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Almost All Antipsychotics Result in Weight Gain: A Meta-Analysis
Open accessAbstract
INTRODUCTION: Antipsychotics (AP) induce weight gain. However, reviews and meta-analyses generally are restricted to second generation antipsychotics (SGA) and do not stratify for duration of AP use. It is hypothesised that patients gain more weight if duration of AP use is longer. METHOD: A meta-analysis was conducted of clinical trials of AP that reported weight change. Outcome measures were body weight change, change in BMI and clinically relevant weight change (7% weight gain or loss). Duration of AP-use was stratified as follows: ≤6 weeks, 6-16 weeks, 16-38 weeks and >38 weeks. Forest plots stratified by AP as well as by duration of use were generated and results were summarised in figures. RESULTS: 307 articles met inclusion criteria. The majority were AP switch studies. Almost all AP showed a degree of weight gain after prolonged use, except for amisulpride, aripiprazole and ziprasidone, for which prolonged exposure resulted in negligible weight change. The level of weight gain per AP varied from discrete to severe. Contrary to expectations, switch of AP did not result in weight loss for amisulpride, aripiprazole or ziprasidone. In AP-naive patients, weight gain was much more pronounced for all AP. CONCLUSION: Given prolonged exposure, virtually all AP are associated with weight gain. The rational of switching AP to achieve weight reduction may be overrated. In AP-naive patients, weight gain is more pronounced.
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“lower BMI has been associated with higher risk of weight gain due to antipsychotics in meta-analyses20 and pooled analyses of brexpiprazole clinical studies.21”
From Brexpiprazole for the maintenance treatment of adults with schizophrenia: an evidence-based review and place in therapy (2019) · cites this paper as [20]
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“Of these risk factors, medication with antipsychotic drugs can be considered partly modifiable, as reducing doses or switching prescriptions only leads to moderate improvement of metabolic risk factors 10,11 .”
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“Although there are other antipsychotics such as amisulpride, aripiprazole and ziprasidone that cause a more moderate weight gain (Bai et al., 2017; Bak et al., 2014; Tek et al., 2016), these have been shown to be less effective in clinical terms than clozapine (Ifteni et al.”
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Bak, M., Drukker, M., Cortenraad, S. A. M., Vandenberk, E., & Gülöksüz, S. (2021) · PLoS ONE · doi:10.1371/journal.pone.0244944 · Cited by 55
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Metadata
- Authors
- Bak, M., Fransen, A., Janssen, J., van Os, J., & Drukker, M.
- Affiliations
- Maastricht University Medical Centre (NL)
- Máxima Medisch Centrum (NL)
- Corresponding author
- Bak, Maarten
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-04-24
- Volume
- 9
- Issue
- 4
- Pages
- e94112
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3998960
- OpenAlex
- W2089001223
- Cited by
- 490
- References
- 362
- Citations by year
- 2026: 17 · 2025: 31 · 2024: 39 · 2023: 42 · 2022: 47 · 2021: 48 · 2020: 45 · 2019: 55 · 2018: 50 · 2017: 43 · 2016: 39 · 2015: 28 · 2014: 5
- FWCI
- 5.28
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Health Sciences › Medicine › Pharmacology (medical) › Pharmacology and Obesity Treatment
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Keywords
- antipsychotic drugs, weight gain, body mass index, antipsychotic switching, amisulpride, aripiprazole, ziprasidone, antipsychotic-naive patients, weight loss
- MeSH terms
- Bipolar Disorder, Humans, Schizophrenia, Antipsychotic Agents, Weight Gain, Body Mass Index, Overweight
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