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Graphical methods and numerical summaries for presenting results form multiple-treatment meta-analysis: an overview and tutorial. Download references. We thank the two referees who reviewed our draft for their valuable comments. Department of Biostatistics, Harvard T. You can also search for this author in PubMed Google Scholar. Lennon provided clinical insight, including selection of confounders, dose to CPZ conversions, and critical review of the manuscript.
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Spertus, J. Risk of weight gain for specific antipsychotic drugs: a meta-analysis. Download citation. Received : 29 August Revised : 15 November Accepted : 05 December Published : 27 June Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.
Neuropsychopharmacology BMC Pharmacology and Toxicology Lipids in Health and Disease Obesity Surgery Scientific Data Advanced search. Skip to main content Thank you for visiting nature. Download PDF. Subjects Pharmacology Schizophrenia. Abstract People with schizophrenia are at considerably higher risk of cardiometabolic morbidity than the general population. Introduction People with schizophrenia are at higher risk for obesity and cardiometabolic disorders including dyslipidemia, hypertension, type 2 diabetes, and cardiovascular disease CVD as a result of a number of factors, some inherent to the illness and associated lifestyle, and some related to the care they receive or fail to receive.
Table 1 Trial characteristics, exposure, baseline participant covariates, and outcomes across trials and treatment groups Full size table. Full size image. All participants were adults aged between 18 and 84, diagnosed with schizophrenia. Treatments and exposures We focused on three SGAs, paliperidone, olanzapine, and risperidone, and make use of placebo arms.
Other confounders Additional baseline participant-level covariates, including age, sex, race, body mass index BMI , use of drugs causing weight gain, and positive and negative syndrome scale PANSS, range: 30— with higher values indicating more severity , were used to adjust for between-arm differences.
Statistical model We utilized a Bayesian hierarchical generalized linear model to combine the data from the 14 clinical trials. Sensitivity analysis We examined the robustness of our results on different exposure scales derived from the Schizophrenia Patient Outcomes Research Team treatment recommendations. Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health.
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R Code. Supplementary Appendix: Risk of weight gain for specific antipsychotic drugs: A meta-analysis. About this article. These side effects can lead to fairly significant impairment in daily functioning but without the […]. When medicines are prescribed surely it makes sense to understand the implications for that person so far as is possible. Including their physiology.
The only person who knows is the patient. I think they use hammers instead of nut crackers. This is especially difficult if on depot injections. Hello, what an interesting and informative article. I was diagnosed with Recurrent Psychotic Depression in I have been hospitalised 4 times since then. I gained a huge amount of weight on Orlanzapine, the only medication that stops the psychosis.
My appetite is horrendous. However, I joined Slimming World January and have lost 6. But the sensation of feeling constantly hungry is draining, I would say the feeling of hunger comes from between the breastbone, not the stomach itself. I quite simply would be dead, no doubt about it. However mirtazapine does cause weight gain and increased appetite… After that I refused to take it…. On my day of hospitalization I was weighing 72kg my highest weight until then and I gained 12kg in three month with the treatment of olanzapine.
I definitely felt food cravings but since I was in hospital my food rations were perfectly normal. The science behind this article must be wrong. Eating more and exercising less does not account for my weight gain.
Olanzapine messes with your metabolism in other ways. Does anyone know what our daily calorie intake and fat intake is suppose to be while on these drugs to prevent weight gain??? I have been on risperdal 20 years and my weight is still going up. I lost a lot of years taking this and my stomach is getting bigger every day because I cannot stop eating lots of carbs! I hope someone can relate with me. Well I can agree with the people on Quetiapine about weight gain.
Simply reducing the problem to calories in vs calories out is not the answer. There is more at play here. I used to ve very slim before the medication, I now eat a third of what I used to now approx calories per day Tried excersise, going down to calories per day. That just made me very weak. Various studies have shown that there are at least two types of gut bacteria that have a marked effect on weight gain. Interesting enough, there has been a study on the effect of Quetiapine on gut bacteria.
