The Role of Anxiety in Metabolic Syndrome

Aline Sardinha; Antonio E Nardi


Expert Rev Endocrinol Metab. 2012;7(1):63-71. 

In This Article

Five-year View

As MS seems to be due to the convergence of a variety of factors, such as genetic predisposition, chronic stress, negative emotion and unhealthy lifestyle habits, it is plausible to think that treatment and prevention strategies should address the modifiable factors. If genetic predisposition and stress triggered by modern society cannot be changed, emotional regulation and lifestyle habits should be focused upon.

However, adherence to long-term life-style changes is challenging. Motivational interviewing – a client-centered, directive counseling approach aimed at promoting motivation in patients to change certain behaviors – has been showed to be effective in promoting short-term lifestyle changes in cardiac rehabilitation patients,[54] cancer survivors,[55] childhood obesity[56] and other health settings, meriting further investigation. Numerous cognitive and behavioral evidence-based techniques could also be potentially useful.[57,58]

Interventions that modify psychological activation concomitantly to psychological symptoms such as biofeedback, relaxation and other psychophysiologic strategies have been studied and used in patients with elements of the MS, particularly diabetes and hypertension, being shown to effectively lower blood glucose and blood pressure.[59]

Despite the important side effects reported by the inverse agonist for the CB1 medications, the ECS still seems to be the best candidate for successful pharmacological interventions. A recent study reuniting the metabolic effects of rimonabant in randomized controlled trials showed that, in all trials, there was a considerable reduction in bodyweight in subjects taking 20 mg of rimonabant daily. The lipidemic profile also improved in these patients, with levels of HDL increasing significantly while levels of triglycerides decreased in all trials. In all cases, prevalence of the MS decreased significantly. The metabolic changes observed were partly independent of the weight loss and could be attributed to the independent peripheral effect of the drug. It is likely that these important findings contribute to further efforts for the development of novel cannabinoid Type 1 receptor blockers with similar metabolic results but decreased prevalence of psychiatric adverse effects.[60]

Additionally, physical activity is known to positively impact the prognoses of numerous chronic diseases, particularly cardiovascular problems.[61] The prescription of exercise is particularly useful for preventing premature death from all causes, ischemic heart disease, stroke, hypertension, colon and breast cancer, Type 2 diabetes, MS, obesity, osteoporosis, sarcopenia, functional dependence and falls in the elderly, cognitive impairment, anxiety and depression. This benefit is observed in both sexes and increases with the volume or intensity of exercise.[62] Regular exercising also seems to play an important role in mental health maintenance.[63] As we have proposed elsewhere,[64] it is plausible that regular exercise could be a useful and simple strategy to address psychological disorders and metabolic alterations simultaneously in both high-risk patients and the general population.


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