Risk factors and pattern of weight gain in youths using antipsychotic drugs

Antipsychotic-induced weight gain is a major health concern in children and adolescents. The aim of this study was to identify risk factors for weight gain during short-, middle- and long-term treatment with antipsychotic drugs in this young population. We analysed a combined prospective and a retrospective observational cohort of Dutch children and adolescents, starting with risperidone, aripiprazole or pipamperone treatment. Linear mixed models were used to test whether sex, age, baseline body-mass-index (BMI)zscore, type of antipsychotic, dose equivalent/kg, duration of use, previous antipsychotic use, ethnicity, physical exercise, IQ, concomitant medication, and psychiatric classification predicted the BMIzscore for a follow-up of < 15 weeks, 15-52 weeks or > 52 weeks. A total of 144 patients were included with a median [interquartile range ([IQR)] age of 9 (4) years and median follow-up of 30 (73) weeks. During the complete follow-up, the median (IQR) weight gain was 0.37 (0.95) BMIzscore points. Antipsychotic-induced weight gain was found to be most pronounced during the first 15 weeks of use (BMIzscore increase per week beta = 0.02, 95% CI 0.01-0.03,p = 0.002). A higher baseline BMIzscore and the absence of stimulant use were associated with a higher BMIzscore during the entire follow-up and after 15 weeks, respectively. Previous treatment with an antipsychotic drug was associated with less weight gain during the first 15 weeks of treatment. Our findings underscore the importance of close patient monitoring during the first weeks of antipsychotic treatment with a focus on patients with a high baseline BMIzscore.

Automated summary

This study aimed to identify risk factors for weight gain during short-, middle- and long-term treatment with antipsychotic drugs in children and adolescents. The results indicated that antipsychotic-induced weight gain was most pronounced during the first 15 weeks of use, with higher baseline BMIzscore and absence of stimulant use associated with higher BMIzscore during the entire follow-up and after 15 weeks, respectively. Previous treatment with an antipsychotic drug was also found to be associated with less weight gain during the first 15 weeks of treatment.