Skip to main content

Advertisement

SpringerLink
Log in

Management of Weight Gain Associated with Antipsychotics

  • Published:
Annals of Clinical Psychiatry

Abstract

The prevalence of overweight and obesity in untreated patients with severe mental illness mimicks the trends seen in the general population. Furthermore, weight gain is likely to occur with the addition of pharmacotherapy with an antipsychotic. The literature does indicate that despite fundamental cognitive and psychosocial deficits seen in patients with severe and persistent mental disorders such as schizophrenia and bipolar disorder, it is possible to effectively manage weight gain in this population. In particular, behavioral interventions have been shown to be effective in the prevention and treatment of weight gain associated with antipsychotic therapy. Some success has also been seen with the use of adjunctive medication such as amantadine, histamine (H2) antagonists, metformin, topiramate, and orlistat. Additional, prospective, controlled studies of long-term antipsychotic drug associated weight gain and its clinical consequences are needed in order to identify the most effective therapy for the reduction and maintenance of body weight in patients taking antipsychotic therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Aronne LJ: Epidemiology, morbidity, and treatment of overweight and obesity. J Clin Psychiatry 2001; 62(Suppl 23):13-22

    Google Scholar 

  2. Mokdad AH, Bowman BA, Ford ES, Vinicor F, Marks JS, Koplan JP: The continuing epidemics of obesity and diabetes in the United States. JAMA 2001; 286:1195-1200

    Google Scholar 

  3. World Health Organization: Obesity Epidemic Puts Millions At Risk (press release). Retrieved February 2002, from http://www.who.int/archives/inf-pr-1997/en/pr97-46.ht

  4. Hochberg MC, Lethbridge-Cejku M, Scott WW, Jr, Reichle R, Plato CC, Tobin JB: The association of body weight, body fatness and body fat distribution with osteoarthritis of the knee: Data from the Baltimore Longitudinal Study of Aging. J Rheumatol 1995; 22(3):488-493

    Google Scholar 

  5. Millman RP, Carlisle CC, McGarvey ST, Eveloff SE, Levinson PD: Body fat distribution and sleep apnea severity in women. Chest 1995; 107(2):362-366

    Google Scholar 

  6. Huang Z, Willet WCD, Mason JE: Body weight, weight change, and risk for hypertension in women. Ann Intern Med 1998; 28:81-88

    Google Scholar 

  7. Stamler R, Stamler J, Riedlinger WF, Algera G, Roberts RH: Weight and blood pressure. Findings in hypertension screening of 1 million Americans. JAMA 1978; 240(15):1607-1610

    Google Scholar 

  8. Colditz GA, Willett WC, Rotnitzky A: Weight gain as a risk factor for clinical diabetes. Ann Intern Med 1995; 122:481-486

    Google Scholar 

  9. Willett WC, Manson JE, Rotnitzky A: Weight, weight change and coronary heart disease in women: Risk within the “normal” weight range. JAMA 1995; 273:461-465

    Google Scholar 

  10. Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH: The disease burden associated with overweight and obesity. JAMA 1999; 282(16):1523-1529

    Google Scholar 

  11. Rexrode KM, Hennekens CH, Willett WC: A prospective study of body mass index, weight change, and risk of stroke in women. JAMA 1997; 277:1539-1545

    Google Scholar 

  12. Practical Guide to the Identification, Evaluation, and Treatment of overweight and Obesity in Adults. Retrieved February 2002, from http://www.nhlbi.nih.gov/guidelines/obesity

  13. Allison DB, Fontaine KR, Moonseong H, Mentore JL, Cappelleri JC, Chandler LP, Weiden PJ, Cheskin LJ: The distribution of body mass index among individuals with and without schizophrenia. J Clin Psychiatry 1999; 60:215-220

    Google Scholar 

  14. Allison DB, Casey DE. Antipsychotic-induced weight gain: A review of the literature. J Clin Psychiatry 2001; 62(Suppl 7):22-31

    Google Scholar 

  15. Allison DB, Mentore JL, Heo M, Chandler LP, Cappelleri JC, Infante MC, Weiden PJ: Antipsychotic-induced weight gain: A comprehensive research synthesis. Am J Psychiatry 1999; 156(11):1686-1696

    Google Scholar 

  16. Harmatz MG, Lapuc P: Behavior modification of overeating in a psychiatric population. J Consult Clin Pharmacol 1968; 32(5):583-587

    Google Scholar 

  17. Rotatori AF, Fox R, Wicks A: Weight loss with psychiatric residents in a behavioral self-control program. Psychol Rep 1980; 46:483-486

    Google Scholar 

  18. Greenberg I, Chan S, Blackburn G: Non-pharmacologic and pharmacologic management of weight gain. J Clin Psychiatry 1999; 60(Suppl 21):31-36

    Google Scholar 

  19. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion: Surgeon General's Report on Physical Activity and Health. Atlanta, GA: CDC; 1996.

