Risk factors for antipsychotic- and antidepressant-associated liver function abnormalities

Antipsychotics (APs) and antidepressants (ADs) are the primary therapies for psychiatric disorders. However, drug-induced liver injury and liver biochemical abnormalities during treatment with APs and/or ADs remain significant safety concerns in clinical practice. Identifying factors associated with liver function abnormalities at an early stage may help support appropriate monitoring and preventive measures. A retrospective unmatched case-control study was conducted, including 708 discharged patients (354 cases and 354 controls) from Xuzhou Oriental Hospital Affiliated to Xuzhou Medical University between January and December 2025. Univariate and multivariable logistic regression analyses were performed to identify factors associated with liver function abnormalities. Olanzapine was the most frequently recorded AP/AD exposure among patients with liver function abnormalities (57.34%). Multivariable logistic regression showed that male sex (odds ratio [OR] = 1.51, 95% confidence interval [CI], 1.07–2.11), age ≥60 years (OR = 5.02, 95% CI, 2.48–10.16), obesity (OR = 3.60, 95% CI, 1.24–10.43), dysglycemia (OR = 2.59, 95% CI, 1.37–4.91), dyslipidemia (OR = 2.18, 95% CI, 1.55–3.05), length of stay (OR = 1.014, 95% CI, 1.003–1.025), and medication history ≤1 year (OR = 2.98, 95% CI, 1.87–4.74) were independently associated with liver function abnormalities. Liver function abnormalities occurring in psychiatric patients after AP and/or AD treatment mainly consisted of liver biochemical abnormalities. Olanzapine was the most frequently recorded AP/AD exposure among affected patients, but this descriptive finding should not be interpreted as indicating a comparative hepatotoxicity risk. These findings may help clinical pharmacists identify patients who require closer liver function monitoring, but multicenter validation is needed.