Abstract
Background:Antipsychotics are often prescribed for long-term periods, however, most evidence of their impact on body weight comes from short-term clinical trials. Particularly, impact associated with dosage has been barely studied.Aims:The aim of this study was to describe the short- and long-term change in body weight of people initiated on high or low doses of the three most commonly prescribed second-generation antipsychotics.Methods:Retrospective cohorts of individuals with a diagnosed psychotic disorder observed from 2005 to 2015 in the UK primary care. The exposure was the first prescription of olanzapine, quetiapine or risperidone. The main outcome was change in body weight four years before and four years after initiation of antipsychotic treatment, stratified on sex and ‘low’ or ‘high’ dose.Results:In total, 22,306 women and 16,559 men were observed. Olanzapine treatment was associated with the highest change in weight, with higher doses resulting in more weight gain. After 4 years, given a high dose of olanzapine (> 5 mg), women gained on average +6.1 kg; whereas given a low dose (⩽ 5 mg), they gained +4.4 kg. During the first six weeks of olanzapine treatment, they gained on average +3.2 kg on high dose and +1.9 kg on low dose. The trends were similar for men. Individuals prescribed risperidone and quetiapine experienced less weight gain in both the short- and long-term.Conclusions:Olanzapine treatment was associated with the highest increase in weight. Higher doses were associated with more weight gain. Doctors should prescribe the lowest effective dose to balance mental-health benefits, weight gain and other adverse effects.
Highlights
Overweight and obesity is a worldwide problem that impacts severely on population health (Newcomer and Haupt, 2006)
Other studies have demonstrated similar differences between men and women (Gebhardt et al, 2009; Najar et al, 2017). Most of these studies are based on small sample sizes of less than 200 individuals, and most do not distinguish between short- and long-term weight gain associated with antipsychotic treatment
Women who had a lower weight before initiation of olanzapine gained more weight in the short term than women who had a higher weight; a similar effect was observed for men (Table S2)
Summary
Overweight and obesity is a worldwide problem that impacts severely on population health (Newcomer and Haupt, 2006). Lahti et al demonstrated that the risk of death is higher in women than in men with schizophrenia (Lahti et al, 2012), suggesting that differences between sexes need to be further investigated. Other studies have demonstrated similar differences between men and women (Gebhardt et al, 2009; Najar et al, 2017) Most of these studies are based on small sample sizes of less than 200 individuals, and most do not distinguish between short- and long-term weight gain associated with antipsychotic treatment. Aims: The aim of this study was to describe the short- and long-term change in body weight of people initiated on high or low doses of the three most commonly prescribed second-generation antipsychotics. Olanzapine treatment was associated with the highest change in weight, with higher doses resulting in more weight gain. Doctors should prescribe the lowest effective dose to balance mental-health benefits, weight gain and other adverse effects
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