Weight Gain, Obesity, and Psychotropic Prescribing

SUNY Upstate Medical University, Syracuse, NY 13210, USA.
Journal of obesity 01/2011; 2011(11):893629. DOI: 10.1155/2011/893629
Source: PubMed


A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment with these agents. There is newer literature looking at the etiology of this weight gain and the potential treatments being used to alleviate this side effect. The authors undertook a comprehensive literature review in order to present epidemiology, etiology, and treatment options of weight gain associated with antipsychotics, mood stabilizers, and antidepressants.

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Available from: Nikhil Nihalani, Jul 08, 2015
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    • "For both psychosis and depression, a number of explanations have been proposed, including lifestyle and dietary habits (i.e. sedentary behavior, sleep dysregulation, and increased appetite) [28] [29], alterations of the hypothalamic–pituitary–adrenal axis (HPA) [30] [31], vulnerability to a genotypic peculiar form of MetS [32] [33] [34] [35] and direct action of antidepressant and antipsychotic drugs on lipid and carbohydrate metabolism [36] [37] [38] [39] [40] [41]. "
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    ABSTRACT: Objective: Several studies indicate increased prevalence of metabolic syndrome (MetS) among patients with psychiatric disorders as well as among individuals with gender dysphoria (GD) treated by cross-sex hormonal treatment. However, the MetS prevalence among hormone treated GD individuals suffering from psychiatric problems has not been detected. Methods: From a sample of 146 GD patients we selected 122 metabolically healthy individuals in order to investigate the prevalence of MetS after the beginning of the cross-sex hormonal treatment in a 2 year follow-up assessment. Furthermore, we assessed differences in MetS prevalence between hormone treated GD patients with and without concomitant psychiatric problems. Results: When treated with hormone therapy, GD patients reported changes in several parameters which are clustered in MetS, with statistically significant differences compared to baseline. Glyco-insulinemic alterations were more pronounced in male to female patients (MtFs). However, weight gain, waist circumference increases, blood pressure increases, and lipid alterations were similar in MtFs and female to male patients (FtMs). 14.8% of the sample at year 1 and 17.2% at year 2 developed MetS. Among patients with concomitant psychiatric problems, 50% at year 1 and 55% at year 2 developed MetS against 8% at year 1 and 10% at year 2 of patients without concomitant psychiatric problems. Conclusion: This study indicates that sex hormones induce MetS in a relatively low proportion of healthy GD individuals and especially during the first year of hormonal treatment. Most importantly, concomitant psychiatric problems are associated with considerably greater MetS prevalence in hormone treated GD individuals.
    Full-text · Article · Feb 2015 · Journal of Psychosomatic Research
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    • "For example, obesity can be 1.5 to 2 times more prevalent in people with schizophrenia and affective disorders than in the general population [4]. Recent findings suggest that psychotropic medications used to treat this population also contribute to weight gain [5]. In a five-year naturalistic study of patients treated with clozapine, a researcher found that weight gain increased until 46 weeks after drug initiation [6]. "
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    ABSTRACT: The use of atypical antipsychotic agents has rapidly increased in the United States and worldwide in the last decade. Nonetheless, many health care practitioners do not appreciate the significance of the cardiovascular side effects that may be associated with their use and the means to minimize them. Thus, atypical antipsychotic medications can cause cardiovascular side effects such as arrhythmias and deviations in blood pressure. In rare cases, they may also cause congestive heart failure, myocarditis, and sudden death. Patients with schizophrenia have a higher risk of cardiovascular mortality than healthy individuals, possibly because of excessive smoking, the underlying disorder itself, or a combination of both factors. Increased awareness of these potential complications can allow pharmacists and physicians to better manage and monitor high risk patients. Accurate assessments are very important to avoid medications from being given to patients inappropriately. Additionally, monitoring patients regularly via blood draws and checking blood pressure, heart rate, and electrocardiogram can help catch any clinical problems and prevent further complications. Finally, patient and family-member education, which pharmacists in particular can play key roles in, is central for the management and prevention of side effects, which is known to reflect positively on morbidity and mortality in these patients.
    Full-text · Article · Feb 2014
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    • "In addition, a recent and growing body of literature has identified the negative consequences of common psychotropic medications, resulting in further metabolic dysfunction and weight gain (Curtis et al. 2012; Teff et al. 2013). Modifiable risk factors, such as smoking, substance abuse, physical inactivity, and poor dietary habits, are known to further compound the poor physical health of mental health consumers (Curtis et al. 2012; Nihalani et al. 2011). "
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    ABSTRACT: The aim of the present study was to: (i) document the prevalence of risk factors for non-communicable diseases among mental health consumers (inpatients) with various diagnoses; and (ii) audit the frequency of waist circumference (WC) documentation before and after an intervention that involved a single nurse-education session, and change in assessment-form design. The study was undertaken in a private psychiatric hospital in Sydney, Australia. Twenty-five nurses participated in the educational intervention. File audits were performed prior to intervention delivery (n = 60), and 3 months' (n = 60), and 9 months' (n = 60) post-intervention. Files were randomly selected, and demographic (age, diagnosis) and risk factor (WC, body mass index (BMI), smoking status, blood pressure) data were extracted. WC was higher in this cohort compared to published general population means, and only 19% of patients had a BMI within the healthy range. In total, 37% of patients smoked, while 31% were hypertensive. At baseline, none of the audited files reported WC, which increased to 35 of the 60 (58%) files audited at the 3-month follow up. At the 9-month follow up, 25 of the 60 (42%) files audited reported a WC. In the 120 post-intervention files audited, only two patients refused measurement. These results illustrate the poor physical health of inpatients, and suggest that nurse-assessed metabolic monitoring can be enhanced with minimal training.
    Full-text · Article · Jan 2014 · International journal of mental health nursing
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