Review of atypical antipsychotics and weight gain

Prescribing an antipsychotic for a patient with schizophrenia requires a ri sk-benefit analysis. Weight gain has become an issue recently as a result o f reports that 2 of the atypical antipsychotic agents, clozapine and olanza pine, are associated with a higher risk than other drugs of causing excessi ve weight gain, Some degree of weight gain may occur with any atypical anti psychotic agent, particularly early in treatment. A more important consider ation is the long-term effects of the atypical antipsychotic on body weight , since many of the patients in this population require chronic therapy. Th is is important because weight gain is an adverse effect that is associated with noncompliance and medical problems. In this article, I review recent reports about the weight effects of different atypical antipsychotic drugs. To provide accurate understanding of the effects of atypical antipsychotic agents, data analyses should include both short-term and long-term finding s, the relationship of changes in body weight to pretreatment body mass ind ex (BMI), relationship to dose, both intent-to-treat and complete analyses, and presentation of both mean and median changes in weight. It is also imp ortant to know whether the studies have been done in an inpatient or outpat ient setting, since patients who are institutionalized may be less likely t o exhibit increases in body weight. Such complete information and multidime nsional analysis would minimize obfuscation about the true nature of a drug 's impact on body weight.