    Google Scholar 

  20. McGuire MT, Wing RR, Klem ML, Seagle HM, Hill JO: Long-term maintenance of weight loss: Do people who lose weight through various weight loss methods use different behaviors to maintain their weight? Int J Obes Relat Metab Disord 1998; 22:572-577

    Google Scholar 

  21. Poston WSC, Foreyt JP: Successful management of the obese patient. Am Fam Physician 2000; 61:3615-3622

    Google Scholar 

  22. Davis BR, Blaufox MD, Oberman A, Wassertheil-Smoller S, Zimbaldi N, Cutler JA, Kirchner, Langford HG: Reduction in long-term antihypertensive medication requirements. Effects of weight reduction by dietary intervention in overweight persons with mild hypertension. Arch Intern Med 1993; 153(15):1773-1782

    Google Scholar 

  23. Granberry MC, Fonseca VA: Insulin resistance syndrome: Options for treatment. South Med J 1999; 92:2-15

    Google Scholar 

  24. Rossner S, Sjostrom L, Noack R, Meinders AE, Naseda G: Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity. Obes Res 2000; 8(1):49-61

    Google Scholar 

  25. Berke EM, Morden NE: Medical management of obesity. Am Fam Physician 2000; 62(2):419-426

    Google Scholar 

  26. Dickerson LM, Carek PJ: Drug therapy for obesity. Am Fam Physician 2000; 61(7):2131-2138

    Google Scholar 

  27. Yanovski SZ, Yanovski JA: Obesity. N Engl J Med 2002; 346(8):591-602

    Google Scholar 

  28. Guy-Grand B, Apfelbaum M, Crepaldi G, Breis A, LeFebvre P, Turner P: International trial of long-term dexfenfluramine in obesity. Lancet 1989; 2(8672):1142-1145

    Google Scholar 

  29. Weintraub M, Sundaresan PR, Schuster B: Long-term weight control study. IV (weeks 156 to 190). The second double-blind phase. Clin Pharmacol Ther 1992; 51(5):608-614

    Google Scholar 

  30. US Department of Health and Human Services interim public health recommendations: Cardiac valvulopathy associated with exposure to fenfluramine or dex-fenfluramine. MMWR Morb Mortal Wkly Rep 1997; 46:1061

    Google Scholar 

  31. Baptista T: Body weight gain induced by antipsychotic drugs: Mechanisms and management. Acta Psychiatr Scand 1999; 100:3-16

    Google Scholar 

  32. Knox JM: A study of weight reducing diets in psychiatric in-patients. Br J Psychiatry 1980; 136:287-289

    Google Scholar 

  33. Klein B, Steel RI, Simon WE, Primavera LH: Reinforcement and weight loss in schizophrenics. Psychol Rep 1972; 30(12):581-582

    Google Scholar 

  34. Sletten IW, Ognjanov V, Menendez S, Sundland D, El-Toumi A: Weight reduction with chlorphenetermine and phenmetrazine in obese psychiatric patients during chlorpromazine therapy. Curr Ther Res Clin Exp 1967; 9:570-575

    Google Scholar 

  35. Vreeland B, Roemhelf-Hamm B, Menza M, Stern R, Touger-Decker R, Minsky S, Radler DR: Managing atypical antipsychotic-associated weight gain: The Healthy Living Program. Poster presented at 155th American Psychiatric Association Annual Meeting, May 18–23, 2002, Philadelphia, PA

  36. Ball MP, Coons VB, Buchanon RW: A program for treating olanzapine-related weight gain. Psychiatr Serv 2001; 52(7):967-969

    Google Scholar 

  37. Centorrino F, Wurtzman JJ, Duca KK, Kelleher JP, Fellman VH, Berry JM, Guay DM, Romeling M, Tardivo J, Kidwell JE, Fogarty KV: Comprehensive weight loss program for overweight subjects treated with atypical antipsychotics. Poster presented at 155th American Psychiatric Association Annual Meeting, May 18–23, 2002, Philadelphia, PA

  38. O'Keefe C, Noordsy D, Liss T, Weiss H: Reversal of weight gain associated with antipsychotic treatment. Poster presented at 154th Annual American Psychiatric Association, May 2001, New Orleans, LA.

