Introduction
This article, written primarily for people with mental health problems and their carers, is about weight gain with antipsychotic medication. Antipsychotics are a group of drugs that are mainly used to treat schizophrenia and manic episodes in bipolar disorder. In both conditions, they are effective in treating symptoms and reducing the risk of a person becoming unwell again (i.e. having a relapse). Some antipsychotics are helpful in other mental health disorders. Unfortunately, antipsychotics can cause side effects. One of the most common and serious is weight gain. People with schizophrenia are twice as likely to be obese than people in the general population.[1] Antipsychotic medication contributes to this. Other causes of overweight include physical inactivity, an unhealthy diet, other medications and the effect of some symptoms of mental illness. For example, depressed mood and lack of drive can make a person less active and contribute to weight gain. Overweight increases the risk of having a heart attack and stroke and developing many physical illnesses including high blood pressure, type 2 diabetes, sleep apnoea, osteoarthritis and some cancers. In general, the more overweight a person is, the greater their risk of developing these problems. Overweight is associated with reduced self-esteem, reduced quality of life and stigma. People taking antipsychotics regard weight gain as one of the most distressing side effects caused by their medication.
Risk of weight gain with different antipsychotics
The fastest weight gain occurs in the first 6 months after starting an antipsychotic. Weight gain can continue after this but more slowly. There is no clear relationship between weight gain and antipsychotic dose, at least within the ranges usually used to treat mental health problems.2 Antipsychotics differ in their risk of causing weight gain, and other side effects, but do not differ in their effectiveness in treating symptoms of schizophrenia or mania. The one exception is clozapine which is more effective than other antipsychotics in treatment resistant schizophrenia. This is a form of schizophrenia in which psychotic symptoms (e.g. hearing voices) have not responded to treatment with at least two different antipsychotics.
The table shows the risk of weight gain with different antipsychotics. However, weight change can differ greatly from person to person. With any antipsychotic, some people may gain a lot of weight, some a moderate amount and some may not gain any weight or actually lose some weight. Greater weight gain during the first month of antipsychotic treatment tends to predict greater weight gain in the longer term. Antipsychotics can increase glucose (sugar) and lipid (fat) levels in the blood. The drugs that do this the most tend to be the same ones that cause the most weight gain.
| Antipsychotic | Risk of weight gain |
| Olanzapine | High |
| Clozapine | High |
| Chlorpromazine | High/medium |
| Quetiapine | Medium |
| Risperidone | Medium |
| Paliperidone | Medium |
| Asenapine | Low |
| Amisulpride | Low |
| Aripiprazole | Low |
| Lurasidone | Low |
| Ziprasidone | Low |
| Haloperidol | Low |
Starting antipsychotics for the first time
A person starting antipsychotic medication for the first time is likely to gain more weight than someone starting the same medication who has previously taken other antipsychotics. This is because weight will often have been put on with earlier antipsychotic treatment. In a study of people early in the course of schizophrenia, who received treatment for up to one year, approximately eight out of ten people prescribed olanzapine developed significant weight gain (defined as an increase of 7% or more of their starting weight).[3] This compared to about five or six out of ten people who gained significant weight when treated with quetiapine or risperidone. In a different study of people who had previously received long-term antipsychotics, and were followed for 18 months, significant weight gain (more than 7% of starting weight) occurred in one third of people who started olanzapine with rates about half of this for those starting quetiapine or risperidone.[4] Comparing the two studies shows that weight gain is more likely in people earlier on in their illness. This corresponds to people being treated by early intervention teams in the UK.
How antipsychotics cause weight gain
Weight gain is the result of taking in more energy (calories) from food and drink than are used up through the body’s resting metabolism plus activity and exercise. The extra energy or calories are stored as body fat. Many factors can affect this energy balance and lead to weight gain. The main way that antipsychotics cause weight gain is by stimulating appetite so that people feel hungry, eat more food and take in more calories. Some people taking antipsychotics report craving sweet or fatty food.
