Depression

Updated 13 March 2015

Weight can be managed when taking antipsychotics

Lifestyle changes can minimise weight gain in people taking anti-psychotic drugs to treat mental illness.

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The drugs people take to help ease serious mental illnesses often contribute to weight and blood sugar problems - but researchers say a lifestyle intervention can be helpful on both fronts.

The so-called "anti-psychotic drugs" that patients take to control their symptoms tend to stimulate hunger and thirst and cause metabolic changes.

But in a new test of a year-long intervention, people taking these drugs for illnesses like schizophrenia or bipolar disorder were able to lose weight and improve their blood sugar levels.

Read: Anti-psychotic drugs tied to diabetes


With the right tools, weight loss is possible

"The results are somewhat surprising because people with serious mental illnesses have many barriers to losing weight," said lead author Carla A. Green, of the Centre for Health Research at Kaiser Permanente Northwest in Portland, Oregon. "That is really important because people with serious mental illness are already at much higher risk for obesity and obesity-related disease and they have a reduced life expectancy because of this."

A number of medication side-effects, including weight gain, deter some people from taking their prescribed anti-psychotics, Green said.

"Our study showed that if given the right tools, they can lose similar amounts of weight as people without severe mental illnesses," she told Reuters Health by email.

Clozapine (FazaClo), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal), which treat schizophrenia, bipolar disorder or other mental illnesses, have all been linked to increased risk of weight gain.


Read: 
Antipsychotics make kids fat

How the study was conducted

Green and her team studied 200 adults who'd been taking anti-psychotic medications for at least a month and who had a body mass index (BMI) of at least 27. BMI is a measure of weight relative to height; the cut-off for "overweight" is 25.

They explain in the American Journal of Psychiatry that patients were randomly assigned to an "intervention" group that participated in the new program, or a comparison group that just got their usual medical care

In the intervention group, participants attended weekly two-hour group meetings for the first six months of the study. At each session, they met with mental health counsellors and nutritionists; each meeting also included 20 minutes of physical activity.

In addition, participants recorded what and how much they ate, how much they slept and how much they exercised, with a goal of at least 25 minutes of moderate activity per day.

The intervention was focused on improved diet with more vegetables, fruits, and low-fat dairy, moderate caloric restriction, increased exercise primarily from walking, stress management, and improved sleep, Green said.

For the second half of the year, the participants met to discuss strategies for maintaining weight loss.

The comparison group did not participate in the weight loss or maintenance interventions.


Results of the study
People in the intervention group lost an average of about 10 pounds over the duration of the study. Those in the comparison group also lost some weight, but much smaller amounts, the authors write.

In the intervention group, 40 percent of participants lost at least five percent of their initial body weight, and 18 percent lost at least 10 percent of their initial weight.

Over the course of the year, fasting blood sugar levels went down in the intervention group, but they went up in the comparison group.

Use of anti-psychotic drugs in the U.S. has been on the rise since the 1990's, especially among kids.

The intervention resulted in a relatively modest weight loss, and did not depend on the type of medication, said Dr. Daniel J. Mueller, who has done research on ways to improve psychiatric drug treatment at the Centre for Addiction and Mental Health in Toronto.

Individual motivation is key when addressing weight loss, Mueller told Reuters Health by email. Although patients with serious mental illness face more difficulties, some will be motivated enough to overcome them, he said.


Read: 
Alternative to anti-psychotics for schizophrenics

Prescribe drugs with low weight gain risk first

"Some doctors will now routinely start treatment with relatively weight-neutral antipsychotics first, like aripiprazole (Abilify) or ziprasidone (Geodon), if they work," he said.

But the drugs that work the best on average also have a high weight gain risk, like clozapine and olanzapine, or at least moderate risk, like risperidone, Mueller said.

"In our qualitative interviews, we found that group support was one of the most important components of our intervention," Green said. "Many of our participants said they benefited from the camaraderie of others who faced the same challenges, and this may be particularly important among people with serious mental health problems because they tend to be more socially isolated."

People taking anti-psychotics can talk to their doctors about weight gain and medication alternatives, weight management programs and support groups while increasing physical activity, decreasing calories and portion size, she said.

"Perhaps more importantly, lifestyle change programs of this type are not routinely offered in community mental health centres because the programs focus on physical health concerns and this makes reimbursement for those services difficult if not impossible in mental health settings," Green said.

That makes it hard to provide lifestyle change programs in the places where people with serious mental illnesses are most likely to be able to take advantage of them, she said.

Read more:
Anti-psychotics can kill
Many kids on anti-psychotics for ADHD
Anti-psychotics over-prescribed

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Depression expert

Michael Simpson has been a senior psychiatric academic, researcher, and Professor in several countries, having worked at London University in the UK; McMaster University in Canada; Temple University in Philadelphia, USA.; and the University of Natal in South Africa.

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