Bodyweight gain with atypical antipsychotics. A comparative review

Area of Science:

• Pharmacology
• Psychiatry
• Clinical Medicine

Background:

• Atypical antipsychotics offer improved efficacy over typical antipsychotics for schizophrenia, particularly for negative symptoms, with fewer extrapyramidal side effects.
• However, significant body weight gain is a common adverse effect associated with several atypical antipsychotic medications.

Purpose of the Study:

• To compare the frequency, amount, and conditions of body weight gain in patients treated with various atypical antipsychotics.
• To explore potential mechanisms underlying atypical antipsychotic-induced weight gain.

Main Methods:

• A MEDLINE search was conducted to identify studies on body weight gain associated with atypical antipsychotics from 1966 to March 2000.
• Data on average body weight gain, timing, patient risk factors, and potential pharmacological correlates were extracted and analyzed.

Main Results:

• Olanzapine (2.3 kg/month), clozapine (1.7 kg/month), quetiapine (1.8 kg/month), and zotepine (2.3 kg/month) were associated with high body weight gain.
• Risperidone (1.0 kg/month) showed moderate changes, while ziprasidone (0.8 kg/month) induced slight weight gain.
• Weight gain predominantly occurred within the first 12 weeks of treatment, with underweight patients at highest risk.

Conclusions:

• Body weight gain is a significant concern with certain atypical antipsychotics, necessitating clinical consideration due to its impact on treatment adherence and long-term health.
• Histamine H1 receptor affinity and the ratio of serotonin 5-HT2 to dopamine D2 receptor affinity appear to be key correlates of weight gain.
• Further research is needed to fully elucidate the pathogenesis of weight gain, including the role of leptin secretion.