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The effect of antidepressants and antipsychotics on weight gain in children and adolescents
J Reekie1, S P M Hosking2, C Prakash3,4
1University of Aberdeen, Aberdeen, UK.
Insights
Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) may improve weight in youth, while antipsychotics generally cause weight gain. Monitor children on antipsychotics for weight changes, especially those with pre-existing obesity.
Area of Science:
- Child and Adolescent Psychiatry
- Pharmacology
- Pediatric Obesity
Background:
- Increasing rates of psychiatric illness in children and adolescents.
- Unclear weight effects of common psychiatric medications.
- Need for evidence-based guidance on medication-associated weight changes.
Purpose of the Study:
- To review the literature on weight changes associated with antidepressant and antipsychotic use in pediatric populations.
- To compare the weight effects of different psychiatric medications.
- To identify potential weight-protective strategies.
Main Methods:
- Comprehensive literature search for studies on pediatric weight and psychiatric medication use.
- Selection and review of 42 relevant articles from 636 identified.
- Analysis of weight gain associated with selective serotonin reuptake inhibitors (SSRIs), serotonin and norepinephrine reuptake inhibitors (SNRIs), and antipsychotics.
Main Results:
- SSRIs and SNRIs were not associated with weight gain and may offer short-term weight improvements.
- Antipsychotics were generally linked to significant weight gain.
- Risperidone showed a greater weight gain effect compared to lithium, divalproex sodium, and pimozide.
- Augmentation therapy with metformin or topiramate demonstrated weight-protective effects.
Conclusions:
- SSRIs and SNRIs may benefit weight status in youth, but evidence for use in obesity outside psychiatric illness is limited.
- Close monitoring for weight gain is crucial for pediatric patients on antipsychotics.
- Alternative antipsychotics like olanzapine, clozapine, and risperidone may be less advantageous for obese youth.
Abstract:
Psychiatric illness in the paediatric population is increasing and the weight effect of medications for these problems is often unclear. A comprehensive literature search was undertaken to identify studies reporting weight in relation to antipsychotic and antidepressant use in children and adolescents. From 636 articles, 42 were selected for review. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) do not cause weight gain and may lead to improvements in weight status over the short, but not, long term. Antipsychotics were generally associated with weight gain. In drug comparison studies, risperidone had a larger weight gain effect than lithium, divalproex sodium and pimozide. Studies assessing the weight-protective effects of augmentation therapy with metformin or topiramate show less weight gain with addition of these agents. In conclusion, prescribing of SSRIs and SNRIs may be associated with improvements in weight status in children and adolescents but trials assessing their use in obesity, outside of established psychiatric illness, are limited and still experimental. Youth prescribed antipsychotic medication should be monitored for exaggerated weight gain and in those where obesity is a pre-existing concern agents other than olanzapine, clozapine and risperidone may be advantageous.
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