The Commission, co-led by experts from the University of Oxford’s Department of Psychiatry, King’s College London, and the University of Queensland, Australia, sets out practical recommendations for clinicians to manage the physical side effects of psychiatric drugs while preserving their mental health benefits.

Psychiatric medications are essential in the treatment of conditions such as depression, bipolar disorder, and schizophrenia. However, these drugs can cause significant physical side effects – including weight gain, high blood pressure, diabetes, and raised cholesterol. These complications are often under-recognised and under-treated in routine care. If left unaddressed, these side effects can reduce quality of life, increase risk of long-term physical illness, and may lead some individuals to stop taking medications that are otherwise effective for their mental health.

The Commission systematically reviewed the available evidence across 11 major domains of side effects, including metabolic, cardiovascular, renal, sexual, and neurological complications. In response, it proposes a set of core monitoring and management strategies, beginning with a comprehensive physical health assessment at the point of prescribing, followed by early monitoring (e.g., weight checks within four weeks), and long-term follow-up of cardiometabolic markers such as blood sugars, cholesterol, and blood pressure.

Associate Professor Robert McCutcheon

Joint senior author on the paper, Associate Professor Robert McCutcheon from the Department of Psychiatry, University of Oxford, and Oxford Health NHS Foundation Trust said:

“Understanding how to manage and minimise the side effects of psychiatric medication is crucial if we want to maximise the chances of people with mental illness achieving both physical and mental health. The commission sets out practical steps that healthcare providers can use in clinical practice to help achieve this.”

Co-senior author Dr Toby Pillinger, Academic Clinical Lecturer at the Institute of Psychiatry, Psychology & Neuroscience, King’s College London, said: “Psychiatric medications save lives and help people regain stability in their daily lives – but they can also cause serious physical side effects. Too often, these are seen as the cost of treatment, or worse, ignored altogether. This Commission is about saying that patients deserve better. We can and must protect both mental and physical health. With simple monitoring and timely interventions, we hope to reduce the burden of side effects and improve long-term outcomes.”

Dr Sean Halstead, a psychiatrist at the University of Queensland and the study’s lead author, said “Helping people recover from mental illness requires a fine balance between treating the mind and the body.  We need to consider the whole person’s health when we are prescribing. This Lancet Commission aims to help prescribers, persons living with mental illness and their loved ones have the tools to look after both mental and physical health.”

Other authors on the paper from Oxford’s Department of Psychiatry included Chloe Yap, Bodyl Brand and Andrea Cipriani, NIHR Oxford Health Clinical Research Facility Director and Theme Lead for Oxford Health Biomedical Research Centre Data Science.