It kills exactly the gut bacteria that are missing in obese people. Maybe someone studying for a medical degree might want to take this up. FMT maybe? Bang on Kevin it has nothing to do with calories In and out this drug just makes you gain massive weight no matter what you do and they really need to address this as a matter of urgency as our health is at stake here n as we all know obesity n the complications it causes r the biggest killer.
You take care. It seems one has to starve in order to stop gaining weight. Im trying everything. My weight was 55kg and it doubled in a year on paliperidone.
Doctors dont car. We are just guineypigs it seems. I have been on quetiapine for nearly a year. I started a diet and weight training in the gym when I started taking it and have never been fitter. I am having a crisis at the moment. I really was hopeful and thought I had lost a lot of weight until I weighed myself and I got down and out.
I was given a cocktail of drugs when in hospital and injections of abilify from October until February The worst thing I find is the weight gain. I never used to suffer with weight gain until taking medication. There does seem to be a link between carbs and weight gain when taking anti-psychotics. If I eat carbohydrates my belly swells. If I cut out carbs I lose weight although this is very difficult to do as I feel tired and hungry. Time will tell.
I am in the same situation as you, please message me to keep in contact. I understand you. I am taking Olanzapine 3 days ago. I will try harder eat more heathly and do more exercise and, obviously talk with my psychiatrist. I take 75mg of Seroquel per night for severe insomnia. I generally walk at least miles per day. I drink a celery smoothei with a cup or less of coconut water or juice each morning. For lunch I usually have random fresh vegetables and 1 or 2 slices of whole wheat bread.
Often I skip lunch and have fresh veggies and rice, maybe a small amount of meat for dinner. It seems no matter how little or what I eat, my stomach becomes bloated and swollen very easily.
Now it seems very difficult or nearly impossible to lose stomach fat. Sometimes even just drinking water makes my stomach bloated and hard. The sleep from Seroquel has been decent compared to various benzos and z meds I tried in the past.
I have alot of the same concerns about weight gain and anti-psychotic meds. My son just got out of the hospital due to relapse. He gained 23 lbs in 5 wks. His condition improved. But I know he is concerned over this large gain. He has been dealing with this more 5 yrs now. Not only does the condition break my heart, but the fact that the weight gain makes him sad. Im very fat. From 51 kilos im 75 kilos.
All from antipsyhotic. I m on ariprizole and its nightmare. My body can do anymore from all the side effects. Please give me some addvice.
I food prep all my dinners i do medium sized portions of chicken breast, mushrooms, capsicum, brussel sprouts and avocado but for breaky I will have two or three boiled eggs with a coffee dont really eat lunch I just eat lots of fruit and will have a can of tuna. If you can be stupidly strict and have ridiculous self control then its possible to lose weight im actually starting to feel scared that I will put on alot more down the track because fighting that constant feeling of hunger is the most tormenting and hardest feeling.
We cant just go to the gym and be on diets and expect to lose weight because we no were gonna binge out on the wrongs food and gain back all the weight then all our hard work is all for nothing.
I have been on anti psychotic drugs for over 10 years brands have varied from Olanzapine and Risperidone to my current Amisulpride. A switch to aripiprazole was associated with a mean 5. By contrast, a switch to olanzapine was associated with a mean 2. In the before-to-after switch meta-analyses, there was significant decrease in weight on switching to ziprasidone Switching to aripiprazole, lurasidone, or ziprasidone was generally associated with improvements in other cardiometabolic outcomes, whereas clozapine was associated with an increase in BMI.
The authors performed the most comprehensive synthesis to date of antipsychotic switching on weight and metabolic outcomes. The strongest evidence for weight loss upon antipsychotic switching was for aripiprazole and ziprasidone. By contrast, switching to olanzapine or clozapine was more robustly associated with weight gain , which is associated with increased risk of cardiometabolic disease morbidity eg, hypertension, hyperlipidemia, diabetes mellitus type 2, and mortality.
