Psychotropic Drug Considerations in Depressed Patients with Metabolic Disturbances (original) (raw)
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Changes in body weight during pharmacological treatment of depression
The international journal of neuropsychopharmacology / official scientific journal of the Collegium Internationale Neuropsychopharmacologicum (CINP), 2011
The risk of weight gain is an important determinant of the acceptability and tolerability of antidepressant medication. To compare changes in body weight during treatment with different antidepressants, body weight and height were measured at baseline and after 6, 8, 12 and 26 wk treatment with escitalopram or nortriptyline in 630 adults with moderate-to-severe unipolar depression participating in GENDEP, a part-randomized open-label study. Weight increased significantly more during treatment with nortriptyline compared to escitalopram. The weight gain commenced during the first 6 wk of nortriptyline treatment, reached on average 1.2 kg at 12 wk (0.44-point BMI increase), and continued throughout the 6-month follow-up period. Participants who were underweight at baseline gained most weight. Participants who were obese at baseline did not gain more weight during treatment. Weight gain occurred irrespective of whether weight loss was a symptom of current depressive episode and was ide...
The Association of Antidepressant Medication and Body Weight Gain
Online Journal of Health and Allied Sciences, 2013
Objective: To review the literature and discover which antidepressants are responsible for weight gain and then to discuss the areas with lack of adequate knowledge. Method: An electronic search was conducted through Medline, Pubmed, Cochrane library, and ScienceDirect. Forty nine empirical researches were identified and reviewed. Results: Amitriptyline, clomipramine, and mirtazapine have been associated with more weight gain induction in clinical studies, but not in animal-based studies. All TCAs have been reported to cause weight gain except protriptyline. MAOIs have been associated with weight gain. In SSRI group, citalopram and ecitalopram induce weight, yet mixed results exist for paroxetine and fluoxetine. Researches unanimously reported weight loss effect for bupropion. Some studies suggest contributing factors in the relationship of antidepressants with body weight changes including age, gender, base-line weights and treatment duration. Various results of different treatment durations have been reported in some cases but there are not continuous time-dependent studies for the influences of antidepressants on body weight changes. Conclusion: More studies are required to discover underlying mechanisms and the time-dependent effects of antidepressants on body weight changes.
Psychiatric medication-induced obesity: a review
Obesity Reviews, 2004
A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment with these agents. There is newer literature looking at the aetiology of this weight gain and the potential treatments being used to alleviate this sideeffect. We found solid evidence that weight gain is often associated with the mood stabilizers, and antipsychotics and antidepressants. Only few weight neutral or weight loss producing psychotropics are available, and weight gain, outside of an immediate side-effect, may generate secondary side-effects and medical comorbidity. Weight gain may cause hypertension, diabetes, osteoarthritis, sedentary lifestyle, coronary artery disease, etc. Given the likelihood of inducing weight gain with psychotropic medications and the longitudinal impact on physical health, a thorough literature review is warranted to determine the epidemiology, aetiology and treatment options of psychotropic-induced weight gain.
Weight Gain, Obesity, and Psychotropic Prescribing
Journal of Obesity, 2011
A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment with these agents. There is newer literature looking at the etiology of this weight gain and the potential treatments being used to alleviate this side effect. The authors undertook a comprehensive literature review in order to present epidemiology, etiology, and treatment options of weight gain associated with antipsychotics, mood stabilizers, and antidepressants.
Psychiatric medication induced obesity: an aetiologic review
Obesity Reviews, 2004
A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. There is much speculation about the prevalence of weight gain and the degree of weight gain during acute and longitudinal treatment, but consensus shows that weight gain is prominent. The present review looked at the aetiology and cause of weight gain associated with psychotropic use and presents hypotheses as to why patients gain weight on antipsychotics, mood stabilizers and antidepressants. It is found that most psychotropic medications induce some weight gain, and clinicians are encouraged to utilize active interventions to alleviate the weight gain in order to prevent more serious obesity related comorbidities.
