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Treating the whole patient: Selective serotonin reuptake inhibitors and metabolic syndrome.

There has been mounting concern about metabolic syndrome in modern psychiatry and mind-body medicine. The metabolic syndrome, also known as syndrome x (obesity, impaired glucose metabolism, dyslipidemia, hypertension, hypercoagulability) has been linked to the development to cardiovascular disease and type 2 diabetes which are associated with an increase in health care costs as well as with excessive morbidity and all-cause mortality (Kinder et al. 2004). In United States an estimated 23.7% of adults, without difference between men and women, meet criteria for the metabolic syndrome, making this an intense focus of research among epidemiologist and clinicians (Ford et al. 2002). Not only poor diet and decreased physical exercise have been linked to its development, but various medications (antpsychotics, antidepressants, protease inhibitors, etc.). Psychiatric patients seem to have a higher predisposition and prevalence of this sindrome than general population and there is a link between the metabolic syndrome and premature death in psychatric patients. Many reports have speculated that depression may be linked to adverse health outcomes through an association with metabolic syndrome (Kinder et al. 2004). Therefore, it is pertinent for psychiatrists in everyday practice to identify those patients at risk or those presenting with the metabolic syndrome. On the other side, depression is common in medical patients and often goes untreated or undertreated. Failure to recognize and treat depression in patients with the metabolic syndrome may have deleterious physiological as well as psychological consequences. Addressing the syndrome and its various symptoms will help clinicians to treat the patient as a whole and improve overall morbidity and mortality.

Selective serotonin reuptake inhibitors and metabolic syndrome

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