Pharmacologic and nonpharmacologic strategies for weight gain and metabolic disturbance in patients treated with antipsychotic medications.
OBJECTIVE
To provide an overview of pharmacologic and nonpharmacologic strategies for antipsychotic-associated weight gain and metabolic disturbance, to identify important areas for future research, and to make practice recommendations based on current knowledge.


METHODS
We undertook a selective review of interventions for weight gain and metabolic disturbance in the general population and in individuals treated with antipsychotic medications, focusing on randomized controlled trials in schizophrenia.


RESULTS
Pharmacologic strategies include medication choice, medication dosage and formulation, choice of concomitant psychotropic medications, medication switching, medication addition to effect weight loss or prevent weight gain, and medications to increase insulin sensitivity. Medication choice and medication switching may have the most potent influence on weight and metabolic parameters. Modest short-term weight loss can occur with the addition of selective medications and (or) lifestyle interventions. However, more rigorous and longer-term studies are needed.


CONCLUSIONS
Although difficult, the prevention of weight gain and the promotion of weight loss are possible for individuals treated with antipsychotic medications. Further research, including diabetes prevention studies, is required. We suggest a pathway for the management of weight gain and emerging metabolic disturbance.
Faulkner
Guy
G
Faculty of Physical Education and Health, University of Toronto, Ontario.
Cohn
Tony A
TA
D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000145:classification; D015992:Body Mass Index; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000517:prevention & control*; D004032:Diet; D018450:Disease Progression; D015444:Exercise; D006801:Humans; D007333:Insulin Resistance; D008019:Life Style; D001523:Mental Disorders / Q000188:drug therapy; D009765:Obesity / Q000139:chemically induced* / Q000188:drug therapy / Q000628:therapy*; D012559:Schizophrenia / Q000188:drug therapy*; D015430:Weight Gain
D014150:Antipsychotic Agents