Weight gain from antipsychotic medications: strategies for prevention and treatment

Metabolic abnormalities among people with schizophrenia were recognized over 100 years ago. Emil Kraepelin (1919) commented on diminished metabolic rates among those with the illness he called dementia praecox. Several studies from the 1920s to the 1940s (well before the advent of antipsychotic medication) revealed distortions in glucose metabolism and in insulin response among patients with schizophrenia.

That metabolic vulnerabilities are a built-in feature of schizophrenia is evident in the fact type 2 diabetes is substantially more likely to occur in first-degree relatives of people with schizophrenia than in the general population.

Antipsychotic medications can exacerbate this endogenous vulnerability, risking significant weight gain in patients who take them. Prescribers of these medications should therefore be vigilant in monitoring weight and metabolic parameters – and should be prepared both to prevent these side effects and to treat them if the occur.

Here are the PowerPoint slides from a presentation to the First Episode Schizophrenia Treatment Group on 23 March 2017. The slides address topics that include:

  • metabolic vulnerability is an inherent feature of schizophrenia
  • first degree relatives of people with schizophrenia have higher risk of type 2 diabetes
  • strategies to reduce weight gain risk from antipsychotic medications
  • efficacy of behavioral interventions (diet, exercise, support)
  • efficacy of pharmacological interventions:
    • metformin
    • topiramate
    • melatonin
    • liraglutide

Weight Gain from Antipsychotic Medications: Strategies for Prevention and Treatment, PowerPoint Deck