Psychotropic medication use, lifestyle, genetic risk for high BMI and the incidence of cardiovascular disease – Nature Mental Health

psychotropic-medication-use,-lifestyle,-genetic-risk-for-high-bmi-and-the-incidence-of-cardiovascular-disease-–-nature-mental-health

Data availability

UKB data are available to bona fide researchers upon application to UKB (https://www.ukbiobank.ac.uk) and are subject to approval and a material transfer agreement. The authors do not have permission to share the data directly.

Code availability

Custom analysis code for this study is available at https://doi.org/10.5281/zenodo.18504977 ref. 41. Access to UKB data (application 54176) is required to run the code; data are available to approved researchers via UKB (http://www.ukbiobank.ac.uk/register-apply/).

References

  1. Correll, C. U. et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry 16, 163–180 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  2. De Hert, M. et al. Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur. Psychiatry 24, 412–424 (2009).

    Article  PubMed  Google Scholar 

  3. Goldfarb, M. et al. Severe mental illness and cardiovascular disease: JACC state-of-the-art review. J. Am. Coll. Cardiol. 80, 918–933 (2022).

    Article  PubMed  Google Scholar 

  4. Nielsen, R. E., Banner, J. & Jensen, S. E. Cardiovascular disease in patients with severe mental illness. Nat. Rev. Cardiol. 18, 136–145 (2021).

    Article  PubMed  Google Scholar 

  5. Correll, C. U. et al. Factors and their weight in reducing life expectancy in schizophrenia. Schizophr. Res. 250, 67–75 (2022).

    Article  PubMed  Google Scholar 

  6. Mazereel, V., Detraux, J., Vancampfort, D., van Winkel, R. & De Hert, M. Impact of psychotropic medication effects on obesity and the metabolic syndrome in people with serious mental illness. Front. Endocrinol. 11, 573479 (2020).

  7. Goodarzi, M. O. Genetics of obesity: what genetic association studies have taught us about the biology of obesity and its complications. Lancet Diabetes Endocrinol. 6, 223–236 (2018).

    Article  PubMed  Google Scholar 

  8. Vancampfort, D. et al. Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry 16, 308–315 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Correll, C. U., Detraux, J., De Lepeleire, J. & De Hert, M. Effects of antipsychotics, antidepressants and mood stabilizers on risk for physical diseases in people with schizophrenia, depression and bipolar disorder. World Psychiatry 14, 119–136 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Abosi, O., Lopes, S., Schmitz, S. & Fiedorowicz, J. G. Cardiometabolic effects of psychotropic medications. Horm. Mol. Biol. Clin. Investig. 36, 20170065 (2018).

    Article  Google Scholar 

  11. Serretti, A. & Mandelli, L. Antidepressants and body weight. J. Clin. Psychiatry 71, 1259–1272 (2010).

    Article  PubMed  Google Scholar 

  12. Pillinger, T. et al. Antidepressant and antipsychotic side-effects and personalised prescribing: a systematic review and digital tool development. Lancet Psychiatry 10, 860–876 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Burschinski, A. et al. Metabolic side effects in persons with schizophrenia during mid- to long-term treatment with antipsychotics: a network meta-analysis of randomized controlled trials. World Psychiatry 22, 116–128 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Ness-Abramof, R. & Apovian, C. M. Drug-induced weight gain. Drugs Today 41, 547–555 (2005).

    Article  Google Scholar 

  15. Bak, M., Fransen, A., Janssen, J., van Os, J. & Drukker, M. Almost all antipsychotics result in weight gain: a meta-analysis. PLoS ONE 9, e94112 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  16. Serretti, A. & Porcelli, S. Antidepressant induced weight gain. BMJ 361, k2151 (2018).

  17. Teasdale, S. B. et al. Dietary intake of people with severe mental illness: systematic review and meta-analysis. Br. J. Psychiatry 214, 251–259 (2019).

