Antipsychotic Drug-Induced Insulin Resistance: A Narrative Literature Review

Anna Dąbrowska; Wojciech  Zgliczyński

doi:10.36553/wm.177

Published: 2025-08-27

Vol. 7 No. 1 (2025)

Antipsychotic Drug-Induced Insulin Resistance: A Narrative Literature Review

Anna Dąbrowska , Wojciech Zgliczyński

Wiedza Medyczna

Section: Review papers

https://doi.org/10.36553/wm.177

Abstract

Insulin resistance is a metabolic disorder and a key factor in the pathogenesis of conditions such as type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD), and atherosclerosis. Risk factors for insulin resistance include genetic and environmental influences, such as overweight/obesity, low physical activity, and the use of certain medications, including glucocorticosteroids or antipsychotics.

Antipsychotics (neuroleptics) are widely used in the treatment of various mental disorders, primarily schizophrenia, and such therapy is often lifelong. Due to the mechanism of action via receptors, including serotonergic, muscarinic, and histaminergic, atypical (second-generation) antipsychotics cause metabolic disorders of varying severity. Clozapine and olanzapine have the worst metabolic profiles and aripiprazole and lurasidone are associated with the mildest profiles. Regardless of the potential for developing metabolic complications from specific antipsychotics, baseline predictors of susceptibility are sought in patients. To date, studies have identified risk factors such as higher body weight, male gender, and non-white ethnicity. In addition, patients with schizophrenia are at greater risk for insulin resistance, as shown in studies involving individuals with a first episode of psychosis. This supports the hypothesis that schizophrenia and diabetes may share a common pathogenesis. Despite clear evidence of an increased risk for insulin resistance and, consequently, metabolic syndrome and high cardiovascular risk, insufficient attention is paid to early diagnosis, prevention, and treatment of carbohydrate and lipid metabolism disorders in patients taking neuroleptics. Improved management in this area could benefit not only physical health but also adherence to medical recommendations and the overall effectiveness of psychiatric treatment.

Keywords:

insulin resistance, antipsychotics, diabetes, appetite, obesity

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Dąbrowska, A., & Zgliczyński, W. . (2025). Antipsychotic Drug-Induced Insulin Resistance: A Narrative Literature Review. Wiedza Medyczna, 7(1), 1–9. https://doi.org/10.36553/wm.177

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