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28 October 2009

Antipsychotics make kids fat

Children and teens who take medicines for conditions such as schizophrenia, bipolar disorder and autism tend to put on a substantial amount of weight, a new study finds.

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Children and teens who take medicines for conditions such as schizophrenia, bipolar disorder and autism tend to put on a substantial amount of weight, a new study finds.

The worry is that excessive weight gain and other metabolic changes in childhood can place kids at risk for chronic health problems as adults. Some of these medicines, collectively known as "atypical antipsychotics," have been linked to increased blood-fat levels.

"We are very much afraid that this will lead to diabetes and metabolic syndrome," said study author Dr Christoph Correll, medical director of the Recognition and Prevention program at the Zucker Hillside Hospital in Glen Oaks, US.

The study, reported in the Journal of the American Medical Association, is the largest analysis of its kind, Correll said.

Jeanette M Jerrell, a professor of neuropsychiatry at the University of South Carolina School of Medicine in Columbia, is the co-author of a similar study published last year in the Archives of Pediatrics and Adolescent Medicine.

Obesity more prevalent
"We found that obesity/weight gain, type 2 diabetes mellitus and cardiovascular conditions were more prevalent in the treated cohort," she noted.

Her study also found that kids taking multiple antipsychotics were at significantly higher risk for obesity/weight gain, type 2 diabetes, abnormal blood-fat levels and cardiovascular problems.

"This new study is important because it draws further attention to the safety profile of antipsychotics in young populations, and the critical need for expanding the evidence base to guide clinical decisions," she said.

Concern not new
Concerns about the safety of atypical antipsychotics are not new. In 2003, the US Food and Drug Administration ordered manufacturers of these drugs to add a warning about the risk for hyperglycemia and diabetes.

What's more, a 2008 report in The Lancet suggested that some of these drugs - sometimes called "second-generation" antipsychotics - may be no better than older, "first-generation" medicines. The authors concluded that each drug must be weighed individually based on its efficacy and side effects.

Study
Correll's study was designed to assess the safety and effectiveness of the newer class of drugs in youth. His team followed 272 patients, aged 4 to 19, who were taking an antipsychotic for the first time. Patients were being treated for mood spectrum, schizophrenia spectrum or aggressive behaviour spectrum disorders. Fifteen pediatric patients who refused to participate or discontinued their antipsychotic medication within four weeks of starting served as a control group.

The study focused on four antipsychotics commonly prescribed to children: aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal).

After nearly 11 weeks, the treated kids gained an average of 8.5kg on Zyprexa, 6.1kg on Seroquel, 5.3kg on Risperdal and 4.4kg on Abilify, while the control group gained less than 250g. Between 10% and 36% became overweight or obese during the treatment period, according to the study.

Dramatic weight gain
"In these kids that we studied, there was rapid and dramatic weight gain, more than has been described before," said Correll, who is also a scientist in the Center for Psychiatric Neuroscience at the Feinstein Institute for Medical Research in Manhasset, US.

Use of each drug was linked to wider bellies and increased "fat mass" - the proportion of the body comprised of fat.

The drugs had varying effects on metabolic levels. Zyprexa and Seroquel users experienced significant adverse changes in total cholesterol and trigylcerides. Risperdal use resulted in a significant increase in triglycerides. Abilify, however, appeared "metabolically neutral," Correll said.

Long-term treatment
"Some of these kids are maintained on these medications for many years if not indefinitely, so it's definitely a concern," said Ronald T Brown, dean and professor of public health at Temple University Health Sciences Centre in Philadelphia, US. "For children who really don't absolutely need these drugs, they need to be doing more behavioural approaches in psychotherapy."

In an accompanying editorial, Drs Christopher K Varley and Jon McClellan of Seattle Children's Hospital concluded that large, independently funded studies are needed to establish the long-term safety and benefit of these drugs in children.

"Until those data are available, consideration of less risky treatment interventions and scrupulous attention to metabolic parameters in children and adolescents who receive atypical antipsychotic medications are essential," they wrote.

Correll, in fact, is currently involved in a longer-term follow-up study to assess the health effects of these drugs in children over an extended period of time.

For now, he advises clinicians and families to carefully weigh the risks and benefits of the medications against the risk of the illness, and to consider other pharmaceutical and non-pharmaceutical options. It's also important to teach children about healthy lifestyles and to closely monitor kids' weight, lipid levels and blood glucose, he said. - (Karen Pallarito/HealthDay News)

 
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