[Psychotropic drug-induced obesity in older adults: complications, preventive and therapeutic interventions]

Weight gain and obesity are significant side effects of psychotropic pharmacotherapy in older adults, contributing to increased cardiometabolic risk and impaired functional capacity. Among psychotropic drugs, olanzapine, clozapine, quetiapine, mirtazapine, valproate, and lithium are associated with the most significant weight gain through complex mechanisms (H1 blockade, 5-HT2C antagonism, metabolic effects); however, other antipsychotics, mood stabilizers, and antidepressants may also contribute to weight increase. In older adults, obesity particularly increases the risk of diabetes, cardiovascular diseases, malignancies, sarcopenic obesity, and frailty - a geriatric syndrome characterized by reduced physiological reserves and increased vulnerability. Prevention hinges on preferring agents with lower metabolic risk (e.g., aripiprazole, venlafaxine, lamotrigine), regular monitoring, and proactive lifestyle interventions. Therapeutically, switching medications, intensive lifestyle programs, metformin, or GLP1 agonists may be employed. For younger-old adults (65-74 years), weight reduction is a primary goal, while for the oldest-old (≥75 years), preserving functional capacity is paramount, requiring a multidisciplinary approach. Orv Hetil. 2026; 167(11): 410-418.