Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients

Zimmermann, U.; Kraus, Thomas; Himmerich, Hubertus; Schuld, Andreas; Pollmächer, Thomas

doi:10.1016/s0022-3956(03)00018-9

Cited by 307 publications

(198 citation statements)

References 213 publications

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“…With regard to type of medication, as in other studies, weight gain appeared to be more related to carbamazepine and valproate 3,5,14 . Here, weight gain was found in 66.7% of patients on monotherapy with carbamazepine, as well as in 60% of patients on monotherapy with valproate.…”

Section: Discussionsupporting

confidence: 67%

Modification in body weight associated with antiepileptic drugs

Gaspari

Guerreiro

2010

Arq. Neuro-Psiquiatr.

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Antiepileptic drugs (AED) may cause body weight changes. Objective: To evaluate the dietary habits and body weight associated with AED in epileptic patients. Method: Sixtysix patients were subjected to two interviews, and had their weight and body mass index calculated and compared at both times, interval between six to eight months. Results: It was observed that 59.1% showed weight gain. The patients who had no weight gain had a greater proportion of individuals who engaged in some form of physical activity. However, of the 45 patients who maintained their initial dietary and medication pattern, 75.6% recorded a weight gain. Weight gain was seen in 66.7% of patients on carbamazepine (n=18), 60% on valproate (n=5), 50% on carbamazepine+clobazam treatment (n=14), and 58.3% of patients on other(s) polytherapy (n=12). Conclusion: The patient should be alerted to possible weight gain, and should be advised about dieting and participating in regular physical activity. Key words: epilepsy, antiepileptic drugs, dietary habits, body weight.Alteração de peso corpóreo associado às drogas antiepilépticas RESUMO Drogas antiepilépticas (DAE) podem causar alteração do peso corpóreo. Objetivo: Avaliar o hábito alimentar e do peso corpóreo associado às DAE em pacientes epilépticos. Método: Sessenta e seis pacientes foram submetidos a duas entrevistas, e tiveram peso e índice de massa corpórea (IMC) calculados e comparados nos dois momentos, com intervalo de 6 a 8 meses. Resultados: Apresentaram aumento de peso 59,1% dos pacientes. Porém, os pacientes que não tiveram ganho de peso apresentaram maior proporção de indivíduos desenvolvendo alguma atividade física. Enquanto que dentre os 45 que mantiveram o padrão alimentar e medicação inicial 75,6% registraram ganho de peso. Observou-se ganho de peso em 66,7% dos pacientes com

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Section: Discussionsupporting

confidence: 67%

Modification in body weight associated with antiepileptic drugs

Gaspari

Guerreiro

2010

Arq. Neuro-Psiquiatr.

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“…However, achieving these goals with mentally ill patients poses particular challenges, including difficulty in motivating them to continue in organized programs, limited financial support of all medical services for the chronically and severely mentally ill, and the continuing deleterious physical and metabolic effects of required psychotropic medication. [1][2][3][4][5][6][7] Despite these challenges, our results dispel the belief that chronically ill psychiatric patients are not able, because of mental and physical limitations, to maintain consistent participation in a weight loss program. It is important to note that the present subjects were clinically stable, relatively high functioning (six subjects worked or volunteered, and all but one subject lived alone or with family), and motivated to take part in a weight-loss program.…”

Section: Discussionsupporting

confidence: 50%

“…[1][2][3][4][5][6][7] Risks of weight gain are particularly high with certain modern antipsychotic agents, notably clozapine and olanzapine, [2][3][4][5] with potent interactions with serotonin (especially 5-HT 2C ) and histamine receptors (especially H 1 and H 3 ) implicated in the neurobiology of obesity. [8][9][10][11][12] Weight gain associated with long-term psychotropic drug treatment likely adds to risks of metabolic and general medical disorders that may be more prevalent among persons with chronic major mental illnesses independent of treatment.…”