The regulation of appetite and food intake is extremely complex and is controlled by part of the brain called the hypothalamus. The hypothalamus integrates information it receives from other part of the brain and from hormones released from outside of the brain including fat (adipose) tissue and the gut. These hormones include leptin and ghrelin but there are many others. Exactly how this complex system works and how antipsychotics disrupt it are not fully understood. Neurotransmitter receptors in the brain seem to play a part, with evidence implicating the serotonin 5-HT2C and 5-HT1A receptors, histamine H1 receptor and dopamine D2 receptor among others. Antipsychotics differ in their ability to block these receptors and this partly explains their different liability to cause weight gain. Both olanzapine and clozapine, drugs with a high risk of weight gain, bind strongly to the histamine H1 and serotonin 5-HT2C receptors.
The pharmacology of antipsychotics is not the only factor that determines their effect on weight. As already mentioned, if a group of people take the same antipsychotic there will be differences between them in their subsequent weight change. This reflects differences between people in their diet, level of activity and genetic makeup. Variations (polymorphisms) in a large number of genes, including the gene that codes for the 5-HT2C receptor, have been linked to susceptibility to gain weight with antipsychotics. It is the combined effect of these genes, rather that variation in a single gene, that is relevant to weight gain. Currently doctors and patients choose drugs partly based on their ‘average’ effects seen in clinical trials, for example the risk of weight gain as summarised in the table. In the future, it may be possible to conduct a simple blood test (i.e. a genetic screen) to identify a person’s likelihood to gain weight, and to develop other side effects, when treated with different drugs, so called personalised medicine. This could help people choose the best drug for their treatment. However, such a test is not currently available.
Managing weight gain with antipsychotics
Decisions on choosing medication and managing weight, as with other areas of treatment, should be made jointly by a patient and their doctor. The main approaches to managing weight with antipsychotics are:
- Ensure that the risk of weight gain, and other side effects, are considered when choosing an antipsychotic. Wherever possible use drugs with a lower risk of weight gain.
- Monitor weight and Body Mass Index (BMI) during antipsychotic treatment. More regular measurements are needed in the first few months of treatment as this is when the risk of weight gain is highest.
- Use lifestyle approaches to manage weight gain. These include increased physical activity, exercise and changes to diet and eating behaviours, for example eating regular meals, having smaller portions and cutting down on foods and drinks rich in sugar and fat.
- If weight gain with an antipsychotic is problematic, consider switching to an antipsychotic with a lower risk of weight gain. Depending on the drugs involved, this can lead to weight loss. The risks of switching include the new medication causing side effects and being less effective for that person, leading to a relapse of their psychiatric disorder.
Other approaches can sometimes help manage weight gain including adding certain medications to antipsychotics. These approaches are reviewed in a recent BAP Guideline that also considers the broader issue of reducing the risk of cardiovascular disease (i.e. heart disease and stroke) in people with psychosis.2
Some people may consider stopping antipsychotic treatment due to weight gain. The issue of how long to continue antipsychotic treatment is complex. Space only allows some basic comments to be made here. Excess weight caused by an antipsychotic will usually be lost gradually after medication is stopped. Weight put on for other reasons is likely to remain. The downside of stopping antipsychotics is an increased risk of becoming unwell, especially for people with schizophrenia and bipolar disorder. Sometimes relapse occurs suddenly with serious repercussions. A person should never stop their antipsychotic, or alter the dose, without discussing this first with their psychiatrist. Together, the patient and doctor should carefully consider the advantages and disadvantages of continuing medication, stopping medication and other options for managing mental health, weight gain and other side effects. These will differ from person to person and reflect their medical history and current circumstances. The discussion should lead to a jointly agreed management plan that is tailored to the individual. For some people stopping medication is a realistic option but for others it is inappropriate. If a decision is made to stop antipsychotic treatment, then the dose should be reduced gradually. Medication should not be stopped suddenly. A healthcare professional should monitor the person for signs and symptoms of relapse while the dose is reduced and after it is stopped. For people with schizophrenia or psychosis, monitoring is recommended for at least two years after antipsychotics are stopped.[5]
Recent and ongoing research
