Therapeutic management of obesity induced by antipsychotic drugs

Abstract

The introduction of second-generation antipsychotic drugs (SGAs) has contributed to a more effective treatment of mental diseases and patients’ improved quality of life. Their particular superiority to first-generation antipsychotics (FGAs) includes better outcomes in treating "negative" symptoms, impact on mood and lower risk of motor side effects (1). Their increasing use, going beyond psychotic disorders, has highlighted the problem of medication-induced weight gain and obesity in patients. Obesity leads to increased cardiovascular morbidity and mortality, decreased quality of life, and poor adherence. This narrative review discusses the impact of various SGA on weight gain and related adherence to medication, as well as available pharmacological and non-pharmacological interventions to counteract these effects. Most SGA commonly cause weight gain but the risk appears to be highest with olanzapine and clozapine. The best preventative strategies are tailored antipsychotic drugs and close monitoring of body weight and other metabolic parameters. Switching from one SGA to another less likely to cause metabolic disturbances is an option but carries a risk of relapse. Non-pharmacological interventions in the form of dietary counseling, exercise programs, cognitive and behavioral strategies appear to be equally effective in both individual and group forms. Both non-pharmacological prophylaxis and intervention strategies showed little effect on weight. Of the additional weight loss medications, metformin appears to be the compound with the best documented efficacy. There is no evidence of benefit from the routine prescription of additional weight loss medications. Drawing conclusions is hampered by the high heterogeneity of research methodology, as well as the participation of other factors such as lifestyle, genetic and disease-related factors.