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Professional Issues >> Total Wellness
Antipsychotic-induced Weight Gain
 
Weight gain is an adverse event associated with the use of virtually all antipsychotic medications, both traditional and atypical. The development of obesity in patients taking antipsychotic agents has been documented since the 1950s.31 The relative obesity-inducing potential of different atypical antipsychotics has not been definitively established, although some comparative data are available. Two review articles32,33 concur that among the atypical agents, clozapine appears to cause the most weight gain; olanzapine, quetiapine, and risperidone an intermediate amount; and ziprasidone the least, although data on ziprasidone are few. Despite these attempts to rank antipsychotics in terms of which causes the most weight gain, the more important questions concern which patients gain weight and what their baseline status was.
Beasley et al.34 evaluated 5 clinical trials and found that the most significant increases in weight occurred in the patients who were the most underweight prior to beginning treatment with olanzapine (figure). Less than half (40.5%) of patients treated with olanzapine gained 7% or more of their body weight (the FDA-defined threshold for weight gain as an adverse event). Among the patients who gained _ 7% of their baseline weight by endpoint, 32% were underweight at baseline;18% had normal baseline weight; and 11% were already overweight. Of all the patients taking olanzapine, 6% lost weight.
Incidence of Weight Gain (_7%) by BMI Category at Baseline in 5 Olanzapine Studiesa
aData from Beasley et al. 1997.34
bsignificant difference (p<.001) at endpoint compared with baseline weight.
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