A great deal of research is trying to improve outcomes for people with mental health problems. This includes developing more effective medications with a lower risk of weight gain and other side effects. Lifestyle modification programmes have a modest benefit in reducing weight gain in people starting antipsychotics and helping those established on antipsychotics to lose weight.[6] An additional advantage is that these programmes can reduce lipid (fat) and glucose (sugar) levels in the blood. These interventions can be given to individuals or to groups or both approaches can be combined. A recent example of a group intervention is the STRIDE study in the United States.[7] In STRIDE, people who were overweight, had a serious psychiatric illness and were taking an antipsychotic were randomised to weekly two-hour group meetings for six months or to normal care alone i.e. a control group. Participants were encouraged to eat a healthier diet and spend at least 25 minutes per day doing moderate activity. At six months, 40% of participants (compared with 17% of controls) had lost at least 5% of their initial body weight and 18% of participants (compared to 5% of controls) had lost at least 10% of their initial weight. It is generally accepted that for people who are overweight, losing 5% to 10% of total weight has health benefits[8], though greater weight loss is more beneficial. The intervention in STRIDE was also effective in reducing weight and lowering blood sugar levels at 1 year i.e. after an additional 6-month follow-up period. The STEPWISE study is currently assessing the effectiveness of a group programme to reduce weight in people with psychosis taking antipsychotics across ten mental health NHS trusts in England.[9]
If psychosis, at least in some people, could be treated by giving antipsychotics for shorter periods than is current practice then it would reduce weight gain and other medication side effects. The RADAR trial is an ongoing randomised trial in the UK that compares a gradual and supported programme of antipsychotic reduction to maintenance antipsychotic treatment (i.e. staying on the current antipsychotic dose).[10] Within the dose reduction group, it is envisaged that some people will eventually stop medication whereas others will stabilize on a lower dose. The main outcomes in the RADAR trial are social functioning and relapse.
There is strong evidence that adding cognitive behaviour treatment (CBT), a ‘talking treatment’, to antipsychotic medication reduces symptoms of schizophrenia further and decreases the likelihood of rehospitalisation.5 Researchers have started investigating CBT as an alternative to antipsychotic medication to treat psychosis. This approach has the advantage of avoiding antipsychotic side effects altogether. This work is at an early stage and at the time of writing its effectiveness is not known, though initial results are promising.[11] CBT without antipsychotic medication, if proven to be effective, would not be suitable for everyone with psychosis. Nevertheless, it would widen treatment choice for some people and represent a major step forward in treating psychosis.
Summary
Antipsychotics are effective in treating schizophrenia and mania but can cause a range of side effects. Weight gain is a common and serious side effect, especially due to its impact on physical health. Various interventions can help and a psychiatrist will be able to offer advice on these. Many people taking antipsychotics can lose some weight with simple changes to their diet and lifestyle. Losing even a small amount of weight can have important health benefits. Ongoing research is attempting to find ways to better manage or ideally avoid this problem.
Further information
Body Mass Index: The best way to determine whether weight is ‘normal’, or should be regarded as overweight and unhealthy, is to calculate the Body Mass Index (BMI) using a person’s height and weight. An NHS online BMI calculator is available at: www.nhs.uk/Tools/Pages/Healthyweightcalculator.aspx
The BAP Guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment are available at: www.bap.org.uk/pdfs/BAP_Guidelines-Metabolic.pdf
An article reviewing these Guidelines is available at: www.bap.org.uk/articles/bap-guidelines-metabolic/
References
[1] De Hert M et al (2009). Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry 24(6):412-24.
[2] Cooper SJ et al (2016). BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. J Psychopharmacol 30(8):717-48.
[3] McEvoy JP et al (2007). Efficacy and tolerability of olanzapine, quetiapine, and risperidone in the treatment of early psychosis: a randomized, double-blind 52-week comparison. Am J Psychiatry 164(7):1050-60.
[4] Lieberman JA et al (2005). Effectiveness of Antipsychotic Drugs in Patients with Chronic Schizophrenia. N Engl J Med 353:1209-1223
[5] National Institute of Health and Care Excellence (NICE) (2014). Clinical guideline [CG178] Psychosis and schizophrenia in adults: Treatment and management [CG178]. Last updated: March 2014.
[6] Bruins J et al (2014). The Effects of Lifestyle Interventions on (Long-Term) Weight Management, Cardiometabolic Risk and Depressive Symptoms in People with Psychotic Disorders: A Meta-Analysis. PLoS One 9(12): e112276.
[7] Green CA et al (2015). The STRIDE weight loss and lifestyle intervention for individuals taking antipsychotic medications: a randomized trial. Am J Psychiatry 172(1):71-81.
