Dr Shock is not very impressed with these new antipsychotics. Most research is done with comparison to high dose haloperidol, not very honest. Anyway the most dreaded side-effect of these new antipsychotics is weight gain. And I mean really weight gain, not just a few kilo’s. Clozapine and olanzapine produce the most weight gain followed by quetiapine and risperidone. Ziprasidone and aripiprazole produce the least weight gain.
The trouble is that those antipsychotics are mostly used in patients with schizophrenia and they usually have to use it for the rest of their lives. Moreover, these patients can have other risk factors for cardiovascular disease as well. Weight gain may also adversely affect treatment adherence, is associated with reduced quality of life, social stigma, and greater morbidity and mortality.
Wouldn’t it be nice if we had effective interventions and specific treatment approaches to control this anti psychotic weight gain. And I mean non-pharmacological. Recently I wrote a post about the use of metformine during treatment with atypical antipsychotics. Metformine was combined with lifestyle intervention, this consisted of a diet,psycho education and exercise.
A recent study indicates that lifestyle intervention and metformine in combination has the greatest effect on weight loss and increases insulin sensitivity for patients taking atypical antipsychotics. These methods result in a decrease of 1.8 of the BMI, an increase in insulin resistance index of 3.6 and the waist circumference decreases with 2.0 cm.
Fortunately their is a recent systematic review and meta analysis about this topic. And this is the result:
Ten trials were included in the meta-analysis. Adjunctive non-pharmacological interventions, either individual or group interventions, or cognitive–behavioural therapy as well as
nutritional counselling were effective in reducing or attenuating antipsychotic-induced weight gain compared with treatment as usual, with treatment effects maintained over follow-up.
I was interested in these interventions. Six of the included trials investigated cognitive–behavioural
intervention strategies; three nutritional counselling interventions; and one combined nutritional and exercise interventions. Five used group interventions and 5 examined individual interventions. There was no statistically significant or practically important differences between therapeutic approaches, either individual compared with group interventions, or CBT compared with nutritional counselling.
Only one trial was found with a young cohort with recent-onset psychosis. Weight gain is a greater problem for these young patients, they are especially susceptible for this side-effect. Treatments offered in early stages should be more benign as well as effective to improve treatment adherence. These interventions against weight gain are especially beneficial to this young group of patients.
Overall weight loss was on average 2,6 kg. Is statistically significant also clinically relevant?
In this review, the average baseline weight was approximately 80 kg (ranging from 66.5 to 101.3 kg). Therefore, even a weight loss of 1.9–3.2 kg represents a reduction of 2.5–4.0% of initial body weight in a significant number of patients. It may be plausible, then, to expect that these reductions in body weight could result in corresponding reductions in morbidity and early mortality.
So start implementing these interventions when prescribing new antipsychotics.
M. Alvarez-Jimenez, S. E. Hetrick, C. Gonzalez-Blanch, J. F. Gleeson, P. D. McGorry (2008). Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials The British Journal of Psychiatry, 193 (2), 101-107 DOI: 10.1192/bjp.bp.107.042853
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Hi Dr. Shock,
My pdoc provided me with excellent advice when I was taking medicine that had the potential for weight gain. It was easy to do, and it worked.
He said: Weigh yourself everyday, but do not worry about da to day flucuations. Each week average out your weekly weight. If you have gained anything take immediate action to lose that for the following week by watching what you eat, by walking a bit more than usual etc.
It really worked for me, because a pound or two were not impossible to lose. It helped me never gain in the first place. The great thing was it did not take a great deal of effort, motivation, or energy to lose a pound. Which was good because I was really lacking in those departments.
Including atypical antipsychotics? I think your right but wasn’t weighing yourself everyday difficult?
Some say once a week is enough but than I get your point that immediate action does help better than when things get out of hand. Was it always relatively easy to keep a steady weight even before using medication that can increase weight?
Regards Dr Shock
Hi Dr. Shock,
No I have always had a really difficult time keeping my eight down when depressed. Eating too much, and of the wrong things, is a huge indicator that I am heading into or in a depressive episode. One of the first symptoms of me coming out of one is less eating and weight loss.
Originally I followed his advice for atypical antipsychotics i was trying (Seroquel and Risperidone), but I really began having trouble with Epival and was terrified of all the info I read about it causing people to gain 50-60lbs.
I added my weight to my mood chart, so it just became part of my filling out my mood chart routine. Then on Sundays I would average out the week. I swear it really, really “protected” me from weight gain as all those meds made it excrutiatingly difficult to do anything, but sit, or sleep, or eat.
What a discipline, awesome.
Regards Dr Shock
Hello Guru, what entice you to post an article. This article was extremely interesting, especially since I was searching for thoughts on this subject last Thursday.