Antipsychotic metabolic effects: weight gain, diabetes mellitus, and lipid abnormalities.
OBJECTIVE
To review published and nonpublished literature describing changes in weight, glucose homeostasis, and lipid milieu with antipsychotics.


METHODS
A Medline search was completed using the words weight gain, diabetes mellitus, cholesterol, triglycerides, risperidone, clozapine, olanzapine, quetiapine, ziprasidone, predictors, prolactin, obesity, and conventional antipsychotics. Publications, including original articles, review articles, letters to the editor, abstracts or posters presented at professional meetings in the last 4 years, and references from published articles, were collected. Manufacturers, including Eli Lilly Canada Inc, JanssenOrtho Inc, Pfizer Canada Inc, AstraZeneca Inc, and Novartis Pharmaceuticals, were contacted to retrieve additional medical information.


RESULTS
The topic of antipsychotic-induced weight gain is understudied, and there are relatively few well-controlled studies. Weight gain as a side effect has been described with both conventional and atypical antipsychotics. Moreover, some atypical antipsychotics are associated with de novo diabetes mellitus and increased serum triglyceride levels. Predictors of weight gain may be age, baseline body mass index, appetite stimulation, previous antipsychotic exposure, and antipsychotic treatment duration.


CONCLUSIONS
Significant weight gain is reported with the existing atypical antipsychotics. The weight gain described is highly distressing to patients, may reduce treatment adherence, and may increase the relative risk for diabetes mellitus and hypertriglyceridemia. Physicians employing these agents should routinely monitor weight, fasting blood glucose, and lipid profiles.
McIntyre
R S
RS
Centre for Addiction and Mental Health, Clarke Site, Mood and Anxiety Disorders Program, 250 College Street, Toronto, ON M5T 1R8. roger_mcintyre@camh.net
McCann
S M
SM
Kennedy
S H
SH
D000328:Adult; D014150:Antipsychotic Agents / Q000009:adverse effects*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000209:etiology*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006706:Homeostasis; D006801:Humans; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009765:Obesity; D010349:Patient Compliance; D012307:Risk Factors; D015430:Weight Gain
D014150:Antipsychotic Agents; D008055:Lipids; D005947:Glucose