title: Is there a 'weight neutral' second-generation antipsychotic for bipolar disorder?
abstract: Antipsychotic-induced weight gain (WG) and metabolic abnormalities are major concerns. This review was untaken to answer if there is a weight-neutral second-generation antipsychotic for bipolar disorder (BPD). Areas covered: English-language literature in MEDLINE was searched with the keywords of antipsychotic/second-generation antipsychotic or generic/brand name of second-generation antipsychotic, and BPD/mania/depression or bipolar maintenance, and safety/tolerability or WG/weight increase, and randomized, placebo-controlled trial. Difference between an antipsychotic monotherapy and placebo in absolute weight gain (AWG) and/or ≥ 7% (WG in three phases of BPD was compared based on the data from original publications. The number needed to treat to harm was used for the comparison of ≥ 7% WG. Among antipsychotics with short-term (mania and/or bipolar depression) and long-term (maintenance) studies, olanzapine, asenapine, quetiapine, risperidone had significant WG compared to placebo in both short-term and long-term trials. Aripiprazole did not cause significant WG compared to placebo in short-term studies, but caused significant WG in long-term studies. Paliperidone-ER-induced WG was significant in a mania study as measured with AWG, and ziprasidone caused significant WG in a mania study measured with ≥ 7% WG. Expert commentary: These data suggest that it is unlikely there is a weight-neutral second-generation antipsychotic in BPD.
authors.affiliation: a Division of Mood Disorders , Shanghai Hongkou District Mental Health Center , Shanghai , China.
authors.forename: Fang
authors.initials: F
authors.lastname: Fang
authors.affiliation: a Division of Mood Disorders , Shanghai Hongkou District Mental Health Center , Shanghai , China.
authors.forename: Zuowei
authors.initials: Z
authors.lastname: Wang
authors.affiliation: b Institute of Mental Health of Second Xiangya Hospital , Central South University , Changsha , Hunan , China.
authors.forename: Renrong
authors.initials: R
authors.lastname: Wu
authors.affiliation: c Mood and Anxiety Clinic in the Mood Disorders Program, Department of Psychiatry , University Hospitals Cleveland Medical Center/Case Western University School of Medicine , Cleveland , OH , USA.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.affiliation: c Mood and Anxiety Clinic in the Mood Disorders Program, Department of Psychiatry , University Hospitals Cleveland Medical Center/Case Western University School of Medicine , Cleveland , OH , USA.
authors.forename: Keming
authors.initials: K
authors.lastname: Gao
mesh_terms: D014150:Antipsychotic Agents / Q000737:chemistry / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D006801:Humans; D000077152:Olanzapine; D018967:Risperidone / Q000627:therapeutic use
chemical_list: D014150:Antipsychotic Agents; D001569:Benzodiazepines; D018967:Risperidone; D000077152:Olanzapine
keywords: Antipsychotic-induced weight gain; absolute weight gain; bipolar disorder; long- and short-term weight gain; ≥ 7% weight gain