What are the most effective strategies for managing weight gain associated with antipsychotic medications?
In my experience, the following things have worked.
- Reassurance that it is a medication side-effect.
- Consider switching the anti-psychotic (or at least try and decrease the dose of the antipsychotic). Aripiprazole, Caplyta (Lumateperone), and Vraylar (Cariprazine) have shown benefits vis a vis weig...
When counseling for lifestyle modification is insufficient, I've experienced with the four different medications:
- Metformin - I've had the best results with this.
- Topiramate - I've used it when there may be a benefit for comorbidity, such as migraines or binge eating disorder (I have had good luck ...
I like to start with ziprasidone, when possible. I have seen no weight gain with it. Bear in mind that the patient population I’m working with presently are teens and young adults in foster care with intellectual disability who have high rates of PTSD, bipolar disorder, schizophrenia, ADHD, impulsiv...
While I have had great results using Abilify in bipolar patients, it has been consistently a problem concerning weight gain. The increased "hunger" especially for sweets has caused almost all my patients to gain significant weight leading to poorer self-image and increased depression especially mark...
I have found that for many of my patients, recommending dietary changes and exercise is not helpful at all. The amount of exercise one would have to do to burn off the excess calories is simply not attainable. I find that most of my patients on antipsychotic medications are not running marathons, in...
- Dietary consult to work on diet.
- Metformin to help with glucose tolerance. Weight loss is very minimal but I like to use this in hopes that weight gain is minimal.
- I have heard great results from using GLP-1 agonists and some patients lose 25-30 lbs especially clozapine where weight gain is very hi...
I definitely agree with Dr. @Dr. First Last that weight gain in teens and children is more variable (i.e., which agent can cause it) than in the adult population and I would add that significant weight gain (>5% BMI) is more common for all of the atypicals. The most difficult aspect of this weight g...
Low-carb diet, e.g., <100 grams total carbs per day. If significant weight loss is the goal, I would recommend a gentle ketogenic diet, e.g., <50 grams of total carbs per day.
I discuss with each patient their diet and consumption of soda. Unfortunately, quitting soda is very difficult for a lot of patients as they are literally addicted to it. It takes a lot of effort to decrease daily and then weekly amounts. I think quitting soda is close to quitting nicotine. Intermit...
I like Vraylar too. Exercise and diet.
I have had success with asking patients about the consumption of beverages containing sugar. In particular, I have engaged patients in conversations about the number of such beverages they drink daily, focusing both on the potential for weight loss and the amount of money that could be saved by drin...
Many of the above solutions are excellent for adults and weight gain. If you are considering children. The antipsychotics do not respond the same. Abilify can cause significant weight gain and even Zyprexa isn't a surefire weight increase. Latuda and Geodon are often used in youth and consistently d...
Thoughtful responses about how to manage weight gain due to antipsychotic medication treatment. I’d be interested to hear more from those who recommended ketogenic diet and/or intermittent fasting about how they help their patients make such radical dietary/lifestyle interventions. As someone with a...
I have had some favorable results with metformin in a young female patient fearful of weight gain. She has been on antipsychotic medicine (aripiprazole) for a schizoaffective disorder with hallucinosis. She also seems to have had some cognitive impairment. Since starting metformin, weight gain has b...
I start with a discussion about this important side effect. Discussing diet options is also part of the routine. The diet that I am aware of that has the most support is the Mediterranean diet, not really a ketogenic diet, but definitely something to consider. Monitor the metabolic panel every 6 mon...