Antipsychotic Weight Gain May Be Avoidable
> 1/17/2008 12:45:37 PM

One of the most unfortunate side effects of the atypical antipsychotic medications so crucial to many schizophrenic and bipolar patients is dramatic weight gain. Patients have been known to add more than 100 pounds to their frames in a matter of months due to these drugs' tendencies to compromise the body's capacity for glucose metabolism and appetite suppression. Beyond the social stigmas and compromised self-worth common to obesity, diabetes and cardiovascular complications are distressingly widespread among chronic victims of psychoses who, because they're unable to function effectively without their medications, have very few medical alternatives. Encouraging new research, however, indicates that these patients can counteract some of the physical extremes prompted by antipsychotics with a combination of mild exercise routines and (possibly) diabetes drugs.

Atypical antipsychotics like Zyprexa and Risperdol alter basic body functions in dramatic ways, and they've long been known to both stimulate unregulated appetites and upset metabolic rates. Histamine, a protein primarily involved in regulating allergic reactions, has very recently been linked to these physiological changes;  many of the drugs in question suppress its release while increasing the presence of appetite enzyme AMPK. The internal reactions create insatiable consumptive urges and interfere with the body's ability to process the simple carbohydrate glucose. The latter quality defines diabetes, and a large portion of the antipsychotic patient population will eventually develop that disease.

In response, researchers subjected study patients to the most obvious solution: regular exercise. Approximately one-half of a group of overweight patients who'd been taking antipsychotics for an average of 3 years participated in a dietary seminar and supervised exercise program, and the time committments required by the plan were minimal - 2 hour-long workout sessions each week. The programs were not especially intense. They involved mild cardiovascular and strength training exercises, but their benefits stretched far beyond the thinner waistlines brought about by 4% decreases (on average) in body mass: levels of good and bad cholesterol respectively increased by 21% and decreased by 14%. Levels of triglycerides (the body's most common form of fat) went down by a significant 26%. When considering such resoundingly successful numbers, one can only imagine the health gains that could be possible if patients devoted only a slightly larger percentage of their personal time to some form of moderate physical activity.

Independent studies have also considered the use of complimentary medications in the weight loss program: metformin, a drug designed for type 2 diabetes, works to balance quantities of sugar in the blood; it's one of the most commonly prescribed pharmaceuticals in the world. It's also been known to prevent weight gain via the same glucose-regulator mechanism. A Chinese study of more than 100 medicated schizophrenics plagued by unhealthy BMIs found that, surprisingly, the drug alone proved more effective than exercise-based lifestyle interventions in prompting weight loss; metformin subjects lost an average of 7 pounds over the study's first 12 weeks while those assigned to placebo and interventions (consisting of the American Heart Association's step 2 diet and 30 minutes of moderately intense physical activity each day) lost only 3. The most effective treatment method, of course, was a combination of the two, under which subjects lost approximately 10 pounds. Unfortunately, because its drug interactions remain somewhat uncertain, metformin has not been approved for such uses, and further studies focusing on the relationship between metformin and various antipsychotics must take place before this study's findings come to bear upon schizophrenic patients worldwide.

Many patients suffering from some of the more severe and debiltating mental illnesses try, at some point, to brave their conditions without medication. This decision almost always proves misguided and may be fatal. Unfortunately, weight gain is a near-universal side effect. But patients must be reminded that they are not without options in combating that trend, because even very moderate exercise plans can go a long way toward balancing one's physical (and, subsequently, emotional) health. These lifestyle changes often prove even more challenging for those affected, but their importance cannot be overemphasized. And, with time, alternative medications may be available to compliment the process.

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