Metabolic Effects of Antidepressant Treatment
Noro Psikiyatri Arsivi, 2017
Mortality and morbidity are relatively high among patients with severe psychiatric disorders such as schizophrenia, bipolar disorder, and depression compared with those among the general population (1). It is known that patients with severe psychiatric disorders have a shorter life expectancy (2). This decreased life expectancy results from an increased risk for suicide and also medical disorders such as cardiovascular diseases (3). The cardiovascular risk is associated with cardiometabolic risk factors such as diabetes mellitus, smoking, dyslipidemia, and obesity (4). Genetic, lifestyle-related factors, limited access to good quality physical care, the disease itself, and psychopharmacotherapy play a role in the increased risk for cardiovascular diseases (1). Although modifiable cardiometabolic risk factors such as smoking, hyperglycemia, hypertension, dyslipidemia, and obesity are frequently observed in patients with severe psychiatric disorders, they are not sufficiently recognized or are overlooked in these patients (5). Obesity that results from reduced activity and irregular nourishment is one of the most important risk factors in psychiatric patients. Obesity is more frequently observed among psychiatric patients than among the general population (6). There are many reasons for increased obesity in patients with severe psychiatric disorders (7). Lifestyle alterations related to the psychiatric disorder can cause increased food intake and decreased energy expenditure, thus leading to increased fat accumulation (8). In addition, drugs used for treating psychiatric disorders may also play a role in the etiology of obesity in such patients (9). It is known that psychotropic agents, primarily antipsychotics and mood stabilizers, lead to weight gain. Furthermore, weight gain is a serious problem that can compromise adherence to psychotropic drug regimens and lead to symptomatic relapse and medical comorbidity. In this context, antidepressants have attracted lesser attention than anti-psychotic agents and mood stabilizers. However, if there is a higher risk for antidepressant-related weight gain, it is more important because these drugs are more commonly used. There are a few studies regarding antidepressant-related weight change. It was reported that the likelihood and amount of weight gain may vary in tricyclic antidepressants (TCAs), although TCAs, as a class, are considered to generally result in weight gain through anticholinergic activity (10). In contrast to TCAs,
CNS Neuroscience & Therapeutics, 2012
Weight gain is on the rise in the United States as is the diagnosis and treatment of mental disorders. These two phenomena are distinctly separate but tend to overlap in that most psychotropic agents approved for use in the United States are associated with the potential to induce weight gain. Metabolic disorders such as diabetes, hypercholesterolemia, and hypertension are also on the rise and often associated with weight gain and clearly associated with certain psychotropic medications. This article serves to provide a succinct review regarding the epidemiology, etiology, and treatment options for psychotropic-induced obesity.
Psychiatric medication-induced obesity: treatment options
Obesity Reviews, 2004
A majority of psychiatric medications are known to generate weight gain and ultimately obesity in some patients. The authors undertook a comprehensive literature review in order to provide a better understanding of novel treatment options in regards to alleviating weight gained by use of antidepressants, antipsychotics, and mood stabilizers. There are no agents for management of this weight gain approved by the Food and Drug Administration (FDA), and existing studies on options are mainly uncontrolled, small-scale projects with limited power to produce coherent conclusions. There is a clear need for larger studies on existing options, and future psychotropics without these side-effects are currently in the pipeline. obesity reviews (2004) 5 , 233-238 234 Psychiatric medication induced obesity T. L. Schwartz et al. obesity reviews © 2004 The International Association for the Study of Obesity. obesity reviews 5 , 233-238 obesity reviews Psychiatric medication induced obesity T. L. Schwartz et al. 235
Weight gain and associated factors in patients using newer antidepressant drugs
General Hospital Psychiatry, 2015
The aim of the present study was to examine weight gain and its association with clinical and sociodemographic characteristics in patients using newer antidepressants. Methods: The study had a cross-sectional design. A total of 362 consecutive psychiatric patients taking antidepressant drugs for 636 months were included in the study. Results: The prevalence rate of weight gain was 55.2%; 40.6% of the patients had a weight gain of 7% or more compared to the baseline. Overall, antidepressant use was significantly related to increased body weight. Specifically, citalopram, escitalopram, sertraline, paroxetine, venlafaxine, duloxetine, and mirtazapine, but not fluoxetine, were associated with significant weight gain. Multivariate logistic regression analysis indicated that lower education status, lower BMI at the onset of antidepressant use, and family history of obesity were independent predictors of weight gain ≥7% compared to the baseline. Conclusions: The study results suggest that patients who take newer antidepressants might have significant problems related to body weight.
Journal of Psychiatric Research, 2012
To describe the weight gain-related side-effects of psychotropic drugs and their consequences on metabolic complications (hypercholesterolemia, obesity) in a Swiss cohort of psychiatric patients. Method: This cross-sectional observational study was performed in an outpatient psychiatric division with patients having received for more than 3 months the following drugs: clozapine, olanzapine, quetiapine, risperidone, lithium, and/or valproate. Clinical measures and lifestyle information (smoking behaviour, physical activity) were recorded. Results: 196 inclusions were completed. Weight gain (!10% of initial weight) following drug treatment was reported in 47% of these patients. Prevalence of obesity (BMI ! 30), hypercholesterolemia (!6.2 mmol/L) and low HDL-cholesterol (<1.0 mmol/L in men, <1.3 mmol/L in women) were present in 38%, 21%, and 27% of patients, respectively. A higher standardised dose, an increase of appetite following medication introduction, the type of medication (clozapine or olanzapine > quetiapine or risperidone > lithium or valproate), and the gender were shown to be significantly associated with evolution of BMI. Conclusion: High prevalence of obesity and hypercholesterolemia was found in an outpatient psychiatric population and confirms drug-induced weight gain complications during long-term treatment. The results support the recently published recommendations of monitoring of metabolic side-effects during treatment with atypical antipsychotics. Moreover, the weight gain predictors found in the present study could help to highlight patients with special health care management requirement.