title: Weight gain and metabolic risks associated with antipsychotic medications in children and adolescents.
abstract: BACKGROUND
  Antipsychotic-related weight gain and metabolic adverse effects have become a major focus, especially in youth.
  
  
  METHODS
  Review of randomized, cohort, and pharmacoepidemiologic studies of antipsychotic-related weight gain and metabolic adverse effects and of interventions for their reduction in youth.
  
  
  RESULTS
  Across 34 published head-to-head and placebo-controlled studies in youth with psychotic and bipolar disorders, weight gain ranged from 3.8 to 16.2 kg with olanzapine (n=353), 0.9-9.5 kg with clozapine (n=97), 1.9-7.2 kg with risperidone (n=571), 2.3-6.1 kg with quetiapine (n=133), and 0-4.4 kg with aripiprazole (n=451). In 24 placebo-controlled trials, the numbers-needed-to-harm for weight gain ≥7% in youth with bipolar disorder and schizophrenia were 39 (confidence interval [CI]: -1 to +6, not significant) for aripiprazole, 36 (CI: -1 to +7, not significant) for ziprasidone, 9 (CI: 7-14) for quetiapine, 6 (CI: 5-8) for risperidone, and 3 (CI: 3-4) for olanzapine. Data in youth with autism and disruptive behavior disorders, available only for some antipsychotics, suggest greater weight gain, possibly due to less prior antipsychotic exposure. Three-month results from a large cohort study in antipsychotic-naïve youth indicated that metabolic effects differ among second-generation antipsychotics, despite significant weight gain with all studied agents, suggesting additional, weight-independent effects. Further, pharmacoepidemiologic work indicates that antipsychotic polypharmacy increases the risk for obesity (odds ratio [OR]: 2.28 [CI: 1.49-3.65]) or any cardiovascular, cerebrovascular, or hypertensive adverse event (OR: 1.72 [CI: 1.10-2.69]). However, despite marked weight gain and its greater impact on youth, monitoring rates are low and studies of pharmacologic and behavioral interventions are extremely limited.
  
  
  CONCLUSIONS
  More research is needed to develop strategies to minimize antipsychotic-related weight gain and metabolic effects in youth and to discover treatments with lower risk potential.
authors.affiliation: Nathan Kline Institute for Psychiatric Research, Orangeburg, New York, USA.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Maayan
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000293:Adolescent; D014150:Antipsychotic Agents / Q000009:adverse effects*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy; D002648:Child; D002986:Clinical Trials as Topic; D044882:Glucose Metabolism Disorders / Q000139:chemically induced*; D006801:Humans; D050356:Lipid Metabolism / Q000187:drug effects*; D011618:Psychotic Disorders / Q000150:complications / Q000188:drug therapy; D015430:Weight Gain / Q000187:drug effects*
chemical_list: D014150:Antipsychotic Agents