    Article  PubMed  Google Scholar 

  18. Rødevand, L. et al. Cardiovascular risk remains high in schizophrenia with modest improvements in bipolar disorder during past decade. Acta Psychiatr. Scand. 139, 348–360 (2019).

    Article  PubMed  Google Scholar 

  19. Firth, J. et al. A meta-review of ‘lifestyle psychiatry’: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry 19, 360–380 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  20. Singh, R. K., Kumar, P. & Mahalingam, K. Molecular genetics of human obesity: a comprehensive review. C. R. Biol. 340, 87–108 (2017).

    Article  PubMed  Google Scholar 

  21. Borisevich, D. et al. Non-linear interaction between physical activity and polygenic risk score of body mass index in Danish and Russian populations. PLoS ONE 16, e0258748 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Zhang, J. P. et al. Pharmacogenetic associations of antipsychotic drug-related weight gain: a systematic review and meta-analysis. Schizophr. Bull. 42, 1418–1437 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  23. Acharya, T., Acharya, S., Tringali, S. & Huang, J. Association of antidepressant and atypical antipsychotic use with cardiovascular events and mortality in a veteran population. Pharmacotherapy 33, 1053–1061 (2013).

    Article  PubMed  Google Scholar 

  24. Pillinger, T. et al. Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis. Lancet Psychiatry 7, 64–77 (2020).

    Article  PubMed  Google Scholar 

  25. Huhn, M. et al. Comparative efficacy and tolerability of 32 oral antipsychotics for the acute treatment of adults with multi-episode schizophrenia: a systematic review and network meta-analysis. Lancet 394, 939–951 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  26. Peters T, et al. The role of genetic variation of BMI, body composition, and fat distribution for mental traits and disorders: a look-up and Mendelian randomization study. Front. Genet. 11, 373 (2020).

  27. Benedetti, F. et al. Higher baseline proinflammatory cytokines mark poor antidepressant response in bipolar disorder. J. Clin. Psychiatry. 78, e986–e993 (2017).

    Article  PubMed  Google Scholar 

  28. Nayerifard, R., bureng, m. a., Zahiroddin, A., Namjoo, M. & Rajezi, S. Comparison of metabolic syndrome prevalence in patients with schizophrenia and bipolar I disorder. Diabetes Metab. Syndr. Clin. Res. Rev. 11, S411–S416 (2017).

    Article  Google Scholar 

  29. Vancampfort, D. et al. A meta-analysis of cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia versus general population controls. World Psychiatry 12, 240–250 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  30. Alonso-Pedrero, L., Bes-Rastrollo, M. & Marti, A. Effects of antidepressant and antipsychotic use on weight gain: a systematic review. Obes. Rev. 20, 1680–1690 (2019).

    Article  PubMed  Google Scholar 

  31. Vancampfort, D. et al. Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta-analysis. World Psychiatry 15, 166–174 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  32. Vancampfort, D. et al. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry 14, 339–347 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  33. Solmi, M. et al. Antipsychotics use is associated with greater adherence to cardiometabolic medications in patients with schizophrenia: results from a nationwide, within-subject design study. Schizophr. Bull. 48, 166–175 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  34. Correll, C. U. et al. Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors. World Psychiatry 21, 248–271 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  35. Prospective Studies Collaboration Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies. Lancet 373, 1083–1096 (2009).

    Article  Google Scholar 

  36. Davis K. A. S. et al. Indicators of mental disorders in UK Biobank—a comparison of approaches. Int. J. Methods Psychiatr. Res. 28, e1796 (2019).

