Adipositasentwicklung und metabolische Veränderungen unter Psychopharmakotherapie

Zusammenfassung

Adipositasentwicklung und metabolische Entgleisungen sind häufige Nebenwirkungen psychopharmakologischer Therapie mit Antipsychotika, Antidepressiva und Stimmungsstabilisierern. Die verschiedenen psychopharmakologischen Substanzen zeigen klare Unterschiede bezüglich ihres Einflusses auf das Körpergewicht. Diese Unterschiede können teilweise durch unterschiedliche Affinität zum histaminergen H1-Rezeptor erklärt werden. Im Hypothalamus bewirkt der antihistaminerge Effekt dieser Psychopharmaka eine Erhöhung der Aktivität der Adenosinmonophosphat-aktivierten Proteinkinase (AMPK), die eine integrative Funktion bezüglich orexigener und anorexigener Signale hat. Diese Aktivierung führt zur Steigerung von Appetit und Nahrungsaufnahme.

Störungen im Glukose- und Fettstoffwechsel sind nicht nur eine Konsequenz der Veränderungen des Essverhaltens und des Körpergewichts. Zusätzlich tragen muskarinerge und bislang unbekannte zentrale und periphere Faktoren zu dieser metabolischen Problematik bei, die vor allem unter der Therapie mit Antipsychotika auftritt.

Daher ist eine engmaschige Kontrolle des Körpergewichts und des Glukosebzw. Fettstoffwechsels bei diesen Patienten angezeigt.

Summary

Obesity and metabolic disturbances are frequent side effects of psychopharmacological treatment with antipsychotics, antidepressants or mood stabilizers. Various psychopharmacological substances show clear differences concerning their influence on body weight. These differences can partly be explained by distinct affinity of psychotropic drugs towards histaminergic H1 receptors and their antihistaminergic effect. In the hypothalamus, this antihistaminergic effect leads to an enhanced activity of the adenosine monophosphate-activated protein kinase (AMPK) which has an integrative function regarding orexigenic and anorexigenic signals. Hypothalamic AMPK activation induces an increase of appetite and food intake.

Disturbances in glucose and fat metabolism are not only a consequence of changes in weight and eating behavior. Additionally, muscarinergic and probably yet unknown central and peripheral factors contribute to these metabolic problems which appear most notably during antipsychotic treatment. Therefore, continuous monitoring of the patient’s body weight, glucose and fat metabolism is strongly advised.

Schlüsselwörter

Antidepressiva - Antipsychotika - Gewichtszunahme - Glukosestoffwechsel - Fettstoffwechsel

Keywords

Antidepressants - antipsychotics - weight gain - glucose metabolism - fat metabolism

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