Don't replace psychosis with
major weight gain

Newer atypical antipsychotics lead to obesity

By Katherine Addelman

As soon as the first antipsychotics appeared on the scene, they were linked to unusual weight gain. Some of the newer atypical antipsychotics -- like risperidone, olanzapine, quetiapine and clozapine -- have an even greater propensity for packing on the pounds. This is a major concern, both for the patients' health and because they may become so distressed they go off their meds.

The Canadian National Outcomes Measurement Study in Schizophrenia is an ongoing study led by Dr R S McIntyre of the Mood Disorders Psycho-pharmacology Clinic at the University of Toronto. The investigators have been collecting information on schizophrenic patients who are taking novel atypical antipsychotics. The survey, covering 32 sites across Canada, is recording weight changes, among other things. In a recent report, they found that patients on quetiapine gained an average of 7.6kg during their treatment while those on olanzapine gained about half that. Risperidone patients picked up about 1.6kg. In another article in the Journal of Clinical Psychopharmacology, Dr McIntyre and colleagues described how leptin levels leapt in bipolar patients on risperidone and olanzapine as their weight increased, especially with olanzapine.

Other studies have found that clozapine, olanzapine and quetiapine are associated with imbalances in glucose metabolism and that antipsychotic drugs can bring on severe dyslipidemia.

Most studies pointed to olanzapine as the worst offender in terms of weight gain. Quetiapine, clozapine, haloperidol, thioridazine/mesoridazine, sertindole, chlorpromazine, risperidone and ziprasidone all seem to boost weight significantly within a couple of months of treatment.

So what to do?

• First, most patients in psychiatric wards are sedentary and they often smoke at astronomical rates. Programs of physical activity and smoking cessation are a must.
• Second, nutritional counselling can make a big difference and should be included in the treatment regimen.
• Third, switching from a drug that's causing a significant weight gain to one that's less prone to increasing weight may help.
• Fourth, lipids that are out of whack should be treated with medications -- for example, a statin.
• Fifth, some patients may be able to lose weight with a product like orlistat or sibutramine. Dr McIntyre has been studying other products like topiramate and bupropion. Both of these helped patients lose weight, especially topiramate. Histamine antagonists like cimetidine may also be helpful.

Finally, Dr McIntyre and his colleagues recommended that physicians monitor weight and metabolic parameters in all patients taking these drugs.