Antipsychotic medications are powerful drugs
that are used to treat more
than psychotic conditions like schizophrenia.
Many of them are FDA approved
to treat bipolar disorder and depression.
Even though they work very well and fast,
they have some big side effects like weight gain
and insulin resistance,
some more than others.
A new research study has given us some insight
on which ones are better
and worse when it comes to these side effects.
I'm Dr. Tracey Marks,
a psychiatrist and I make mental health education videos.
We've known that antipsychotic medications cause weight gain
but what wasn't clear was is the weight gain dose dependent?
Dose dependent means that the more you take,
the more weight you gain.
A binary model is where it doesn't matter how much you take.
If you take any of it,
you'll gain weight.
And until now,
it wasn't clear whether or not the dose mattered.
A study published in
the Journal of Clinical Psychiatry
in February of this year
analyzed 52 randomized controlled trials
which included 22,000 people taking different
antipsychotic medications
and here's what they found.
All of the medications they studied had
a dose-dependent relationship with weight gain,
meaning higher doses caused more weight gain.
However, some medications plateaued
so that you gained weight up until a certain point,
then it leveled off
even if your dose continued to increase.
The worst situation is where there's a creep effect
and this is where your weight continues to increase
with higher doses,
and you can continue to gain weight the longer
you take the medication
even if your dose doesn't increase.
So that's the backdrop of how these medications can work.
Here are 10 of the medications that were studied ranked
in order of most weight gaining to the least.
This list does not include the injectable forms
and weight is in pounds, rounded up.
Number one is Olanzapine, brand name Zyprexa.
Clinically, this is not a surprise.
This drug has been around for over 20 years
and we knew it caused weight gain,
but what was interesting to see
was more details about the weight gain.
Olanzapine caused a weight gain of eight pounds
in six weeks,
and it has the creep effect where
you can continue to gain weight for as long as you stay
on the medication
even after you get to your maintenance dose.
Gaining eight pounds in six weeks
is 1.3 pounds a week,
which is 69 pounds in a year.
I have seen people put on that much weight
but not everyone does.
Some people plateaued around 10 to 20 pounds,
but that's still a lot of weight.
I don't use it as much because of this problem.
I used it back when we didn't have a whole lot
of other options.
You may be thinking,
"Why would this drug even still be on the market
"and why would doctors continue to prescribe it?"
Because not all
of these medications work the same for everyone.
Sometimes Olanzapine is the only thing that is effective
for the person
or they started on it
before the newer drugs came out,
and then sometimes switching
to a different antipsychotic just doesn't work.
Number two is Paliperidone, brand name Invega.
It caused a four pound weight gain
over six weeks.
Like Olanzapine, the weight gain
did not stabilize, but continued to increase.
Number three is Quetiapine immediate release,
brand name Seroquel.
It caused a four pound weight gain over six weeks
and the weight stabilized around the 600 milligram dose.
Here's an important point about this finding.
Quetiapine is unique in that low doses
under 100 milligrams
are commonly used to help people
with anxiety and sleep.
The drug is not habit forming
and works very well,
especially for anxiety.
A typical anxiety dose is 25 to 50 milligrams.
This study looked at doses starting at 75 milligrams,
so it's not clear
if these tiny doses affect weight much.
In my own experience,
patients taking these small doses didn't notice weight gain.
If you want to look into using Quetiapine this way,
you'll have to speak to your doctor of course,
but you would still need to keep
up with regular medical checks
with blood work to make sure that the Quetiapine
is not affecting your metabolic functioning
like increasing your glucose, triglycerides, or cholesterol.
Number four is Risperidone, brand name Risperdal.
It caused a three pound weight gain
over five weeks
and the weight gain levels off
between three and four milligrams.
Number five is Quetiapine extended release.
It caused a three pound weight gain over six weeks.
The weight gain peaks around the 400 milligram dose,
after which you get less weight gain at the higher doses.
Quetiapine extended release is not as sedating
as the immediate release
and because of this,
it's not as good
as the immediate release is for treating anxiety and sleep.
It's designed to help people be able to take it
during the day and still feel alert.
Number six is Asenapine, brand name Saphris.
It caused a three pound weight gain also over six weeks
and the weight gain levels off between
the five and six milligram dose.
Number seven is Brexpiprazole, brand name Rexulti.
It caused a two pound weight gain
over six weeks at doses up to two milligrams.
The weight levels off
and is less if you take three to four milligrams.
Number eight is Aripiprazole, brand name Abilify.
It caused a two pound weight gain
over five weeks at doses up to 30 milligrams.
The weight gain was still happening at five weeks,
which means it has the potential to keep going
but not a given that it will continue to creep up
if you stay on the same dose.
I've used a lot of Abilify
and mostly use it in dose ranges
between five and 15 milligrams
for bipolar disorder and depression.
Most of my patients didn't continue to gain weight,
but some did.
The higher doses of 20 to 30 milligrams tend
to be used more for schizophrenia.
Number nine is Cariprazine, brand name Vraylar.
It caused a two pound weight gain
over six weeks at a dose of 4.5 milligrams.
There was less weight gain with the higher doses.
Number 10 and the one with the least amount of weight gain,
drum roll please,
Lurasidone brand name Latuda.
It caused a one pound weight gain
over six weeks at a dose of 60 milligrams.
Higher doses caused less weight gain.
Usually bipolar disorder
and schizophrenia require more than 60 milligrams,
so that's good news there.
These medications can also change your metabolic profile
in a dose-dependent manner.
That is they can increase your glucose, triglycerides
and cholesterol.
Just like weight,
some medications have a better metabolic
profile than others.
If you want more detail on the individual medications,
metabolic effects and information on the injectables,
join my Mental Wellness Space
where I'll have a handout
summarizing all of this information.
It's a lot of information.
How can we use this information?
Some people really need to take these medications,
but we can first look to try and use ones
with the least amount of weight and metabolic changes.
What these findings establish is
that for most of these medications
the higher the dose, the more weight gain.
There were a few exceptions where the higher dose
didn't result in more weight gain,
so this means you and your doctor
can aim to use the least effective
dose possible to minimize the negative effects.
Sometimes the medication strategy will be to get you up
to a higher dose than you may need
at the moment to keep you
from having breakthrough symptoms later.
But with this new information,
we should look to keep your dose as low as possible.
You may need a somewhat high dose
in the acute phase when you have the most symptoms.
But once your symptoms improve,
your doctor may want to see
if they can lower your dose just a little
for your maintenance dose,
especially if you're on one of the medications
that doesn't level off
but keeps increasing your weight over time.
For more on this topic, take a look
at this video that I did on metabolic syndrome.
Thanks for watching.
See you next time.