Antipsychotic-associated weight gain: management strategies and impact on treatment adherence

Madhubhashinee Dayabandara, Raveen Hanwella, Suhashini Ratnatunga, Sudarshi Seneviratne, Chathurie Suraweera, Varuni A de Silva Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka Abstract: Antipsychotic-induced weight gain is a major management problem for cli...

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Autores principales:	Dayabandara M, Hanwella R, Ratnatunga S, Seneviratne S, Suraweera C, de Silva VA
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2017
Materias:	Antipsychotics weight gain weight-reducing agents Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/1b8b9943893a46289bc6ddc0297fc234
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spelling	oai:doaj.org-article:1b8b9943893a46289bc6ddc0297fc2342021-12-02T04:11:26ZAntipsychotic-associated weight gain: management strategies and impact on treatment adherence1178-2021https://doaj.org/article/1b8b9943893a46289bc6ddc0297fc2342017-08-01T00:00:00Zhttps://www.dovepress.com/antipsychotic-associated-weight-gain-management-strategies-and-impact--peer-reviewed-article-NDThttps://doaj.org/toc/1178-2021Madhubhashinee Dayabandara, Raveen Hanwella, Suhashini Ratnatunga, Sudarshi Seneviratne, Chathurie Suraweera, Varuni A de Silva Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka Abstract: Antipsychotic-induced weight gain is a major management problem for clinicians. It has been shown that weight gain and obesity lead to increased cardiovascular and cerebrovascular morbidity and mortality, reduced quality of life and poor drug compliance. This narrative review discusses the propensity of various antipsychotics to cause weight gain, the pharmacologic and nonpharmacologic interventions available to counteract this effect and its impact on adherence. Most antipsychotics cause weight gain. The risk appears to be highest with olanzapine and clozapine. Weight increases rapidly in the initial period after starting antipsychotics. Patients continue to gain weight in the long term. Children appear to be particularly vulnerable to antipsychotic-induced weight gain. Tailoring antipsychotics according to the needs of the individual and close monitoring of weight and other metabolic parameters are the best preventive strategies at the outset. Switching to an agent with lesser tendency to cause weight gain is an option, but carries the risk of relapse of the illness. Nonpharmacologic interventions of dietary counseling, exercise programs and cognitive and behavioral strategies appear to be equally effective in individual and group therapy formats. Both nonpharmacologic prevention and intervention strategies have shown modest effects on weight. Multiple compounds have been investigated as add-on medications to cause weight loss. Metformin has the best evidence in this respect. Burden of side effects needs to be considered when prescribing weight loss medications. There is no strong evidence to recommend routine prescription of add-on medication for weight reduction. Heterogeneity of study methodologies and other confounders such as lifestyle, genetic and illness factors make interpretation of data difficult. Keywords: antipsychotics, weight gain, weight-reducing agents, metabolic, treatment adherenceDayabandara MHanwella RRatnatunga SSeneviratne SSuraweera Cde Silva VADove Medical PressarticleAntipsychoticsweight gainweight-reducing agentsNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571Neurology. Diseases of the nervous systemRC346-429ENNeuropsychiatric Disease and Treatment, Vol Volume 13, Pp 2231-2241 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	Antipsychotics weight gain weight-reducing agents Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429
spellingShingle	Antipsychotics weight gain weight-reducing agents Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Neurology. Diseases of the nervous system RC346-429 Dayabandara M Hanwella R Ratnatunga S Seneviratne S Suraweera C de Silva VA Antipsychotic-associated weight gain: management strategies and impact on treatment adherence
description	Madhubhashinee Dayabandara, Raveen Hanwella, Suhashini Ratnatunga, Sudarshi Seneviratne, Chathurie Suraweera, Varuni A de Silva Department of Psychiatry, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka Abstract: Antipsychotic-induced weight gain is a major management problem for clinicians. It has been shown that weight gain and obesity lead to increased cardiovascular and cerebrovascular morbidity and mortality, reduced quality of life and poor drug compliance. This narrative review discusses the propensity of various antipsychotics to cause weight gain, the pharmacologic and nonpharmacologic interventions available to counteract this effect and its impact on adherence. Most antipsychotics cause weight gain. The risk appears to be highest with olanzapine and clozapine. Weight increases rapidly in the initial period after starting antipsychotics. Patients continue to gain weight in the long term. Children appear to be particularly vulnerable to antipsychotic-induced weight gain. Tailoring antipsychotics according to the needs of the individual and close monitoring of weight and other metabolic parameters are the best preventive strategies at the outset. Switching to an agent with lesser tendency to cause weight gain is an option, but carries the risk of relapse of the illness. Nonpharmacologic interventions of dietary counseling, exercise programs and cognitive and behavioral strategies appear to be equally effective in individual and group therapy formats. Both nonpharmacologic prevention and intervention strategies have shown modest effects on weight. Multiple compounds have been investigated as add-on medications to cause weight loss. Metformin has the best evidence in this respect. Burden of side effects needs to be considered when prescribing weight loss medications. There is no strong evidence to recommend routine prescription of add-on medication for weight reduction. Heterogeneity of study methodologies and other confounders such as lifestyle, genetic and illness factors make interpretation of data difficult. Keywords: antipsychotics, weight gain, weight-reducing agents, metabolic, treatment adherence
format	article
author	Dayabandara M Hanwella R Ratnatunga S Seneviratne S Suraweera C de Silva VA
author_facet	Dayabandara M Hanwella R Ratnatunga S Seneviratne S Suraweera C de Silva VA
author_sort	Dayabandara M
title	Antipsychotic-associated weight gain: management strategies and impact on treatment adherence
title_short	Antipsychotic-associated weight gain: management strategies and impact on treatment adherence
title_full	Antipsychotic-associated weight gain: management strategies and impact on treatment adherence
title_fullStr	Antipsychotic-associated weight gain: management strategies and impact on treatment adherence
title_full_unstemmed	Antipsychotic-associated weight gain: management strategies and impact on treatment adherence
title_sort	antipsychotic-associated weight gain: management strategies and impact on treatment adherence
publisher	Dove Medical Press
publishDate	2017
url	https://doaj.org/article/1b8b9943893a46289bc6ddc0297fc234
work_keys_str_mv	AT dayabandaram antipsychoticassociatedweightgainmanagementstrategiesandimpactontreatmentadherence AT hanwellar antipsychoticassociatedweightgainmanagementstrategiesandimpactontreatmentadherence AT ratnatungas antipsychoticassociatedweightgainmanagementstrategiesandimpactontreatmentadherence AT seneviratnes antipsychoticassociatedweightgainmanagementstrategiesandimpactontreatmentadherence AT suraweerac antipsychoticassociatedweightgainmanagementstrategiesandimpactontreatmentadherence AT desilvava antipsychoticassociatedweightgainmanagementstrategiesandimpactontreatmentadherence
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Antipsychotic-associated weight gain: management strategies and impact on treatment adherence

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