Atypical Antipsychotics: Do Their Direct Actions on Adipocytes Contribute to Metabolic Disturbances?

The introduction of Atypical Antipsychotics (AAP) has improved the treatment of many psychiatric disorders by reducing the incidence of extrapyramidal side effects, but it has come at the expense of developing severe metabolic disturbances. Although the AAP were initially developed for the treatment of schizophrenia, their use has been expanded to include treatment of bipolar disorder, autism, posttraumatic stress disorder, dementia, and as ‘off label’ therapy for major depression. The current dogma posits that both therapeutic and negative side-effects of the AAP are due to their exclusive actions within the brain. Here we argue that very little consideration has been given to the potential actions of the AAP in peripheral sites, constituting a serious deficit in our understanding of the full spectrum of the biological action of these drugs.