Section: Introductionmentioning

confidence: 99%

Weight loss in overweight patients maintained on atypical antipsychotic agents

et al. 2006

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Background: Weight gain and associated medical morbidity offset the reduction of extrapyramidal side effects associated with atypical antipsychotics. Efforts to control weight in antipsychotic-treated patients have yielded limited success. Methods: We studied the impact of an intensive 24-week program of diet, exercise, and counseling in 17 chronically psychotic patients (10 women, seven men) who entered at high average body weight (105.0718.4 kg) and body mass index (BMI) (36.674.6 kg/m 2 ). A total of 12 subjects who completed the initial 24 weeks elected to participate in an additional 24-week, less intensive extension phase. Results: By 24 weeks, weight-loss/patient averaged 6.0 kg (5.7%) and BMI decreased to 34.5 (by 5.7%). Blood pressure decreased from 130/83 to 116/74 (11% improvement), pulse fell slightly, and serum cholesterol and triglyceride concentrations changed nonsignificantly. With less intensive management for another 24 weeks, subjects regained minimal weight (0.43 kg). Conclusions: These findings add to the emerging view that weight gain is a major health problem associated with modern antipsychotic drugs and that labor-intensive weight-control efforts in patients requiring antipsychotic treatment yield clinically promising benefits. Improved treatments without weight-gain risk are needed.

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“…There are studies that associate its prolonged use with the lowering of glucose tolerance. 29 However, Vestergaard & Schou found just one case of DM in a group of 226 patients with bipolar disorder who were using lithium for up to 6 years. 30 In our study, the mean glycemic values of the patients using lithium is above the new cutoff point of 100 mg/dl, proposed by the IDF.…”

mentioning

confidence: 99%

The prevalence of metabolic syndrome among psychiatric inpatients in Brazil

Teixeira¹,

Rocha²

2007

Rev. Bras. Psiquiatr.

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A b s t r a c t Objective: Metabolic syndrome is a highly prevalent disorder among the general population. Studies show an even higher prevalence among psychiatric patients. The objective of this study is to assess the prevalence of metabolic syndrome among inpatients of a psychiatric ward of a general hospital in Brazil and correlate it with their respective psychiatric diagnoses and with the antipsychotics and mood stabilizers used. Method: 170 inpatients (mean age: 45.6 years) were evaluated according to the National Cholesterol Education Program criteria for metabolic syndrome, with a modification of the criteria for blood pressure and fasting glucose. Results: The prevalence found was 29.4%, being higher in women (43.6% versus 20.8%, p = 0.002). The prevalence stratified by psychiatric diagnostic was 48.1% for depression, 38.3% for bipolar disorder, 31.8% for schizophrenia and schizoaffective disorder, 5.1% for alcoholism, and 23.1% for "other mental disorders". The prevalence for alcoholism was significantly lower than the prevalence rates associated with other diagnostic categories (p = 0.035). After using the multivariate analysis, female gender and use of lithium remained as factors associated with a diagnosis of metabolic syndrome. Conclusions: The prevalence found was 29.4%. Gender (female) and use of lithium were factors significantly associated with the diagnosis of metabolic syndrome.Descriptors: Metabolic syndrome X; Mental disorders; Schizophrenia; Bipolar disorder; Depression Resumo Objetivo: A síndrome metabólica é um transtorno de alta prevalência na população em geral. Estudos demonstram prevalência ainda maior em pacientes psiquiátricos. O objetivo deste trabalho é avaliar a prevalência de síndrome metabólica em pacientes internados em uma enfermaria psiquiátrica de um hospital geral no Brasil e correlacioná-la com os diagnósticos psiquiátricos e com o uso de medicamentos antipsicóticos e moduladores do humor. Método: Cento e setenta pacientes (idade média: 45,6 anos) foram avaliados de acordo com os critérios do National Cholesterol Education Program para síndrome metabólica, modificados nos critérios pressão arterial e glicemia de jejum. Resultados: A prevalência encontrada foi de 29,4%, sendo mais elevada em mulheres (43,6% versus 20,8%, p = 0,002). A prevalência estratificada por diagnóstico psiquiátrico foi de 48,1% para depressão, 38,3% para transtorno bipolar, 31,8% para esquizofrenia e transtornos esquizoafetivos, 5,1% para alcoolismo e 23,1% para "outros transtornos mentais". A prevalência para alcoolismo foi significativamente menor, se comparada às prevalências associadas às demais categorias diagnósticas (p = 0,035). Após análise multivariada, o sexo feminino e o uso de lítio permaneceram como fatores associados ao diagnóstico de síndrome metabólica. Conclusão: A prevalência de síndrome metabólica encontrada foi de 29,4%. O sexo feminino e o uso de lítio foram fatores significativamente associados ao diagnóstico de síndrome metabólica.

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Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients

Cited by 307 publications

References 213 publications

Modification in body weight associated with antiepileptic drugs

Modification in body weight associated with antiepileptic drugs

Weight loss in overweight patients maintained on atypical antipsychotic agents

The prevalence of metabolic syndrome among psychiatric inpatients in Brazil

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