Antipsychotics, weight gain, and beautiful minds

My very first experience in mental health was with a young man with schizophrenia who was also diabetic. It was very challenging to help him with his diet, because he was pretty obsessed with telling me how he'd been recruited away from his professional football career to invent the atomic bomb, and that he'd recently invented the Toyota Corolla. I remember thinking, even as a young intern, that it was sad that someone with so much creative energy was sitting in a locked psychiatric unit instead of focusing his mind in a productive direction.

It turns out, schizophrenia and diabetes are a very common combination. No one really knows why, but my guess is that with time, we'll learn that there is some kind of genetic link between the two problems. What makes this relationship especially important to understand, is that there are medications for schizophrenia that can exacerbate the diabetes, as well as other metabolic syndrome-related problems such as increased triglycerides.

A recent study showed that while rates of metabolic syndrome increased over time in patients prescribed antipsychotics, regardless of the specific type of medication, that the risk of developing metabolic syndrome was three times greater in those individuals using second generation antipsychotics. These people also experienced a greater degree of weight gain. The two medications that appeared to be the most problematic were olanzapine (Zyprexa) and clozapine (Clozaril).

The good news is, that there is also research supporting the fact that behavioral and nutrition "training" with individuals who are on these medications can help to lessen the degree of the negative side effects. I have worked with individuals who have not been able to manage their schizophrenia without using one of these two medications, so I understand their value and necessity for the well-being, productivity, and SAFETY of many people who use them. I just wish that every physician who prescribed them also automatically referred their patient to a nutrition professional who could maximize the benefit of the medication while minimizing the risks these medications pose. And I wish that insurance companies would recognize the importance of utilizing this kind of professional help in mental health, so that reimbursement was available. That would encourage many of these people to actually seek help before problems even started.

Sometimes we assume that when a person has a diagnosis such as schizophrenia, or bipolar disorder, that they aren't a candidate for certain types of services. I've not experienced that at all. In fact, some of my most motivated clients have been individuals with these diagnoses. I love my time with them because they are often highly intelligent and creative. They just need people in their lives who take them seriously, who assume that they're intelligent and treat them as such, and who are willing to show them the ropes as far as being healthy.

I think, if I went through my life being treated as if I was not intelligent, that I'd start to believe it myself. Maybe someday, we won't be so afraid of diagnoses such as schizophrenia, and we'll be as comfortable interacting with people who have mental diagnoses as we are with people who have diabetes or high cholesterol.

Imagine how many potential Vincent Van Goghs and John Forbes Nash Jrs. (A Beautiful Mind) are out there just waiting for us to help them access their potential?

De Hert M, Schreurs V, Sweers K, Van Eyck D, Hanssens L, Sinko S, Wampers M, Scheen A, Peuskens J, van Winkel R. Typical and atypical antipsychotics differentially affect long-term incidence rates of the metabolic syndrome in first-episode patients with schizophrenia: A retrospective chart review. Schizophr Res. 2008 Feb 23 [Epub ahead of print]

Kalarchian MA, Marcus MD, Levine MD, Haas GL, Greeno CG, Weissfeld LA, Qin L. Behavioral treatment of obesity in patients taking antipsychotic medications. J Clin Psychiatry 2005 Aug;66(8):1058-63.

Wu MK, Wang CK, Bai YM, Huang CY, Lee SD. Outcomes of obese, clozapine-treated inpatients with schizophrenia placed on a six-month diet and physical activity program. Psychiatr Serv 2007 Apr;58(4):544-50.

Scocco P, Longo R, Caon F. Weight change in treatment with olanzapine and a psychoeducational approach. Eat Behav 2006 May;7(2):115-24.

Kwon JS, Choi JS, Bahk WM, Yoon Kim C, Hyung Kim C, Chul ShinY, Park BJ, Geun Oh C. Weight management program for treatment-emergent weight gain in olanzapine-treated patients with schizophrenia or schizoaffective disorder: A 12-week randomized controlled clinical trial. J Clin Psychiatry 2006 Apr;67(4):547-53.

Alvarez Jimenez M, Gonzalez Glanch C, Vazquez Barquero JL, Perez Iglesias R, Matinez Garcia O, Perez Pardal T, Ramirez Bonilla ML, Crespo Facorro B. Attenuation of antipsychotic-induced weight gain with early behavioral intervention in drug-naive first-episode psychosis patients: A randomized controlled trial. J Clin Psychiatry 2006 Aug;67(8):1253-60.

Mauri M, Simoncini M, Castrogiovanni S, Iovieno N, Cecconi D, Dell'agnello G, Quadrigli M, Rossi A, Donda P, Fagiolini A, Cassano GB. A Psychoeducational Program for Weight Loss in Patients who have Experienced Weight Gain during Antipsychotic Treatment with Olanzapine. Pharmacopsychiatry. 2008 Jan;41(1):17-23.