[8] Wing RR et al (2011). Benefits of Modest Weight Loss in Improving Cardiovascular Risk Factors in Overweight and Obese Individuals with Type 2 Diabetes. Diabetes Care 34(7): 1481–1486.
[9] Gossage-Worrall R et al (2016). STEPWISE – STructured lifestyle Education for People WIth SchizophrEnia: a study protocol for a randomised controlled trial. Trials 17:475
[10] Registration information for the RADAR trial is available here
[11] Morrison AP et al (2014). Cognitive therapy for people with schizophrenia spectrum disorders not taking antipsychotic drugs: a single-blind randomised controlled trial. The Lancet 383(9926), 1395-1403.
My Sons weight more than doubled in the 5 years that he took Clozapine. He recently passed away and complications of obesity is noted on his death certificate. So much more work is needed in the control of weight gain in these poor souls who are already suffering enough
I’m very sorry to hear about your son. Clozapine can sometimes help when standard antipsychotic medications haven’t worked, particularly in treating distressing psychotic symptoms. It’s very unfortunate that clozapine can also cause serious side effects. I agree with you that more work is needed to manage weight gain associated with antipsychotics. The recent ‘BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment’ are one endeavour to help with this.
I am a Special Olympic ski coach and one of my dear athletes is extremely overweight from his anti-psychotic drugs. He was recently told he could not stop his meds. I fear for him. I know his lifestyle is unhealthy too and was wondering if we just got him out walking a few times a week would help. Don’t want to overstep any bounds here but I just need to do something.
Walking can help to lose weight. If you increase your physical activity you will burn more calories. If you burn off more calories than you consume through food and drink, then you will lose weight. Increased activity can be achieved in many ways, for example walking, using stairs in preference to taking a lift, taking part in sport or exercising at home or in a gym. The more intense your activity or exercise, and the longer it lasts for, then the more calories that are burnt. Of course, it’s important not to overdo things and activity levels should be built up gradually. Some people can’t take part in vigorous exercise and walking can be ideal for them. Walking is relatively easy to do. Many people find a walk relaxing and if done with others it can be sociable. Regular walking can have other health benefits including lowering blood pressure and reducing your risk of heart disease. Increased activity is more effective in helping to lose weight if it is combined with changes to diet i.e. consuming less calories.
The weight gain from these medications is more detrimental than the illness (Bipolar II) I personally suffer from initially. The weight gain, irregular heart beat, increased blood pressure, sedation and god knows what else what other told they have taken on my body, they are just a horrific group of drugs that I wish the doctors prescribing them would take for a month just to suffer them so they wouldn’t just push them so freely onto people who are already at the depths of dispair!
As you highlight both psychiatric illness and the side effects of antipsychotic medication can cause great distress. Good psychiatric care aims to ensure that people receive effective treatment, experience as few side effects as possible and are fully involved in decisions about their care.
Shared decision-making by doctors and patients is recommended when choosing treatments. This means that the patient and their doctor discuss the range of treatments available. The doctor’s expert knowledge of each treatment, including its pros and cons, is brought to the table. The patient brings their experience of their illness, including symptoms they want to be treated and particular side effects they wish to avoid. A joint decision on what treatment to use can then be made. This allows treatment to be tailored to the individual. Patients are usually more satisfied when decisions are made in this way.
As antipsychotics vary in their side effects it is usually possible to reduce side effects by choosing medication carefully. Unfortunately, side effects can still occur. When this happens, the doctor and patient need to carefully consider what to do next. This will depend on how they view the trade-off between the advantages and side effects of the current medication. It may be that the antipsychotic has had clear benefits, for example in reducing or eliminating symptoms of illness and allowing the person to manage better in their everyday life. They also need to consider how the current medication fares again any earlier medications that were used and medications and treatment approaches that have not yet been tried. If the person is well and contemplating stopping medication totally, then the risk of a recurrence of illness needs to be assessed; this will partly depend on the frequency and severity of any previous episodes of illness. When all this information is available, the patient and their doctor can consider the options and make a joint decision about what to do next.
