The effect of antidepressants and antipsychotics on weight gain in children and adolescents

Abstract

Psychiatric illness in the paediatric population is increasing and the weight effect of medications for these problems is often unclear. A comprehensive literature search was undertaken to identify studies reporting weight in relation to antipsychotic and antidepressant use in children and adolescents. From 636 articles, 42 were selected for review. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) do not cause weight gain and may lead to improvements in weight status over the short, but not, long term. Antipsychotics were generally associated with weight gain. In drug comparison studies, risperidone had a larger weight gain effect than lithium, divalproex sodium and pimozide. Studies assessing the weight-protective effects of augmentation therapy with metformin or topiramate show less weight gain with addition of these agents. In conclusion, prescribing of SSRIs and SNRIs may be associated with improvements in weight status in children and adolescents but trials assessing their use in obesity, outside of established psychiatric illness, are limited and still experimental. Youth prescribed antipsychotic medication should be monitored for exaggerated weight gain and in those where obesity is a pre-existing concern agents other than olanzapine, clozapine and risperidone may be advantageous.

Morbid obesity and use of second generation antipsychotics among adolescents in foster care: Evidence from Medicaid

“…Alternative treatments that prevent the onset of obesity while also treating the underlying mental health concerns. For example, prescribing a SGA along with topiramate or metformin, which both have been used in weight management, may mitigate their weight gaining side effects (Klein, Cottingham, Sorter, Barton, & Morrison, 2006; Reekie et al, 2015; Wozniak et al, 2009). This evidence indicates clinicians may need to consider weight gain when choosing which SGA to prescribe.…”

“…These were culled from three reviews of psychotropic effects on child and adolescent weight (Correll et al, 2009; De Hert, Dobbelaere, Sheridan, Cohen, & Correll, 2011; Reekie et al, 2015). These prescriptions have been shown to increase weight between 0.79 kgs and 8.54 kgs relative to placebo.…”

“…To our knowledge, however, no studies have used Medicaid claims data to examine obesity among adolescents in foster care, where SGA usage rates are substantially higher than those in the community. As noted by others (Reekie et al, 2015), the clinical trial evidence associating weight gain and psychotropic use among adolescents is sparse, with studies focused on smaller, specialized populations for a short followup period. Our data allow for much longer observation.…”

Pediatric Obesity: Influence on Drug Dosing and Therapeutics

“…With the advent of atypical or second‐generation antipsychotics (SGAs), for example, risperidone, olanzapine, and quetiapine, introduced in the late 1990s, APs were heralded for less motor effects than traditional neuroleptics. That favorable safety feature was offset, however, by enduring negative effects on body weight, insulin resistance, and lipid levels …”

Metabolic risk in depression and treatment with selective serotonin reuptake inhibitors: are the metabolic syndrome and an increase in cardiovascular risk unavoidable?

“…Historically, weight changes have been a hallmark in the side effect profile of most antidepressant classes [59][60][61] . In the case of SSRIs, the specific agent used and the length of therapy may account for the very variable effects these drugs appear to have on body weight [59] .…”