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
-
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).
-
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).
-
Goldfarb, M. et al. Severe mental illness and cardiovascular disease: JACC state-of-the-art review. J. Am. Coll. Cardiol. 80, 918–933 (2022).
-
Nielsen, R. E., Banner, J. & Jensen, S. E. Cardiovascular disease in patients with severe mental illness. Nat. Rev. Cardiol. 18, 136–145 (2021).
-
Correll, C. U. et al. Factors and their weight in reducing life expectancy in schizophrenia. Schizophr. Res. 250, 67–75 (2022).
-
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).
-
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).
-
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).
-
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).
-
Abosi, O., Lopes, S., Schmitz, S. & Fiedorowicz, J. G. Cardiometabolic effects of psychotropic medications. Horm. Mol. Biol. Clin. Investig. 36, 20170065 (2018).
-
Serretti, A. & Mandelli, L. Antidepressants and body weight. J. Clin. Psychiatry 71, 1259–1272 (2010).
-
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).
-
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).
-
Ness-Abramof, R. & Apovian, C. M. Drug-induced weight gain. Drugs Today 41, 547–555 (2005).
-
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).
-
Serretti, A. & Porcelli, S. Antidepressant induced weight gain. BMJ 361, k2151 (2018).
-
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).
-
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).
-
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).
-
Singh, R. K., Kumar, P. & Mahalingam, K. Molecular genetics of human obesity: a comprehensive review. C. R. Biol. 340, 87–108 (2017).
-
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).
-
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).
-
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).
-
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).
-
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).
-
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).
-
Benedetti, F. et al. Higher baseline proinflammatory cytokines mark poor antidepressant response in bipolar disorder. J. Clin. Psychiatry. 78, e986–e993 (2017).
-
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).
-
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).
-
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).
-
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).
-
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).
-
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).
-
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).
-
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).
-
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).
-
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).
-
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).
-
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).
-
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).
-
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).
Acknowledgements
We thank the UKB participants and team for providing access to the data.
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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DOI: https://doi.org/10.1038/s44220-026-00620-w

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