In some cases, it may be decided that a side effect is worth accepting given the benefits of the medication. In other cases, it may be clear that the side effect is intolerable and that the medication needs to be altered. Many side effects lessen when the dose of an antipsychotic is lowered but weight gain is an exception; the degree of weight gain is usually unrelated to the dose of an antipsychotic. Some side effects can be reduced by changing the time at which the medication is taken. For example, sedation may be less troublesome when medication is taken at bedtime rather than in the morning. Some side effects can be lessened by taking another medication to deal with them. Sometimes the best option to manage an antipsychotic side effect is to change to a different medication with a lower risk of causing that side effect. If the person has schizophrenia or psychosis then one will need to switch to a different antipsychotic. If the person has bipolar disorder then it may be possible to switch the antipsychotic to a different type of medication, for example lithium. This will depend on the person’s individual circumstances and medical history.
A person should never stop or reduce the dose of their antipsychotic medication without discussing and agreeing this first with their psychiatrist. Stopping antipsychotics and reducing their dose are both associated with an increased risk of relapse i.e. a return or worsening of the underlying psychiatric illness. A period of close monitoring by a psychiatrist, or other mental health care professional, is needed whenever an antipsychotic is reduced in dose, switched or stopped. This is to ensure that the person remains well and that support and help are promptly available should there be any problems, including side effects or early warning signs of relapse.
Yeah it’s strange…
I’m anorexic and severely depressed and suicidal with bpd and was taking olanzapine for ages!! I somehow managed to get down to 5 stone 6 but was told when hospitalised and force fed (WORST NIGHTMARE may I say!!) The phsychiatrist changed me onto quatiapine because of weight gain (THANK YOU!!)
But now I realise quatiapine causes weight gain too
Anti phsychotics are CRAZY!!
Have stopped taking them though due to me refusing my DAM Ng tube and have been in tears for over 24 hours… Not sleeping. Voices in my head….
May I say though that this doesn’t matter as I didn’t find that quatiapine was ACTUALLY working anyway…
Hi Megan I hope you have remedied your problem although sadly I doubt it anti psychotic are terrible. I have bpd my psyche put me on quetiapine massive weight gain then my doctor put every problem I had down to being over weight but that was out of my hands due to the anti psychotic. I stopped taking my meds n now I’m in a real bad place I wish they would get to grips with this weight gain problem. Take care Megan x
Like what you wrote.
I am struggling on arirprizole, and my mood swings have not got better on it. They tend to be connected to my menstrual cycle. I am hungry all of the time and it makes me tearful. Despite not eating more on the medication, and going to the gym, swimming, eating healthily, I still have a great deal of fat on my body and people are telling me I look ‘well’, which is the usual euphemism for ‘a bit fat’. It is horrible. I want to do my job as an actor and I have lots of additional body fat that gets in my way when I am exercising.
A very helpful article. I personally suffer from psychotic depressive episodes, for which I am prescribed a low dose of olanzapine. As you can see it is at the top of the weight gain list and I have put on about 4 or 5 stone over the 4 years I’ve been taking it. When I most recently stopped taking it, after a long period of stability, I became severely delusional about a month later, resulting in a hospital admission. So, I have concluded that I need to be on antipsychotic medication to keep sane. However, 3 months before the admission, I was using ketamine and magic mushrooms. So the recreational drugs may have had more of an impact than the lack of medication. Anyway, I am keen to lose weight so if anybody can offer advice on going drug free, switching drugs, or simply dieting and hitting the gym, that would be great.
I do intermittent fasting.
Hay did you know that ketimine is now an anti depressant for when no others work…
I was on it for AGES privately until I stopped both eating and drinking.
They decided that it wasn’t working because of this so stopped me taking it…
I’m now in hospital though due to anorexia and have been for the past 8 months… (Hell hole!!)
