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Second-generation antipsychotic use in schizophrenia and associated weight gain: A critical review and meta-analysis of behavioral and pharmacologic treatments

Chandan Das, BS

Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA

Guillermo Mendez, PhD

Department of Mathematics and Statistics, Arizona State University, Tempe, AZ, USA

Sonal Jagasia, MD

Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA, Department of Psychiatry, Georgetown University, Washington, DC, USA

Lawrence A. Labbate, MD

Department of Psychiatry, University of Arkansas for Medical Sciences, Mental Health Service, Central Arkansas Veterans Healthcare, System, Little Rock, AR, USA

BACKGROUND: Weight gain in schizophrenia, particularly secondary to second-generation antipsychotic (SGA) use, is a common adverse effect and often is associated with significant physical and psychological morbidity.

METHODS: We performed a critical literature review of all controlled clinical trials for pharmacologic and/or behavioral management of SGA-induced weight gain in schizophrenia patients by searching PubMed and Google Scholar. A meta-analysis was performed to estimate and compare weight changes for various medications and behavioral interventions.

RESULTS: Sample sizes generally were small. Clinical trials were 6 weeks to 1 year, and weight loss was modest with any treatment. Although several adjunctive pharmacologic treatments showed no weight loss, sibutramine, metformin, and topiramate showed some benefit. Amantadine and orlistat were somewhat less effective and had lower rates of tolerability. Among the behavioral therapies, nutritional counseling combined with exercise showed the most benefit. Behavioral therapies, although modest, showed the most consistent benefits compared with controls.

CONCLUSIONS: Scheduled pharmacologic treatment to prevent weight gain or promote weight loss in schizophrenia patients on SGA therapy is limited based on current studies. Switching antipsychotic agents has not been established as a long-term solution. Additional long-term studies are required to influence clinical practice.

KEYWORDS: second-generation antipsychotics, weight gain, schizophrenia


CORRESPONDENCE: Lawrence A. Labbate, MD, Central Arkansas Veterans Healthcare, System, Mental Health Service, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA E-MAIL:
Annals of Clinical Psychiatry ©2012 Quadrant HealthCom Inc.

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