PsychRounds: The Psychiatry Podcast Mitigating Antipsychotic-Induced Weight Gain
Feb 12, 2025
Junhwan Kim, a fourth-year medical student at CMU College of Medicine and an expert on antipsychotic-induced weight gain, discusses critical strategies to mitigate this common side effect. He highlights the link between antipsychotics and metabolic dysfunction, emphasizing personalized treatment plans. The conversation covers the potential of GLP-1 agonists in promoting weight loss, the challenges patients face accessing these medications, and the importance of non-pharmacological interventions like cognitive-behavioral therapy for effective weight management.
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High Metabolic Syndrome Risk in Schizophrenia
- Patients with schizophrenia have a 32.5% prevalence of metabolic syndrome, increasing risks of diabetes and cardiovascular disease.
- This syndrome contributes significantly to the 10-15 year shorter lifespan seen in patients with schizophrenia.
Mechanisms of Antipsychotic Weight Gain
- Antipsychotic-induced weight gain results mainly from increased appetite via blocking 5-HT2C receptors and altered dopamine signaling.
- Hormonal changes, including increased prolactin and leptin resistance, also contribute to weight gain.
Switch to Lower-Risk Antipsychotics
- Switching from high-risk antipsychotics like olanzapine to lower-risk agents such as Abilify or Latuda can reduce weight.
- This switch can lead to an average weight loss of about 4 to 5.6 pounds within 26 weeks.