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Ep. 012 - How to reverse weight gain from antipsychotic medication?
- 2021/11/12
- 再生時間： 31 分
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あらすじ・解説
This episode deals with the question of weight gain from antipsychotic medication: I'm on 20 milligrams of olanzapine. It's helping me and I don't want to change it. The only thing is that I've gained a lot of weight that makes me feel very unattractive. I’ve spoken to my psychiatrist about it, but I haven't gotten any guidance on the matter. Are there any solutions to weight gain from this kind of medicine? Modern antipsychotic medications can be very helpful for some people. And they are less likely to cause neurological side effects, compared to their first-generation predecessors. However, many of these newer medicines can cause someone to gain significant amounts of weight. This is a serious problem that the psychiatric profession (in my view) has been very slow to address. In this episode, Dr. Erik Messamore describes several strategies that can reduce the risk of medication-related weight gain or that can reverse weight gain once it has started. Strategy 1. Choose antipsychotic medications with low weight gain risk Different antipsychotic medications come with different degrees of weight gain risk. Table 1 in this open-access medical journal article lists medications with higher or lower risk of weight gain. The graph in this article also illustrates the differences in weight gain risk among the various antipsychotic medications. Strategy 2. Switch to an antipsychotic medication with lower weight gain risk People who have gained weight from higher-risk medications – like quetiapine (Seroquel) or olanzapine (Zyprexa), for example – may lose weight after switching to a lower-risk medication. On the other hand, some people (like the person who sent in today’s question) might mostly like their current medication, or may not want to take the risks involved in medication switching (e.g., the switched-to medication might not work as well, or might have other side effects). In situations like these, there are several weight loss options worth considering. Strategy 3. Diet and exercise to reduce weight from antipsychotic medication Many studies show that antipsychotic-induced weight gain does respond to standard diet or exercise interventions. A relatively small reduction of 150 calories per day can lead to about 16 pounds of weight loss over a year. For many people, that can be achieved by sticking to natural, whole foods and avoiding processed foods with a lot of carbohydrates or added sugars. Exercise and physical activity can enhance weight loss. And numerous studies show that exercise can improve mood, reduce anxiety, increase cognitive performance, and reduce symptoms of psychosis. Very low carbohydrate diets like the ketogenic diet are popular these days. These diets are designed to reduce insulin levels, which can make it easier to lose weight (because insulin is a fat-storage signal). Many people who undertake these diets can maintain calorie deficits without feeling hungry. Several case reports and a small clinical study suggest that the low-carb/ketogenic diet might help some people with schizophrenia, psychosis, or bipolar disorder to experience fewer symptoms. Strategy 4. Metformin to reduce weight from antipsychotic medication Metformin is a widely-used treatment for type-2 diabetes. It improves the body’s insulin signals and reduces spikes in blood sugar. Metformin can also help people without diabetes to lose weight. And there are many studies showing the metformin can reduce weight in people who have gained weight from antipsychotic medications. Strategy 5. GLP-1 Agonists to reduce weight from antipsychotic medication GLP-1 is an abbreviation for glucagon-like peptide 1. The GLP-1 agonist drugs mimic the action of natural GLP-1. They optimize the body’s insulin responses and reduce appetite. Some of these medications – liraglutide (Victoza, Saxenda); semaglutide (Ozempic, Rybelsus, Wegovy) – even have FDA approval for treating obesity. Lirgalutide has been studied in weight gain from antipsychotic medication and appears to produce more weight loss than metformin. Strategy 6. Melatonin might reduce weight gain from antipsychotic medications This episode mentions that some studies show that melatonin might reduce the amount of weight gained from antipsychotic medication, while at the same time helping to further reduce symptoms of psychosis. The studies referred to are: Romo-Nava F et al. (2014) Melatonin attenuates antipsychotic metabolic effects: an eight-week randomized, double-blind, parallel-group, placebo-controlled clinical trialModabbernia A et al. (2014) Melatonin for prevention of metabolic side-effects of olanzapine in patients with first-episode schizophrenia: randomized double-blind placebo-controlled study.Mostafavi A et al. (2014) Melatonin decreases olanzapine induced metabolic side-effects in adolescents with bipolar disorder: a randomized double-blind placebo-controlled trial. Summary and suggestions Although the psychiatric ...