The Impact of Psychotropic Drugs on Medical Co-morbidities in Patients with Mental Health Disorders

Abstract

: Introduction: Mental health disorders are associated with excess cardiometabolic and organ-specific morbidity. Psychotropic medications, while essential for symptom control, may further influence trajectories of obesity, dyslipidemia, glucose dysregulation, electrolyte imbalance, and thyroid dysfunction. This study prospectively evaluated the spectrum and evolution of medical co-morbidities among adults with mental health disorders receiving psychotropic drugs in routine tertiary-care practice. Materials and Methods: A hospital-based prospective cohort study was conducted over 12 months of recruitment with follow-up to 12 months per participant in a tertiary-care teaching hospital (Psychiatry–Internal Medicine collaboration). Consecutive adults (≥18 years) with a confirmed mental health disorder prescribed ≥1 psychotropic medication were enrolled (n=50). Psychotropic exposure (class, agents, doses, regimen complexity; monotherapy vs polypharmacy) was recorded at baseline and updated at 3, 6, and 12 months. Outcomes included overweight/obesity, hypertension, type 2 diabetes mellitus, dyslipidemia, metabolic syndrome (when definable), hyponatremia, thyroid dysfunction, renal impairment, and hepatic dysfunction, assessed via standardized clinical evaluation and laboratory testing. Longitudinal trends and repeated-measures comparisons were performed; exposure–outcome associations used 2×2 tests, with p<0.05 considered significant. Results: Participants were predominantly male (60%), commonly aged 30–44 years (36%), and mostly outpatients (76%). Antipsychotic exposure was frequent (70%), largely second-generation antipsychotics (SGAs; 60%); 66% received ≥2 psychotropics. Baseline co-morbidities included overweight/obesity (40%), dyslipidemia (28%), hypertension (22%), diabetes (14%), and metabolic syndrome (18%). Over follow-up, incident overweight/obesity increased to 30% at 12 months (trend p=0.0039), dyslipidemia to 16.6% (p=0.0313), and hypertension to 15.3% (p=0.0313). Weight and BMI rose significantly (64.8±11.2 to 74.2±12.1 kg; 24.1±3.8 to 27.6±4.1 kg/m²; both p=0.0001), with increases in fasting glucose (p=0.011) and triglycerides (p=0.03). Mood stabilizer exposure was significantly associated with thyroid dysfunction (33.3% vs 5.7%; p=0.01). Conclusion: Medical co-morbidities were common at baseline and increased over 12 months among patients receiving psychotropic medications, with significant worsening of adiposity and metabolic markers and rising incident overweight/obesity, hypertension, and dyslipidemia. Regimen-specific, integrated monitoring— particularly for metabolic parameters and mood stabilizer–related thyroid dysfunction—is essential to reduce preventable morbidity.