Weight gain during neuroleptic treatment

Abstract

It has long been noted that patients being treated with neuroleptic medications (major tranquilizers) tend to gain weight. There is a growing awareness that significant weight gain presents several difficulties for the patient. As the patient improves and begins to re-establish relationships with others, he finds that his obesity makes him less physically attractive and as a result less socially desirable. A number of our patients have discontinued their medication in order to reverse the weight gain and end the resulting social ostracism. Weight gain thereby functions as an important source of resistance to effective treatment. Finally, it is well established that obesity predisposes and/or exacerbates a number of medical illnesses, including adult onset diabetes, essential hypertension, cholelithiasis, and atherosclerotic cardiovascular disease. Since chemotherapy remains central to the treatment of the major psychoses, we chose to study the most commonly employed and newer neuroleptic agents to ascertain their, effects on patient weight. We hoped to discover that some neuroleptics would cause relatively less weight gain or ideally that in our population certain medications might be associated with weight loss. We conducted an extensive review of the scientific literature from January 1966 to January 1980, for all references to weight change in psychiatric patients treated with neuroleptics. Our search uncovered varying and conflicting reports, most of which were anecdotal. Many early authors, including Kraepelin, noted that schizophrenic patients lose weight as their condition deteriorates and gain weight as they improve (Gordon and Groth, 1964). This was observed well before the introduction of neuroleptic medication. A psychodynamic explanation of this phenomenon was proposed: that a slimmer patient had greater opportunity for intimacy, which could be experienced as a threat and intensify the need for psychotic defenses. With clinical improvement the patient gained weight and diminished his chances for interpersonal closeness. Some authors maintained that the weight gain associated with medication was really the weight gain previously identified with clinical improvement. Other authors argued that the weight gain was pharmacologically caused by neuroleptics and would mask any weight change formerly used as a clinical indicator of remission.