  37. Sudlow, C. et al. UK Biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age. PLoS Med. 12, e1001779 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  38. Cho, S. M. J. et al. Measured blood pressure, genetically predicted blood pressure, and cardiovascular disease risk in the UK Biobank. JAMA Cardiol. 7, 1129–1137 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  39. Peng, H. et al. Lifestyle factors, genetic risk, and cardiovascular disease risk among breast cancer survivors: a prospective cohort study in UK Biobank. Nutrients 15, 864 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Said, M. A., Verweij, N. & van der Harst, P. Associations of combined genetic and lifestyle risks with incident cardiovascular disease and diabetes in the UK Biobank study. JAMA Cardiol. 3, 693–702 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Hanskamp, I., Lin, B., Boonstra, L., de Boer, N. & Luykx, J. Analysis code for: Psychotropic medication use, lifestyle, genetic risk for BMI and the incidence of cardiovascular disease. Zenodo https://doi.org/10.5281/zenodo.18504977 (2026).

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Acknowledgements

We thank the UKB participants and team for providing access to the data.

Author information

Author notes

  1. These authors contributed equally: Nini de Boer, Iris Hanskamp, Bochao Danae Lin.

Authors and Affiliations

  1. Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands

    Nini de Boer, Iris Hanskamp, Bochao Danae Lin, Liese Boonstra, Marte van der Horst & Wiepke Cahn

  2. Faculty of Biomedical Sciences, University of Amsterdam, Amsterdam, The Netherlands

    Iris Hanskamp

  3. Department of Translational Neuroscience, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands

    Bochao Danae Lin & Kristel van Eijk

  4. Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, The Netherlands

    Bochao Danae Lin, Sinan Guloksuz & Jurjen J. Luykx

  5. Faculty of Biomedical Sciences, Utrecht University, Utrecht, The Netherlands

    Liese Boonstra

  6. GGNet Mental Health, Apeldoorn, The Netherlands

    Marte van der Horst

  7. Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Marco P. Boks, Wouter J. Peyrot, Thomas Goldschmidt, Christiaan H. Vinkers & Jurjen J. Luykx

  8. Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

    Wouter J. Peyrot & Christiaan H. Vinkers

  9. Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands

    Jos Twisk

  10. GGZinGeest Mental Health, Amsterdam, The Netherlands

    Thomas Goldschmidt, Christiaan H. Vinkers & Jurjen J. Luykx

  11. Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands

    Hanno Pijl

  12. Amsterdam Neuroscience (Mood, Anxiety, Psychosis, Stress & Sleep Program) and Amsterdam Public Health (Mental Health Program) Research Institutes, Amsterdam, The Netherlands

    Christiaan H. Vinkers & Jurjen J. Luykx

  13. Department of Anatomy & Neurosciences, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Christiaan H. Vinkers

  14. Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA

    Christoph U. Correll

  15. Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA

    Christoph U. Correll

  16. Center for Psychiatric Neuroscience, The Feinstein Institute for Medical Research, Northwell Health, New Hyde Park, NY, USA

    Christoph U. Correll

  17. Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany

    Christoph U. Correll

  18. German Center for Mental Health (DZPG), Berlin, Germany

    Christoph U. Correll

  19. University Psychiatric Centre, KU Leuven, Kortenberg, Belgium

    Marc De Hert

  20. Department of Neurosciences, Centre for Clinical Psychiatry, KU Leuven, Leuven, Belgium

    Marc De Hert

  21. Leuven Brain Institute, KU Leuven, Leuven, Belgium

    Marc De Hert

  22. Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium

    Marc De Hert

  23. Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA

    Sinan Guloksuz

  24. Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada

    Sinan Guloksuz

  25. Institute of Mental Health, University of British Columbia, Vancouver, British Columbia, Canada

    Sinan Guloksuz

  26. Division of Medical Sciences, University of Northern British Columbia, Prince George, British Columbia, Canada

    Sinan Guloksuz

  27. Altrecht Mental Health, Utrecht, The Netherlands

    Wiepke Cahn

Authors

  1. Nini de Boer
  2. Iris Hanskamp
  3. Bochao Danae Lin
  4. Liese Boonstra
  5. Marte van der Horst
  6. Kristel van Eijk
  7. Marco P. Boks
  8. Wouter J. Peyrot
  9. Jos Twisk
  10. Thomas Goldschmidt
  11. Hanno Pijl
  12. Christiaan H. Vinkers
  13. Christoph U. Correll
  14. Marc De Hert
  15. Sinan Guloksuz
  16. Wiepke Cahn
  17. Jurjen J. Luykx

