The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children

Libowitz, Mark R.; Nurmi, Erika L.

doi:10.3389/fpsyt.2021.623681

Cited by 54 publications

(41 citation statements)

References 305 publications

(271 reference statements)

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“…Weight gain, adipose tissue accumulation, metabolic syndrome, T2DM 12,43,45,46,[50][51][52][53]62 Summary of literature: Youth are more sensitive to weight gain and metabolic complications. Most weight gain occurs within the first 12 wk of treatment; risk is cumulative with time.…”

Section: Antipsychoticsmentioning

confidence: 99%

“…44 Proposed mechanism: Histamine 1 receptor antagonism, 5-HT2C receptor antagonism, alterations in ghrelin, insulin, and leptin sensitivity. 62…”

Section: Antipsychoticsmentioning

confidence: 99%

“…Use agent with lower metabolic risk, if clinically appropriate. 62 Monitor fasting blood glucose/hemoglobin A1c, fasting lipid panel at baseline, 3 mo, 6 mo, and annually. Monitor weight/BMI percentile, blood pressure, and waist circumference at each office visit.…”

Section: Application To Practicementioning

confidence: 99%

“…46,54,55 BMI percentile calculator for children and adolescents (https://www.cdc.gov/ healthyweight/bmi/calculator.html). Consider lifestyle modifications, switch to agent with lower weight gain potential, and/or initiation of metformin if weight gain occurs 62. …”

mentioning

confidence: 99%

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Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing

Stutzman¹

2021

Mental Health Clinician

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It is estimated that 8% to 12% of youth are prescribed psychotropic medications. Those in foster care, juvenile justice systems, residential treatment facilities, and with developmental or intellectual disabilities are more likely to be prescribed high-risk regimens. The use of psychotropic medications in this age group is often off-label and can be associated with significant risk, warranting critical evaluation of their role. Landmark trials, pediatric-specific guidelines, and state-driven initiatives play critical roles in supporting evidence-based use of psychotropic medications in children. Overall, there is a lack of literature describing the long-term use of psychotropic medications in youth—particularly with regard to neurobiological, physical, and social changes that occur throughout development. Deprescribing is an important practice in child and adolescent psychiatry, given concerns for over-prescribing, inappropriate polytherapy, and the importance of reevaluating the role of psychotropic medications as children develop.

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Section: Antipsychoticsmentioning

confidence: 99%

“…44 Proposed mechanism: Histamine 1 receptor antagonism, 5-HT2C receptor antagonism, alterations in ghrelin, insulin, and leptin sensitivity. 62…”

Section: Antipsychoticsmentioning

confidence: 99%

Section: Application To Practicementioning

confidence: 99%

mentioning

confidence: 99%

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Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing

Stutzman¹

2021

Mental Health Clinician

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“…Negative energy balance could be achieved by decreased appetite and by increased physical activity due to lower level of sedation. The effect is likely mediated via neurotransmitter signaling involving histamine and serotonin ( 16 ), and some suggest that thyroid function is associated with antipsychotic medication ( 17 ). Similarly, switch to partial agonists may affect weight through lower affinity to histamine receptors and lower level of sedation.…”

Section: Introductionmentioning

confidence: 99%

Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis

et al. 2021

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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.

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Prevalence of underweight in people with severe mental illness: Systematic review and meta‐analysis

Khan

Khalid

Siddiqi

et al. 2022

Mental Health Science

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People with severe mental illness (SMI) have a higher prevalence of obesity as compared with the general population, however, there is mixed evidence about the prevalence of underweight. Thus, the aim of this study is to determine the pooled prevalence of underweight in people with SMI and its association with socio-demographic factors; and to compare the prevalence of underweight between SMI and the general population. MEDLINE, PsycINFO, and EMBASE databases were searched to identify observational studies assessing the prevalence of underweight in adults with SMI (schizophrenia, major depressive disorder with psychotic features, and bipolar disorders). Screening, data extraction, and risk of bias assessments were performed independently by two co-authors, with disagreements resolved by consensus. Random effect estimates for the pooled prevalence of underweight and the pooled odds of underweight in people with SMI compared with the general population were calculated. Subgroup analyses were conducted for the type of SMI, setting, antipsychotic medication, region of the world, World Bank country income classification, data collection, and sex. Forty estimates from 22 countries were included. The pooled prevalence of underweight in people with SMI was 3.8% (95% confidence interval[CI] = 2.9-5.0). People with SMI were less likely to be underweight than the general population (odds ratio [OR] 0.65; 95% CI = 0.4-1.0). The pooled prevalence of underweight in SMI in South Asia was 7.5% (95% CI = 5.8-14.1) followed by Europe and Central Asia at 5.2% (95% CI = 3.2-8.1) and North America at 1.8% (95% CI = 1.2-2.6). People with SMI have lower odds of being underweight compared to the general population. People with schizophrenia had the highest prevalence of underweight compared to other types of SMI. Japan and South Asia have the highest prevalence of underweight in people with SMI.

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The Burden of Antipsychotic-Induced Weight Gain and Metabolic Syndrome in Children

Cited by 54 publications

References 305 publications

Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing

Long-term use of antidepressants, mood stabilizers, and antipsychotics in pediatric patients with a focus on appropriate deprescribing

Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis

Prevalence of underweight in people with severe mental illness: Systematic review and meta‐analysis

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