  39. Wirshing DA, Wirshing WC, Kysar L, Berisford MA, Goldstein D, Pashdag J, Mintz J, Marder SM: Novel antipsychotics: Comparison of weight gain liabilities. J Clin Psychiatry 1999; 60(6):358-363

    Google Scholar 

  40. Littrell KH, Petty RG, Hilligoss NM, Peabody CD, Johnson CG: Educational interventions for the management of antipsychotic-related weight gain. Poster presented at the New Clinical Drug Evaluation Unit (NCDEU) Meeting, May 2001, Phoenix, AZ.

  41. Goodall E, Oxtoby C, Richard R, Watkinson G, Brown D, Silverstone T: A clinical trial of the efficacy and acceptability of d-fenfluramine in the treatment of neuroleptic-induced obesity. Br J Psychiatry 1988; 153:208-213

    Google Scholar 

  42. Svacina S, Sonka J, Marek J: Dexfenfluramine in psychotic patients. Int J Eat Disord 1998; 24:335-338

    Google Scholar 

  43. Kolakowska T, Gadhvi H, Molyneux S: An open clinical trial of fenfluramine in chronic schizophrenia: A pilot study. Int Clin Psychopharmacol 1987; 2:83-88

    Google Scholar 

  44. Borovicka MC, Fuller MA, Konicki E, White JC, Steele VM, Jaskiw GE: Phenylpropanolamine appears not to promote weight loss in patients with schizophrenia who have gained weight during clozapine treatment. J Clin Psychiatry 2002; 63(4):345-348

    Google Scholar 

  45. Shannon PJ, Leonard D, Kidson MA: Fenfluramine and psychosis [letter]. J Clin Psychopharmacol 1996; 16:470-471

    Google Scholar 

  46. Bagri S, Reddy G: Delirium with manic symptoms induced by diet pills [letter]. J Clin Psychiatry 1998; 59:83.

    Google Scholar 

  47. Preval H, Pakyurek AM: Psychotic episode associated with dexfenfluramine. Am J Psychiatry 1997; 154(11):1624-1625

    Google Scholar 

  48. Tafunski T, Chojnacka J: Sibutramine-associated psychotic episode. Am J Psychiatry 2000; 157:2056-2057

    Google Scholar 

  49. Stromberg U, Svensson TH, Waldeck B: On the mode of action of amantadine. J Pharm Pharmacol 1970; 22(12):959-962

    Google Scholar 

  50. Konig P, Chwatal K, Havelec L, Riedl F, Schubert H, Schultes H: Amantadine versus biperiden: A double-blind study of treatment efficacy in neuroleptic extrapyramidal movement disorders. Neuropsychobiology 1996; 33(12):80-84

    Google Scholar 

  51. Floris M, Lejeune J, Deberdt W: Effect of amantadine on weight gain during olanzapine treatment [case report]. Eur Neuropsychopharmacol 2001; 11(2):181-182

    Google Scholar 

  52. Baruch R, Poulin M, Thakur A, Karagianis J, Raskin J: Amantadine induces weight loss in patients treated with olanzapine. Schizophr Res 2002; 53(3 Suppl 1):159

    Google Scholar 

  53. Wilcox and Tsuang: Psychological effects of amantadine on psychotic subjects. Neuropsychobiology 1990; 23(3):144-146

    Google Scholar 

  54. Stoa-Birketvedt G: Effect of cimetidine suspension on appetite and weight in overweight subjects. BMJ 1993; 30:1091-1093

    Google Scholar 

  55. Stoa-Birketvedt G, Paus PN, Ganss R, Ingebretsen OC, Florholmen J: Cimetidine reduces weight and improves metabolic control in overweight patients with type 2 diabetes. Int J Obes Relat Metab Disord 1998; 22(11):1041-1045

    Google Scholar 

  56. Sacchetti E, Guarneri L, Bravi D: H2 antagonist nizatidine may control olanzapine-associated weight gain in schizophrenic patients. Biol Psychiatry 2000; 48(2):167-168