Limitations of the study included lack of data on the effects of switch versus stay for antipsychotics other than aripiprazole or olanzapine and effects on other non-weight, cardiometabolic outcome measures, as well as lack of statistical power because of small cumulative sample sizes for some comparisons. Antipsychotic switching , notably to aripiprazole or ziprasidone, may lead to weight loss, while switching to olanzapine or clozapine can worsen cardiometabolic status.
However, clinicians should note that antipsychotic switching is only one strategy to mitigate adverse cardiometabolic effects of antipsychotics. We found that olanzapine treatment acutely increased food intake, impaired glucose tolerance, and altered physical activity and energy expenditure in mice.
Furthermore, olanzapine-induced hyperphagia and weight gain were blunted in mice lacking the serotonin 2C receptor HTR2C. Finally, we showed that treatment with the HTR2C-specific agonist lorcaserin suppressed olanzapine-induced hyperphagia and weight gain. Lorcaserin treatment also improved glucose tolerance in olanzapine-fed mice. Collectively, our studies suggest that olanzapine exerts some of its untoward metabolic effects via antagonism of HTR2C.
Atypical antipsychotics AATPs are second-generation antipsychotics that are currently used to treat a variety of psychiatric conditions, including schizophrenia, bipolar disorder, depression, and autism 1.
Despite their documented efficacy and low risks for extrapyramidal symptoms, most AATPs have been linked to drug-induced metabolic side effects, including excessive weight gain, dyslipidemia, and type 2 diabetes 2. Notably, schizophrenic patients have a reduced life span, with obesity-related metabolic syndrome being the leading cause of death 2. Moreover, the incidence of diabetes among AATP users is 4 times higher than in age-, race-, and sex-matched controls 3.
While morbid obesity and type 2 diabetes typically take years to unfold in the general population, these conditions manifest acutely within months following AATP treatment 4. The rapid disease onset suggests a distinct etiology underlying AATP-induced metabolic syndrome that remains poorly understood.
AATPs bind to multiple monoamine receptors in the brain 5. The beneficial psychotropic effects are thought to be mediated primarily by a combinatorial blockade of serotonin 2a and dopamine D 2 receptors 6.
Among them, Htr2c encodes the 5-HT 2C receptor, which acts in the brain to regulate food intake, body weight, and glucose metabolism 10 , However, previous efforts to test this hypothesis using genetic models have been hindered by the difficulty of replicating AATP-induced metabolic perturbations in mice Although it is one of the most commonly prescribed and effective AATPs, olanzapine causes the most weight gain and metabolic impairments in humans In the current study, we investigated the role of Htr2c in olazanpine-induced metabolic impairments in mice.
Nuclear magnetic resonance NMR analysis revealed an increase in fat mass, but not lean mass, in olanzapine-fed mice Figure 1B. In addition to causing obesity, chronic olanzapine treatment impaired glucose tolerance Figure 1C.
Moreover, fasting plasma insulin levels were significantly higher in olanzapine-fed mice Figure 1D. Mice were fed a control diet D; Research Diets Inc. Mice were then switched to the olanzapine diet 50 mg olanzapine compounded into 1 kg of the control diet, Research Diets Inc.
Olanzapine is associated with food craving and binge eating in humans In addition to causing hyperphagia, olanzapine has a sedative effect that is thought to contribute to weight gain in humans We found a reduction in physical activity immediately following the dietary switch Figure 1F.
Furthermore, indirect calorimetry analysis revealed an unexpected increase in parameters of energy expenditure, including heat production Figure 1G , oxygen O 2 consumption, and carbon dioxide CO 2 production following olanzapine exposure Supplemental Figure 1, B and C. The respiratory exchange ratio remained constant before and after olanzapine treatment Supplemental Figure 1D.
However, olanzapine-induced hyperphagia was less prominent in male compared with female mice. We tested whether hyperphagia was a primary contributor to weight gain using a pair-feeding paradigm. When fed ab libitum, mice on the olanzapine diet developed hyperphagia Figure 1E and gained significantly more weight than those fed the control diet during a 7-day period Supplemental Figure 1E.
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