Antipsychotic Tx Linked to Adiposity Changes in Youths

Greatest increase in fat with olanzapine; significant decrease in insulin sensitivity in pooled analysis.
Greatest increase in fat with olanzapine; significant decrease in insulin sensitivity in pooled analysis.

HealthDay News — Youth receiving antipsychotic treatment have adverse changes in adiposity and insulin sensitivity, with the greatest fat increases seen with olanzapine, according to a study published online June 13 in JAMA Psychiatry.

Ginger E. Nicol, MD, from the Washington University School of Medicine in St. Louis, and colleagues recruited antipsychotic-naive youths aged 6 to 18 years who were diagnosed with 1 or more psychiatric disorders and clinically significant aggression and in whom antipsychotic treatment was considered. Participants were randomized to 1 of 3 antipsychotics commonly used in children with disruptive behavioral disorders -- oral aripiprazole (49 patients), olanzapine (46 patients), or risperidone (49 patients) -- and were evaluated for 12 weeks. 

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Overall, 29.9% of participants were overweight or obese at baseline. The researchers found that from baseline to week 12, the dual-energy X-ray absorptiometry percentage total body fat increased by 1.18, 4.12, and 1.66% for risperidone, olanzapine, and aripiprazole, respectively, and was significantly greater for olanzapine than risperidone or aripiprazole. Insulin-stimulated change in glucose rate of disappearance increased by 2.3% for risperidone from baseline to week 12 and decreased by 29.34 and 30.26% for olanzapine and aripiprazole, respectively; the difference across medications was not significant. In the pooled study sample, there was a significant decrease in the primary measure of insulin sensitivity during 12 weeks.

"The results inform risk-benefit considerations for antipsychotic use in youths," the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

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