Contributions

Study concept and design: N.d.B., W.C., J.J.L., I.H., S.G. Acquisition, analysis or interpretation of data: N.d.B., I.H., B.D.L., L.B., M.v.d.H., K.v.E., M.P.B., W.P., J.T., T.G., H.P., C.H.V., C.U.C., M.D.H., S.G., W.C., J.J.L. Statistical analysis: B.D.L., I.H., L.B., N.d.B., J.J.L., W.P., T.G., J.T. Drafting of the manuscript: N.d.B., W.C., I.H., B.D.L., J.J.L., S.G. Critical revision of the manuscript for important intellectual content: N.d.B., B.D.L., L.B., I.H., W.P., T.G., J.J.L., W.C., S.G., M.P.B., M.v.d.H., K.v.E., H.P., C.H.V., C.U.C., M.D.H. Study supervision: J.J.L., S.G., W.C. Data access and integrity: J.J.L., N.d.B., I.H., B.D.L., L.B. had full access to all data in the study and take responsibility for the integrity and accuracy of the data analysis.

Corresponding authors

Correspondence to Nini de Boer or Jurjen J. Luykx.

Ethics declarations

Competing interests

C.U.C. has been a consultant and/or advisor to or has received honoraria from AbbVie, Alkermes, Allergan, Angelini, Aristo, Autobahn, Axsome, Boehringer-Ingelheim, Bristol-Meyers Squibb, Cardio Diagnostics, Cerevel, CNX Therapeutics, Compass Pathways, Darnitsa, Delpor, Denovo, Draig, Eli Lilly, EuMentis Therapeutics, Gedeon Richter, GH Research, Hetero, Hikma, Holmusk, Intra-Cellular Therapies, Jamjoom Pharma, Janssen/J&J, Karuna, LB Pharma, Lundbeck, MedinCell, MedLink Global, Merck, Mindpax, Mitsubishi Tanabe Pharmaceuticals, MapLight, Mylan, Neumora Therapeutics, Neuraxpharm, Neurocrine, Neurelis, Neurosterix, NeuShen, Neusignal Therapeutics, Newron, Noven, Novo Nordisk, Orion Pharma, Otsuka, PPD Biotech, Recognify Life Sciences, Recordati, Relmada, Response Pharmaceuticals, Reviva, ROVI, Saladax, Sanofi, Seqirus, Servier, Sumitomo Pharma America, Sunovion, Sun Pharma, Supernus, Tabuk, Takeda, Teva, TERRAN, Tolmar, Vertex, Viatris and Xenon Pharmaceuticals. He provided expert testimony for Janssen, Lundbeck, Neurocrine and Otsuka. He served on a Data Safety Monitoring Board for Compass Pathways, IntraCellular Therapies, Relmada, Reviva and ROVI. He has received grant support from Boehringer-Ingelheim, Janssen and Takeda. He received royalties from UpToDate and is also a stock option or stock holder of Cardio Diagnostics, Küleon Biosciences, LB Pharmaceuticals, MedLink Global, Mindpax, Quantic and TERRAN. The other authors declare no competing interests.

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Nature Mental Health thanks Xianwen Shang and the other, anonymous reviewers for their contribution to the peer review of this work.

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de Boer, N., Hanskamp, I., Lin, B.D. et al. Psychotropic medication use, lifestyle, genetic risk for high BMI and the incidence of cardiovascular disease. Nat. Mental Health (2026). https://doi.org/10.1038/s44220-026-00620-w

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