From case reports it appears that quetiapine is sought after for recreational use and inappropriate use such as intranasal and intravenous administration. Quetiapine is also for sale on the street, symptom malingering to obtain the drug and higher dosage requests. It’s always important to recognize such misuse of medication because in the case of quetiapine it can induce weight gain, glucose intolerance, in rare cases movement disorders. Moreover, these drugs are very expensive and will cost society more money when misused.
In a recent publication a case report and a review of previous case reports is discussed. The patients mostly seek the “dreamy”, calming, or soporific state with quetiapine. Most patients had a prior drug or alcohol problem and the misuse was often connected to a forensic setting.
Moreover, the authors present possible mechanism as explanation for it’s misuse. First it has an anticholinergic activity which has been described previously with other drugs as cause for misuse. Anticholinergic agents usually cause an euphoric and stimulatory state in patients which doesn’t match with the accounts of patients misusing quetiapine. The authors suggest that the antihistaminic property of questiapine is responsible for it’s misuse.
The misuse potential of quetiapine is likely related to its histaminic blockade coupled with its comparatively mild action at dopamine receptors. Accordingly, quetiapine substitutes for sedating agents and individuals with a history of alcohol, benzodiazepine, or opiate abuse are particularly at risk.
Fischer, B., & Boggs, D. (2010). The role of antihistaminic effects in the misuse of quetiapine: A case report and review of the literature Neuroscience & Biobehavioral Reviews, 34 (4), 555-558 DOI: 10.1016/j.neubiorev.2009.11.003
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 health supplements which help to the actual weight loss which are the Exogenous Ketones Supplements excellent for good health and to maintain your weight, also there’s a new 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.
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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. My friend uses this boiled egg diet and he lost around 2 pounds in 2 weeks.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