Systematic Review and Meta-analysis of Pharmacological Interventions for Weight Gain from Antipsychotics and Mood Stabilizers

Jess G Fiedorowicz; Del D Miller; Jeffrey R Bishop; Chadi A Calarge; Vicki L Ellingrod; William G Haynes

doi:10.2174/157340012798994867

Back

Systematic Review and Meta-analysis of Pharmacological Interventions for Weight Gain from Antipsychotics and Mood Stabilizers

Journal article

Peer reviewed

Systematic Review and Meta-analysis of Pharmacological Interventions for Weight Gain from Antipsychotics and Mood Stabilizers

Jess G Fiedorowicz, Del D Miller, Jeffrey R Bishop, Chadi A Calarge, Vicki L Ellingrod and William G Haynes

Current psychiatry reviews, Vol.8(1), pp.25-36

02/01/2012

DOI: 10.2174/157340012798994867

PMCID: PMC3375952

PMID: 22712004

Files and links (1)

url

https://www.ncbi.nlm.nih.gov/pmc/articles/3375952View

Open Access

Abstract

Pharmacological treatments for serious mental illness (SMI) can cause weight gain and adverse metabolic effects. Many second generation antipsychotics and mood stabilizers appear to be particularly problematic in this regard. Several studies have investigated interventions for antipsychotic-induced, or less commonly mood stabilizer –induced, weight gain. Both lifestyle and pharmacological interventions have demonstrated effectiveness. We systematically review randomized controlled trials of pharmacological interventions for weight gain related to these medications. We conducted a meta-analysis of clinical trials for the most studied agents to estimate mean weight loss: metformin (2.93 kg, 95% C.I. 0.97–4.89, p =0.003), H 2 antagonists (1.78 kg (95% C.I. −0.50–4.06, p =0.13), topiramate (3.95 kg 95% C.I. 1.77–6.12, p =0.0004), and norepinephrine reuptake inhibitors (1.30 kg (95% C.I. −0.06–2.66, p =0.06). Among the studied options for antipsychotic-related weight gain, metformin has the strongest evidence base and may improve vascular risk factors beyond obesity. The use of topiramate is also supported by the literature and may improve psychotic symptoms in those refractory to treatment. A marginal benefit is seen with norepinephrine reuptake inhibitors, and any vascular benefits from such weight loss may be counteracted by increases in blood pressure or heart rate. Pharmacological therapies may offer benefits as a means of supplementing the effects of lifestyle changes for weight loss. However, the existing evidence provides little evidence of specificity for pharmacological therapies to antipsychotic-induced weight gain and has not studied any connection between benefits and reduced incidence of diabetes mellitus or any vascular outcomes.

Obesity

Bipolar Disorder

Dyslipidemias

Vascular Diseases

Weight Loss

Major Depression

Schizophrenia

Antipsychotic agents

Psychotic Disorders

Meta-analysis

Details

Title: Subtitle: Systematic Review and Meta-analysis of Pharmacological Interventions for Weight Gain from Antipsychotics and Mood Stabilizers
Creators: Jess G Fiedorowicz - College of Pharmacy The University of Michigan Ann Arbor, MI
Del D Miller - College of Pharmacy The University of Michigan Ann Arbor, MI
Jeffrey R Bishop - College of Pharmacy The University of Michigan Ann Arbor, MI
Chadi A Calarge - College of Pharmacy The University of Michigan Ann Arbor, MI
Vicki L Ellingrod - College of Pharmacy The University of Michigan Ann Arbor, MI
William G Haynes - College of Pharmacy The University of Michigan Ann Arbor, MI
Resource Type: Journal article
Publication Details: Current psychiatry reviews, Vol.8(1), pp.25-36
DOI: 10.2174/157340012798994867
PMID: 22712004
PMCID: PMC3375952
NLM abbreviation: Curr Psychiatry Rev
ISSN: 1573-4005
eISSN: 1875-6441
Language: English
Date published: 02/01/2012
Academic Unit: Psychiatry; Epidemiology; Internal Medicine
Record Identifier: 9984004079702771

Metrics

40 Record Views

59 Times Cited - Web of Science