipolysis

Norepinephrine (Noradrenaline)

• Roles: Part of fight-or-flight response, increases alertness and focus.
• Imbalances: Low levels linked to depression, fatigue; high levels with anxiety.
• Metabolic Impact:
  • Suppresses appetite acutely, can increase hunger chronically
  • Stimulates fat breakdown and thermogenesis

Medications and Metabolic Consequences

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Examples: Fluoxetine, Citalopram
• Mental Health: Increases serotonin, stabilizes mood
• Metabolic Impact: Weight gain, insulin resistance, increased carbohydrate craving

Tricyclic Antidepressants (TCAs)

• Examples: Amitriptyline
• Mental Health: Increases serotonin and norepinephrine
• Metabolic Impact: Weight gain, insulin resistance, dyslipidemia

Monoamine Oxidase Inhibitors (MAOIs)

• Examples: Phenelzine
• Mental Health: Prevent breakdown of serotonin, dopamine, norepinephrine
• Metabolic Impact: Weight gain, insulin resistance

Atypical Antipsychotics

• Examples: Olanzapine
• Mental Health: Modulates dopamine and serotonin receptors
• Metabolic Impact: Severe weight gain, insulin resistance, metabolic syndrome

Mirtazapine

• Mental Health: Blocks specific serotonin and norepinephrine receptors
• Metabolic Impact: Weight gain, increased fat mass, leptin levels

Trazadone

• Use: Sedative properties, sometimes used for sleep
• Metabolic Impact: Minimal evidence of significant metabolic effect

Carbohydrate Cravings and Mental Health

• Medications: SSRIs, TCAs, and antipsychotics linked to increased carbohydrate cravings.
• Brain Glucose Hypometabolism: Common in mental health disorders like depression and anxiety.
• Ketogenic Diets: May improve outcomes by providing alternative brain fuel through ketones.

Conclusion

• Approach: Respectful understanding of the sensitive nature of mental health disorders.
• Insight: Medications may inadvertently exacerbate metabolic issues.
• Goal: Gain knowledge to manage health more effectively.

Note: This lecture does not provide medical advice. Always consult a healthcare provider for medical decisions.