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| |  Excessive weight gain seen with some newer anti-psychotics TORONTO, ON -- May 1, 2000 -- Weight gain may seem like an inconsequential side effect when it comes to controlling serious mental illnesses such as schizophrenia and bipolar disorder, but there is mounting evidence that use of some anti-psychotic medications is producing such considerable weight gain that these patients are becoming obese. "Weight gain is a significant side effect of anti-psychotic medications that has only recently come to the forefront as an issue in the psychiatric community," said Dr. Roger McIntyre, a psychiatrist with the Mood Disorders Program at the Centre for Addiction and Mental Health, Clarke Division, in Toronto. "We now recognize that being overweight or obese may contribute to the development of additional health problems." The American Psychiatric Association has described schizophrenia as one of the most debilitating and baffling mental illnesses known. It strikes young adults in the prime of their lives, between their late teens and early 30s. The incidence of obesity in the 18-29 age group is much lower than the overall population and body image is typically an important concern. For many patients, weight gain is so intolerable that they discontinue treatment. When patients were asked to select from several comparable drugs, they often chose the one least likely to cause weight gain. Victoria, B.C. resident Marie (who did not want her last name revealed) gained more than 100 lbs. in 15 months after going on a newer anti-psychotic medication to control her schizophrenia. Marie's family physician referred her to endocrinologist Dr. Lucretia van den Berg when her diabetes became difficult to control because of the weight gain. "I never used to see these types of patients in my practice, but it's becoming more and more common," said Dr. van den Berg. A recent article in the Journal of Clinical Psychiatry noted that "obesity increases the risk of several serious health problems, including heart disease, type II diabetes mellitus, hypertension and osteoarthritis. Patients taking certain psychotropic medications may gain a significant amount of weight (as much as a 5 percent increase in body weight within one to two months), placing them at risk for obesity. Body weight monitoring and prudent drug selection are the best approaches to prevent weight gain in patients taking psychotropic drugs." "I'm pleased to see this issue of weight gain finally being addressed in patients whose health is already compromised," said Bill MacPhee, the publisher of Schizophrenia Digest and a patient advocate who himself suffers from schizophrenia. "These are patients who because of the nature of their disease typically are unable to manage their own health, and may not be able to understand all the implications of their treatment." Once patients gain the weight it is very difficult to lose it, even if they go off the medication. A study published last year in the Journal of Clinical Psychiatry stated that losing weight is a challenge, particularly for patients with severe mental illness whose medication is causing them to gain weight. Many of these patients have limited resources, poor diets and problems with medication compliance. The high prevalence of smoking among this patient group also impacts on their weight. According to Dr. McIntyre, the preferred means of treating weight gain associated with anti-psychotic medications is to prevent its occurrence in the first place, which can be done by counselling the patient that drugs can stimulate appetite, primary prevention through diet and behaviour modification as well as switching medication as soon as weight gain becomes a problem. Although the issue has received little attention, weight gain caused by medication is in fact quite common. When a patient is doing well on a medication, physicians may become complacent, overlooking or not carefully monitoring increases in weight until a patient has become severely overweight or obese. "Choosing a medication requires a careful balance of effectiveness versus risks for the patient such as safety and side effects," said Dr. McIntyre. "For people with schizophrenia we must monitor all of the common side effects including weight gain, given that medication adherence is so important for these patients."
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