Antipsychotic Medications and Weight Gain: Etiologies, Predictors and Adverse Clinical Consequences

Background: First and second-generation antipsychotic medications are commonly prescribed to millions of psychiatric patients with psychosis around the world. Antipsychotic medications are associated with a variety of adverse effects including weight gain. Objective: This review aimed to describe etiologies, predictors and morbidity and mortality associated with weight gain induced by antipsychotics in a psychiatric population.

Methods: Electronic searches (2000-2018) of PubMed, Medline, and Google Scholar were conducted using Boolean operators and keywords. Of all articles retrieved (n=37,987), two independent reviewers identified 105 relevant articles published in English peer-reviewed journals.

Results: In conjunction with other biopsychosocial and cultural risk factors, first and second generation antipsychotic medications are associated with weight gain in psychiatric population having a spectrum of severe mental illnesses. The weight gain linked with multiple predictors was differentially more common during initial intake of all antipsychotics but remained stable or decreased during the longer timeline. The most weight gain associated with a variety of adverse consequences affecting safety of patients was reported with clozapine and olanzapine and the least weight gain was seen with aripiprazole and amisulpiride, and no weight gain with the use of newer drugs especially ziprasidone, lurasidone and paliperidone.

Conclusion: Most antipsychotic medications commonly increase weight gain in patients with psychotic conditions around the world. Consequently, weight gained induced and predicted by multiple paradigms causes a variety of additional potentially adverse effects including medical and psychological conditions and premature deaths in psychiatric vulnerable patients who need close monitoring and appropriate management across antipsychotic treatment trajectories.