Bodyweight Gain Induced by Psychotropic Drugs

Ackerman, Sigurd H.; Nolan, Laurence J.

doi:10.2165/00023210-199809020-00005

Cited by 70 publications

(36 citation statements)

References 76 publications

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“…32 This finding in one sense concurs with that of Allison et al 33 who observed that, while some patients with schizophrenia were underweight, a significant percentage were obese, yet their results failed to differentiate between those who were drug-free and those who were drugnaive and therefore their findings may be explicable in terms of prior neuroleptic exposure which in certain instances is associated with weight gain in a significant proportion of patients. 34,35 In contrast to the study by Allison et al, 33 roughly half of our patients were drug-naive while the others were drug-free for clinically significant periods of time. Indeed, a sub-analysis of these two groups indicated that they had similar amounts of IAF.…”

Section: Discussioncontrasting

confidence: 60%

Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia

et al. 2002

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OBJECTIVE:To investigate visceral fat distribution in patients with schizophrenia. DESIGN: Cross sectional study using CT scanning in patients with drug-naive and drug-free schizophrenia. SUBJECTS: Fifteen (13 men and two women) subjects with schizophrenia (mean age 33.7 y; mean body mass index (BMI) ¼ 26.7 kg=m 2 ), and 15 age-and sex-matched controls (mean age 30.5 y; mean BMI ¼ 22.8 kg= 2 ). MEASUREMENTS: Various fatness and fat distribution parameters (by CT scanning and anthropometry) and 16:00 h plasma cortisol. RESULTS: In comparison to controls, patients with schizophrenia had central obesity and had significantly higher levels of plasma cortisol. Furthermore, previous neuroleptic exposure did not appear to influence these findings as both drug-naive and drug-free patients had equally high levels of visceral fat deposition. CONCLUSION: Central obesity is a well recognized risk factor in developing certain general medical conditions. This study shows that patients with schizophrenia have increased intra-abdominal fat which may provide one explanation for why they die prematurely. International Journal of Obesity (2002 Keywords: schizophrenia; cortisol; imaging IntroductionReduced life expectancy is a well recognized feature of psychiatric illness. 1 -3 With respect to schizophrenia, the precise reasons underlying this excessive mortality are as yet unknown. 4,5 However, it is clear that suicide cannot fully account for these findings. 6,7 A meta-analysis of the relevant literature by Harris and Barraclough found that 'unnatural' causes of death such as suicide and accidents were far more likely to occur than expected in patients with schizophrena. 8 However, the standardized mortality ratios for 'natural causes', such as cardiovascular illness, was also significantly increased, a finding which was supported by Allbeck 9 and Ruschena et al. 3 A number of reasons may explain the excessive death rate due to 'natural causes' observed in schizophrenia; these include psychosocial deprivation, an unhealthy lifestyle and psychotropic medication. 10 -12 Yet, the general medical illnesses which tend to occur in those suffering from schizophrenia form a cluster which is termed the metabolic syndrome. 13 Hypertension, type 2 diabetes mellitus and dyslipidaemias are the primary constituents of this syndrome and are associated with increased intra-abdominal fat deposition. 14,15 Abdominal fat distribution consists of two discrete depots, subcutaneous and visceral (intra-abdominal) and numerous variables can account for the pattern of body fat deposition observed in the general population. 16,17 Of note is the fact that cortisol has a marked effect on regional fat distribution, in that patients with Cushing's syndrome who have marked hypercortisolaemia, have increased visceral fat distribution as measured by computerized axial tomography (CT) scanning. 18,19 Indeed, reduction of plasma cortisol in this subgroup of patients leads to a decrease in intra-abdominal fat stores 20 and also a normalization of certain features...

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Section: Discussioncontrasting

confidence: 60%

Increased visceral fat distribution in drug-naive and drug-free patients with schizophrenia

et al. 2002

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“…Several classes of psychotropic medications are associated with unwanted weight gain, including antipsychotics, antidepressants, mood stabilizers, and, to a lesser degree, anxiolytics (68)(69)(70). Weight gain could theoretically be due to increased energy intake, decreased energy expenditure, or a combination of the two; in most cases, we have too little information to distinguish among these possibilities.…”

Section: Do Psychotropic Medications Play a Role In Obesity?mentioning

confidence: 99%

“…Molindone is relatively unique in its lack of association with weight gain and its association with weight loss in several studies (70). In terms of relative effects on weight, the novel antipsychotics appear to be the most potent; they are followed by phenothiazines, which have large effects, haloperidol, which has a relatively small effect, and finally drugs that do not promote weight gain, including molindone and possibly loxapine and pimozide (68,70). When weight gain occurs, it is usually most rapid in the acute phase of treatment and generally plateaus after 1-2 years (70).…”

Section: Antipsychoticsmentioning

confidence: 99%

“…Weight gain of at least 5% (and much more in some cases) occurs in an estimated one-third to two-thirds of patients treated with lithium and in one-quarter to onehalf of patients treated with anticonvulsants, including valproic acid and carbamazepine (68). In the case of lithium, weight gain appears to be dose-related (73), to occur primarily in the first 2 years of treatment, and to occur more frequently in patients who are already overweight at the onset of treatment (74).…”

Section: Mood Stabilizersmentioning

confidence: 99%

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Obesity: What Mental Health Professionals Need to Know

Devlin¹

2000

American Journal of Psychiatry

196

118

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“…Secondly, a proportion of the subjects had been exposed to psychotropic medication in the past. This is of importance as there evidence to suggest that neuroleptics and, in particular, certain atypical agents can induce weight gain (Ackerman and Nolan, 1998;Kraus et al, 1999). Therefore, we had two aims in this study.…”

Section: Introductionmentioning

confidence: 99%