I have been on Divalproax for 3 yrs.I feel like a vegetable. Lathargic,loss of interest in everything, never happy,extreme weight gain.It’s easy for someone to tell patients to join a gym but how do we get there if we don’t have the energy to get out of a chair? Memory loss! What can I do ? I want to feel normal again. What started this was my addiction to alcohol.I havent had a drink in 3 yrs.anychance suggetions
Divalproex is that Epival? I’m on that to and have been for 5 years now I’m always tired always loosing things and I also can’t even leave my house my eyes have went from only wearing glasses to constant wear now I am truly sorry u feel the same as me I just went on seriquel 3 months ago and I gained 37 pounds I cry daily from it now starting tomorrow I’m off it again I had the choice of removing that or the divalproex obviously it was the seriquel that did it lol but in saying that I feel u I use to drink 5 days a week now I havnt drank in almost a year If I could turn back time I would have never went on divalproex in my life om currently on 775mgs and my wish is that someday I will be able to get the hell off it!!! I’ve tried and had severe mental break downs even if my Dr switches 1 around I feel it so my prayers are with u and I hope u can find something that helps other then this garbage med ❤️❤️❤️❤️❤️❤️❤️
Good for staying of drink maybe now ur meds can b reduced c ur doc being tired all the time might mean ur meds r too strong
I have serious weight gain from quetiapine. I went from fit and slim 14.5 stone to 20.5 stones in about 5 months when I switched to the quetiapine. I find the biggest problem is carbohydrates. If I don’t eat them my huge belly swelling reduces quickly. Not the weight as a lot of it is muscle as well. I do find that cutting down on food in take works abut but I get very sore stomach that kicks in at about 4 am. I feel very shaky and this doesn’t go away until I get up and eat a really good breakfast. Even then it’s the same the next night and the next and my anxiety starts kicking in. I feel there is direct link between carbohydrates and quetiapine. If I remove the carbohydrates the swelling around my abdomen reduce dramatically but I start to feel down and everything is ok until that happens.
The passive abdomen swelling is the biggest pain as I lose the weight the pain starts and vice versa. I eat very healthy and don’t touch sugary food or alcohol pretty much accept once a week.
I once read that to go on a low carb diet in very bad while on quetiapine as it undermines the effectiveness of the medication. It’s like the quetiapine needs the carbohydrates to work and I feel that’s pretty much bang on.
I don’t know if this is well understood but might bandage the prescription of these medicines if that link was better understood. It’s a shame because it stops people making choices and informed decisions if these relationship are not accepted.
I’ve taken these meds for 20 years and have monitored exactly how I felt during this period. Every time I try to discuss this with my doctors I get the same answer . Don’t stop taking them. That’s why I don’t think they understand what is going on chemically with these meds and default to the same response.
That’s ok until I finally get something nasty like diabetes or some other horrible condition. I normally do quite a lot of hard training and need food to keep me feeling fit and strong but the weight and the huge belly bloating just doesn’t go away until I remove the carbohydrates.
I keep trying to lose the belly but it goes back to huge when I eat carbohydrates. There is the cycle. It’s bloody hard to take when before I took quetiapine I was pretty slim and had great difficulty actually putting weight on.
A happy medium is what’s required. Either I take less meds or I find a way to stop the pain and be able to eat less carbs without upsetting the mental health balance.
Any chance someone has good advice around this area.
Nice to know someone else gains weight on quatiapine…
Okay I don’t actually know if it does as I am being force fed with an Ng tube and on feed but am ANGRY to find out it does…
Typical…
[…] has been linked to treatment using certain commonly-used atypical anti-psychotics – read more here). These side effects can lead to fairly significant impairment in daily functioning but without the […]
When medicines are prescribed surely it makes sense to understand the implications for that person so far as is possible. Including their physiology. I don’t think they know enough about these medicines. The only person who knows is the patient. I think they use hammers instead of nut crackers.
Ofen,patent&carer views re antipsychotics. ignored, regardless of damage to patient’s health &life. This is especially difficult if on depot injections.
Hello, what an interesting and informative article. I was diagnosed with Recurrent Psychotic Depression in 2013. I have been hospitalised 4 times since then. I gained a huge amount of weight on Orlanzapine, the only medication that stops the psychosis. I currently take: Quetiapine (now I’m stable), Mirtazapine and Venlafaxine. My appetite is horrendous. It’s an overwhelming feeling of hunger, that doesn’t ever feel satisfied. However, I joined Slimming World January 2018 and have lost 6. 5 stone to date (19/2/19). It’s not been easy, far from it, particularly at night but I keep telling myself “I’m not hungry, I’ve eaten”. But the sensation of feeling constantly hungry is draining, I would say the feeling of hunger comes from between the breastbone, not the stomach itself. quite apart from my mental health issues difficulties. But, if I wasn’t taking these medications there’s no doubt I wouldn’t be writing this now. I quite simply would be dead, no doubt about it. My above diagnosis isn’t even documented on Mind mental health charity website so what hope have I got. I’d like to hear anyone else’s thoughts, about this sentsation of overwhelming hunger.
