‘Practical steps’ to manage psychotropic side effects

While psychotropics, antidepressants and mood stabilisers play a central role in the management of mental health disorders, new research shows a range of accompanying side effects are impacting quality of life. But the RACGP says GPs’ provision of ongoing, whole-person care remains central.
 
Published in The Lancet Psychiatry and led by the University of Queensland (UQ), the research spotlights the need for increased monitoring and a more holistic approach to care to help manage potential side effects from these medications, including weight gain, hypertension, sleep disturbance and diabetes.
 
The authors say their findings set out ‘practical steps’ for healthcare providers to manage physical health through ongoing monitoring and timely interventions to help reduce the burden of side effects and improve long-term outcomes.
 
After examining 11 categories of physical side effects among people taking psychotropic medications, the researchers recommend patients undergo a ‘full physical health evaluation’ before being prescribed medication, to determine baselines of heart rate, blood pressure, weight and liver and renal function. 
 
Once they begin taking the medication, both the healthcare provider and patient should monitor the onset of any new symptoms within the first month. This includes checking weight and body mass index before a 6–12-month follow up to measure cardiometabolic parameters such as blood sugar levels and cholesterol. 
 
‘This research aims to help prescribers, people living with mental illness and their loved ones have the tools to look after both mental and physical health,’ lead author Dr Sean Halstead said.
 
‘Healthcare professionals need to consider the whole person’s health when prescribing.’
 
As well as affecting quality of life, the authors note that psychotropic medications’ side effects can also reduce medication adherence, weakening treatment benefits.
 
RACGP Expert Committee – Quality Care Chair Professor Mark Morgan welcomes the calls to monitor for risks before starting patients on psychoactive medication and for side effects after medication is started.
 
‘GPs are ideally placed and skilled to manage physical risks for people taking psychoactive medications,’ he told newsGP.
 
‘In general practice, prescribing alerts can act as a timely reminder to monitor physical health when medications such as antipsychotics are prescribed.’
 
Professor Morgan says the UQ study’s findings are important because people with severe mental illness are at higher risk of dying early from other disease.
 
‘This excess mortality is mostly due to physical health conditions, particularly cardiovascular disease, diabetes, cancer, respiratory disease,’ he said.
 
‘The reasons for these physical conditions include side effects of mental health medication, much higher smoking rates, and challenges engaging with preventive healthcare and lifestyle interventions.
 
‘There are also some biological mechanisms associated with severe mental illness that contribute directly to cardiovascular risk.’
 
Last year, the RACGP endorsed the ‘landmark’ Maudsley Deprescribing Guidelines as the standard evidence-based clinical resource for supporting patients to safely stop antidepressants.
 
Non-pharmacological and lifestyle interventions for managing mental health are also evolving, as the benefits of social prescribing and exercise have been shown.
 
The UQ authors conclude that understanding how to manage and minimise the side effects of medication to treat mental health issues, is ‘crucial’ to achieve both physical and mental health.
 
Professor Morgan also pointed to the Being Equally Well Roadmap which recommends guidelines and protocols to address physical risk factors when medications are commenced.
 
‘Patients being treated for complex or severe conditions should be actively co-managed with their usual GP to ensure other comorbidities and preventive health needs continue to be met,’ he said.
 
‘Higher patient rebates for long consultations would certainly help in this endeavour. Also, there should be acceptance by Medicare that it is the norm for a mental health consult to include physical health and preventive components.
 
‘Vulnerable populations such as those people with mental illness would benefit from funded annual health assessments to address a combination of preventive health needs in funded consults that enable planned, proactive and team-based care.’
 
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