Antipsychotic Drugs Linked To Significant Weight Gain In Children And Teenagers

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Main Category: Psychology / Psychiatry
Also Included In: Pediatrics / Children's Health;  Mental Health;  Obesity / Weight Loss / Fitness
Article Date: 29 Oct 2009 - 11:00 PST

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US researchers found that many children and teenagers treated with second generation antipsychotic drugs put on a significant amount of weight and also experienced a worsening of cholesterol and triglyceride levels and other metabolic measures.

The study was the work of Dr Christoph U. Correll of Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, and The Feinstein Institute for Medical Research, Manhasset, New York, and colleagues, and is published in the 28 October issue of JAMA.

It is common for American children and teenagers treated for bipolar disorder, psychotic disorders, and other non-psychotic mental conditions to be given second-generation antipsychotic drugs.

Correll and colleagues wrote in their paper that doctors have become increasingly worried about the cardiometabolic effects of second-generation antipsychotic drugs, including adverse effects such as "age-inappropriate weight gain, obesity, hypertension, and lipid and glucose abnormalities".

These adverse effects "are particularly problematic during development because they predict adult obesity, the metabolic syndrome, cardiovascular morbidity, and malignancy", wrote the authors.

They suggested these effects have not been studied properly in children and teenagers who have not taken these drugs before.

For the study the researchers looked at weight and metabolic changes in a treatment group of 272 patients aged from 4 to 19 years old who had not used antipsychotic medication before. They were treated with aripiprazole, olanzapine, quetiapine, or risperidone for 12 weeks.

The patients had been diagnosed with mood spectrum (47.8 per cent), schizophrenia spectrum (30.1 per cent), and disruptive or aggressive behavior spectrum (22.1 percent) disorders.

A comparison group was formed from 15 patients who did not take the medications for various reasons.

The results showed that:

• After a median (midrange point) of 10.8 weeks of treatment, there was a signficant average weight increase in the group taking antipsychotic medication compared to the comparison group.


• For the 45 patients who took olanzapine the average weight increase was 18.7 lbs (8.5 kg).


• For the 36 patients on quetiapine it was 13.4 lbs (6.1 kg).


• For the 135 patients on risperidone it was 11.7 lbs (5.3 kg).


• For the 41 on aripiprazole it was 9.7 lbs (4.4 kg).


• The average weight gain in the comparison group of 15 untreated patients was 0.4 lbs (0.2 kg).

The researchers wrote that:

"Antipsychotic medication was associated with significantly increased fat mass and waist circumference."

"Altogether, 10 per cent to 36 per cent of patients transitioned to overweight or obese status within 11 weeks," they added.

Weight gain was not the only adverse effect that the researchers observed in the treated patients.

They found that over the study period, there were statistically significant adverse changes in levels of cholesterol, triglycerides, non-HDL cholesterol, and ratio of triglycerides to HDL cholesterol for patients on olanzapine and quetiapine.

And for patients on risperidone they found levels of triglycerides increased significantly.

"Metabolic baseline-to-end-point changes were not significant with aripiprazole or in the untreated comparison group," wrote the authors, adding that:

"Patients receiving quetiapine had modestly higher incidence rates of hyperglycemia and the metabolic syndrome and patients receiving olanzapine experienced the highest incidence rates."

They commented that these results are worrying because they include fat mass and waist size, which are linked to metabolic syndrome in adults treated with antipsychotic drugs and with heart disease in the general population.

"Moreover," they wrote, "abnormal childhood weight and metabolic status adversely affect adult cardiovascular outcomes via continuation of these risk factors or independent or accelerated mechanisms".

They concluded that these results, together with data from first-episode studies, suggest that:

"Guidelines for antipsychotic medication exposure for vulnerable pediatric and adolescent patients naive to antipsychotic medication should consider more frequent (eg biannual) cardiometabolic monitoring after the first 3 months of treatment."

They also suggested doctors should carefully weigh up the risks versus benefits of giving second-generation antipsychotic medications to the severely mentally ill, given that metabolic monitoring in this group is not as good as it should be, in addition to the poor physical health outcomes.

They wrote that the benefits of these drugs for this group should be "balanced against their cardiometabolic risks through a careful assessment of the indications for their use, consideration of lower-risk alternatives, and proactive adverse effect monitoring and management."

"Cardiometabolic Risk of Second-Generation Antipsychotic Medications During First-Time Use in Children and Adolescents."
Christoph U. Correll; Peter Manu; Vladimir Olshanskiy; Barbara Napolitano; John M. Kane; Anil K. Malhotra.
JAMA, October 28, 2009; 302: 1765 - 1773.

Source: JAMA/Archives.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today
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