Psychopharmacologic treatment of psychiatric disorders in patients with diabetes mellitus: Clinical considerations and options

The purpose of this chapter is to provide the practitioner with a selection of potential treatment options for the care ofdepression, bipolar disorder, the anxiety disorders, insomnia, and schizophrenia in patients who also have comorbid diabetes mellitus (DM) or where DM risk is a factor in medication selection. A greater detailed discussion regarding the diagnostics, risk factors, and specific metabolic relationships of the various psychiatric illnesses as well as the metabolic effects of the antipsychotics is provided elsewhere in this book and therefore only briefly addressed in this chapter. Although no particular psychotropic medication is specifically contraindicated in persons with DM, certain agents probably carry a higher risk for exacerbating this chronicendocrinologic and metabolic disorder. Some psychotropics may increase plasma glucose levels, increase glycosylated hemoglobin A1c (HbA1c), or cause insulin resistance vs other psychotropics that may cause hypoglycemia or increase insulin sensitivity. The negative effects of some psychotropics on diabetic control may have more to do with appetite stimulation or weight gain than a direct effect on glucose and insulin physiology. These changes in glucose response may be short-term reactions to the psychotropic drug. At other times, effects may only occur after long-term exposure to theagent, making it difficult to discern the influence of the medication from the possible progression of the underlying diabetes pathology. Either way, the person with DM and a comorbid psychiatric illness must receive a higher level of monitoring for both the clinical and laboratory outcomes of their DM and glycemic control andfor the psychiatric management of the targeted mental illness which may be secondary to, or exacerbated by, the person’s DM.