Yep…
I binged for AGES!!
However mirtazapine does cause weight gain and increased appetite…
After that I refused to take it…
You are getting getting a double dose of hunger driven meds in mirtazapine and quietapine. Ask doc to at least switch the mirtazapine if not both
I’ve tried around 7 of the above. Still looking for right one.
Still hear voices.
I reckon it’s the environment and circumstances, variables that come into play.
I’m a bboy. So I need to be light. Soccer and and ball.
Thanks for this site. With weight gain vs meds.
The weight gain from these medications is more detrimental than the illness (Bipolar II) I personally suffer from initially. The weight gain, irregular heartbeat, increased blood pressure, sedation and god knows what else what others told they have taken on my body, they are just a horrific group of drugs that I wish the doctors prescribing them would take for a month just to suffer them so they wouldn’t just push them so freely onto people who are already at the depths of despair! i like this blog.
On my day of hospitalization I was weighing 72kg (my highest weight until then) and I gained 12kg in three month with the treatment of olanzapine. I definitely felt food cravings but since I was in hospital my food rations were perfectly normal. The science behind this article must be wrong. Eating more and exercising less does not account for my weight gain. Olanzapine messes with your metabolism in other ways. Don’t blame the patient on eating too much.
Does anyone know what our daily calorie intake and fat intake is suppose to be while on these drugs to prevent weight gain???
I have been on risperdal 20 years and my weight is still going up. I was 130 now I’m 240. I lost a lot of years taking this and my stomach is getting bigger every day because I cannot stop eating lots of carbs! I’m a woman but I feel like dirt and if the eating problem doesn’t go away there is not much hope because I eat to the point that I get chest pains. I make plans to eat better but can’t follow through. I hope someone can relate with me. I was just put on rexulti instead of risperdal and do not know what to expect but the doctor said it won’t cause weight gain but I looked it up and it can! I’m just so disappointed.
Well I can agree with the people on Quetiapine about weight gain. Simply reducing the problem to calories in vs calories out is not the answer. There is more at play here. I used to ve very slim before the medication, I now eat a third of what I used to (now approx 800 calories per day) Tried excersise, going down to 600 calories per day. That just made me very weak. Yes, I’m always hungry but I don’t act on it at all. I’m investigating another way of looking into this problem. Various studies have shown that there are at least two types of gut bacteria that have a marked effect on weight gain. If missing, you put on weight thought I’m not yet sure how the mechanism works. Interesting enough, there has been a study on the effect of Quetiapine on gut bacteria. It kills exactly the gut bacteria that are missing in obese people. Now I wouldn’t presume to establish a causal link between the two but it is worth investigating. Maybe someone studying for a medical degree might want to take this up. FMT maybe?
Bang on Kevin it has nothing to do with calories In and out this drug just makes you gain massive weight no matter what you do and they really need to address this as a matter of urgency as our health is at stake here n as we all know obesity n the complications it causes r the biggest killer. You take care
It seems one has to starve in order to stop gaining weight. Im trying everything. My weight was 55kg and it doubled in a year on paliperidone. Doctors dont car. We are just guineypigs it seems.
I have been on quetiapine for nearly a year. I started a diet and weight training in the gym when I started taking it and have never been fitter. I’m a size 10 down from 16 pre medication and actually have a six pack. It’s not been easy but I think it was giving up sugar that made the difference.
hi Peter, thanks for sharing and explaining.
I am having a crisis at the moment. I’ve tried everything apart from weight loss surgery to lose weight I gained when out on anti psychotic meds like abilify 32kg! My dr presecribed me duromine 30mg and I’m currently on my 5th week with 1kg weight loss.. I’ve been eating 500-100 calories per day little coffee and alcohol and exercising 4-7 hours everyday! Mostly walking, gym machines, weights and resistance/toning bands. I really was hopeful and thought I had lost a lot of weight until I weighed myself and I got down and out. My blood tests came back normal and I have had plenty of energy and eating less but really why can’t I lose weight? I thought maybe muscle mass I’m gaining but wouldn’t that result in burning more fat and losing weight? my clothes are a little looser than before and I have less fluid but still my stomach is hard like a rock and bloated up like a pregnant lady I have no idea what that is from apart from before abilify and other meds that were forced onto me by TA I was able to lose weight easy and was a healthy bmi. I’ve tried fasting, supplements, cleanses, Akins/paleo, raw foods etc even recreational drugs and nothing has worked. I was given a cocktail of drugs when in hospital and injections of abilify from October 2018 until February 2019. No one at the hospital or Doctors have taken my claims seriously and lawyers have said as I was under a TA I couldn’t take this to court even though development of obesity. gained 15kg after stopped drug.