    Google Scholar 

  57. Breier A, Tanaka Y, Roychowdhury S, Clark WS: Nizatidine for the prevention of olanzapine-associated weight gain in schizophrenia and related disorders-a randomized controlled double-blind study. Poster presented at the 41st New Clinical Drug Evaluation Unit, Lilly Research Laboratories, May 28–31, 2001, Phoenix, AZ. Unpublished data

  58. Bailey CJ, Turner RC: Metformin. N Engl J Med 1996; 334:574-579

    Google Scholar 

  59. Fontbonne A, Charles MA, Juhan-Vague I, Bard JM, Andre P, Isnard F, Cohen JM, Grandmottet P, Vague P, Safar ME, Eschwege E: The effect of metformin on the metabolic abnormalities associated with upper-body fat distribution. Results of the BIGPRO 1 trial. Diabetes Care 1996; 19(9):920-926

    Google Scholar 

  60. Diabetes Prevention Program Research Group: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New Engl J Med 2002; 346(6):393-403

    Google Scholar 

  61. Morrison J, Cottingham EM, Barton BA: Metformin for weight loss in pediatric patients taking psychotropic drugs. Am J Psychiatry 2002; 159(4):655-657

    Google Scholar 

  62. Glucophage Prescribing Information. Bristol Myers Squibb Company, New York, NY, June 2001

  63. Al-Jebawi AF, Lassman MN, Abourizk NN: Lactic acidosis with therapeutic metformin blood level in a low-risk diabetic patient. Diabetes Care 1998; 21(8):1364-1365

    Google Scholar 

  64. Marcotte D: Use of topiramate, a new anti-epileptic as a mood stabilizer. J Affect Disord 1998; 50:245-251

    Google Scholar 

  65. Gordon A, Price LH: Mood stabilization and weight loss with topiramate. Am J Psychiatry 1999; 156:968-969

    Google Scholar 

  66. Norton J, Potter D, Edwards K: Sustained weight loss associated with topiramate. Epilepsia 1997; 38(Suppl 3):58

    Google Scholar 

  67. Dursun SM, Devarajan S: Clozapine weight gain, plus topiramate weight loss. Can J Psychiatry 2000; 45:198.

    Google Scholar 

  68. Chengappa KN, Levine J, Rathore D, Parepally H, Atzert R: Long-term effects of topiramate on bipolar mood instability, weight change and glycemic control: A case-series. Eur Psychiatry 2001; 16:186-190

    Google Scholar 

  69. Littrell KH, Petty RG, Hilligoss NM, Peabody CD, Johnson CG: Weight loss with topiramate. Ann Pharmacother 2001; 35:1141-1142

    Google Scholar 

  70. Meyer JM: Effects of atypical antipsychotics on weight and serum lipid levels. J Clin Psychiatry 2001; 62(Suppl 27):27-34

    Google Scholar 

  71. Dinan TG, Tobin A: Orlistat in the management of antipsychotic-induced weight gain: Two case reports. J Serotonin Res 2001; 7:14-15

    Google Scholar 

  72. Anghelescu I, Klawe C, Benkert O: Orlistat in the treatment of psychopharmacologically induced weight gain. J Clin Psychopharmacol 2000; 20(6):716-717

    Google Scholar 

  73. Nagele H, Peterson B, Bonacker U, Rudiger W: Effect of orlistat on blood cyclosporine concentrations in an obese heart transplant patient. Eur J Clin Pharmacol 1999; 55:667-669

    Google Scholar 

  74. Hilger E, Quiner S, Ginzel I, Walter H, Saria L, Barnas C: The effect of orlistat on plasma levels of psychotropic drugs in patients with long-term psychopharmacotherapy. J Clin Psychopharmacol 2002; 22:68-70

    Google Scholar 

  75. Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kivkaanniemi S, Laakso M, Louheranta A, Raslas M, Salminen V, Uusitupa M: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344(18):1343-1350

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Lilly Corporate Center, Lilly Research Laboratories, Eli Lilly and Company, Drop Code 2534, Indianapolis, Indiana, 46285

    Julie Birt

Authors
  1. Julie Birt
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Birt, J. Management of Weight Gain Associated with Antipsychotics. Ann Clin Psychiatry 15, 49–58 (2003). https://doi.org/10.1023/A:1023280610379

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1023280610379

Search

Navigation