Metabolic syndrome is a general problem in the population at large, a particular problem in mental health patients such as schizophrenics, and an acute problem in patients on the pine class of second-generation antipsychotics (clozapine, olanzapine, quetiapine). One way to interpret the facts is that the individuals who end up having metabolic syndrome are suffering the consequences of an unhealthy lifestyle on top of a genetic predisposition, and that metabolic syndrome is also a side-effect of pines.
Another way to look at the facts, however, is that the metabolic syndrome is an adaptive atavistic defense reaction of the organism to buffer a perceived stressful and hostile environment, mobilizing and storing resources for anticipated unfavorable circumstances ahead. The pines may be acting on neurobiological pathways involved in this defense reaction, and their metabolic syndrome-inducing side-effect may actually be part of why these medications are effective. One way to test this hypothesis is to see if patients who experience an increase in metabolic syndrome after starting a pine do better from a psychiatric standpoint than patients who do not experience an increase in metabolic syndrome after the start of the pine, particularly in regard to suicidality.
If the above hypothesis turns out to be true, then the solution would be to find ways of activating the central neurobiology involved in this response while blocking the peripheral consequences. This may not be feasible, however, if the peripheral feedback loops triggered by food ingestion, hyperglycemia, hyperlipidemia and sodium retention are necessary for the central effects. If so, a proactive behavioral lifestyle strategy, focused on a concerted daily exercise regimen, coupled with a diet rich in vegetables and fruits, may be the way to mitigate the peripheral effects of metabolic syndrome while maintaining a sense of well-being and promoting health in patients. Mitigating the perception of a hostile environment by an anxiolytic such as an SSRI may also help reduce metabolic syndrome. This is why the combination of a pine and an SSRI may be particularly effective long-term, and with less health liability.