Abstract
Background and AimsWeight gain is a major adverse effect of antipsychotic medication, negatively affecting physical and mental well-being. The objective of this study was to explore if dose reduction, discontinuation, switch to a partial agonist, or switch from polypharmacy to monotherapy will lead to weight loss.MethodsControlled and uncontrolled studies reporting the effects of discontinuation, dose reduction, switch to a partial agonist, or switch from polypharmacy to monotherapy on weight were included. Primary outcome was difference in weight compared to maintenance groups based on controlled studies. Secondary outcome was change in weight from initiation of one of the included interventions until follow-up in a pre-post analysis.ResultsWe identified 40 randomized controlled trials and 15 uncontrolled studies including 12,279 individuals. The effect of the interventions, i.e. dose reduction, drug discontinuation, or switch to a partial agonis, reduced the weight with 1.5 kg (95% CI −2.03 to −0.98; P < 0.001) compared to maintenance treatment. The weight change from pre to post was a reduction of 1.13 kg (95% CI −1.36 to −0.90; P < 0.001).ConclusionWe found a significant but small reduction in weight, suggesting that antipsychotic-induced weight gain can be reversed to some degree. Only a few studies were designed to address the question as primary outcome, which limits the generalizability of our findings.
Highlights
Shared decision making is the cornerstone of modern, evidence-based medicine and requires transparency about risks and benefits associated with any treatment decisions
For the primary outcome (Figure 2), weight change in intervention groups compared to maintenance treatment, based on 40 randomized trials, we found a weight reduction of -1.51 kg in groups who had their medication discontinued/reduced/switched to partial agonist, compared to control groups who continued maintenance treatment (Table 2)
We found that the pooled effect of discontinuation, dose reduction, and switch to partial agonists reduced the weight with 1.54 kg compared to maintenance treatments with a second generation antipsychotic drug
Summary
Shared decision making is the cornerstone of modern, evidence-based medicine and requires transparency about risks and benefits associated with any treatment decisions. Weight gain is a major adverse effect of second-generation antipsychotics, affecting quality of life [4], personal recovery, and somatic morbidity and is a common reason for antipsychotic discontinuation [5]. Knowledge about the reversibility of antipsychotic weight gain is important to qualify the informed decision of both initiation and discontinuation. Information about the risk of weight gain during treatment is important, and it is well documented in the scientific literature [6]. Knowledge about the reversibility of weight gain when the antipsychotic medication is reduced or discontinued remains scarce. Many may expect adverse effects to be reversible upon discontinuation, but this is not always the case with antipsychotic medication, as exemplified by tardive dyskinesia [7]. Weight gain is a major adverse effect of antipsychotic medication, negatively affecting physical and mental well-being. The objective of this study was to explore if dose reduction, discontinuation, switch to a partial agonist, or switch from polypharmacy to monotherapy will lead to weight loss
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