I’m currently on Olanzapine albeit a very low dose of 5mg. I’ve tried several anti-psychotics and this seems to be the best one for me. The worst thing I find is the weight gain. Since I’ve started taking anti-psychotics (about a year and a half ago) I’ve gained 9kgs. It’s difficult to keep the weight off and very easy to gain it.
I never used to suffer with weight gain until taking medication. There does seem to be a link between carbs and weight gain when taking anti-psychotics. If I eat carbohydrates my belly swells. If I cut out carbs I lose weight although this is very difficult to do as I feel tired and hungry. I’m in a bit of a crisis as to whether or not I should continue taking them or not.
I’m doing about 30 minutes of cardio a day at the moment and plan to increase to an hour a day. I’ve also just ordered some weights and plan to do 30 minutes of weights a day on top of the cardio. If I can’t see my abs in 12 months time after eating really healthy and exercising like this I’m going to stop taking Olanzapine.
I’m hoping that by living a healthy and active lifestyle I can receive the benefits of taking Olanzapine and have a nice body. Time will tell.
I am in the same situation as you, please message me to keep in contact. i already spent all money i can to get a personal trainer to exercise weekly. i went from 56kg to 70kg now with big belly when im only 1.6m tall.
Hi!! I understand you. I am taking Olanzapine 3 days ago. I know it’s too soon to take conclusions but im very concerned about the weight gain. Despite everything i’m heathly (my last blood test was great) and i dont want to lose it because mental health. there has to be a balance, too.
I will try harder (eat more heathly and do more exercise) and, obviously talk with my psychiatrist.
I’m sending you a big hug and luck!
(sorry for my english)
I take 75mg of Seroquel per night for severe insomnia. I generally walk at least 7-10 miles per day. I drink a celery smoothei with a cup or less of coconut water or juice each morning. For lunch I usually have random fresh vegetables and 1 or 2 slices of whole wheat bread. Often I skip lunch and have fresh veggies and rice, maybe a small amount of meat for dinner. It seems no matter how little or what I eat, my stomach becomes bloated and swollen very easily. I’ve always been able to gain or lose weight easily until I started Seroquel. Now it seems very difficult or nearly impossible to lose stomach fat. Sometimes even just drinking water makes my stomach bloated and hard. The sleep from Seroquel has been decent compared to various benzos and z meds I tried in the past. It’s a pity antipsychotics seem to cause such negative metabolic changes even at low doses.
I am bloated from taking antipsychotic med, does the bloat ever go away?
Very complete article about body weight
But members what should I do to gain weight am too slim and I don’t have appetite of eating.
I have alot of the same concerns about weight gain and anti-psychotic meds. My son just got out of the hospital due to relapse. He gained 23 lbs in 5 wks. His condition improved. But I know he is concerned over this large gain. Not sure of his BMI but I’m sure it is greater than 30%. He has been dealing with this more 5 yrs now. Not only does the condition break my heart, but the fact that the weight gain makes him sad. He has a family history of CVD and HTN. I agree that pharmaceutical companies need to work on finding meds that help with M issues, but doesn’t cause all of the side effects, especially weight gain as this effects one health also.
Im very fat. From 51 kilos im 75 kilos. All from antipsyhotic. I m on ariprizole and its nightmare. My body can do anymore from all the side effects. Please give me some addvice.
I have been taking quetiapine for the last 6 months i suffer from manic depression and schizophrenia I was addicted to meth for 8 years in that time never took my medication after doing detox and rehab I started the quetiapine I have always been skinny my hole life I use to be a personal fitness trainer before drugs my normal weight was 53-55kg I now weigh 60kg and I find it’s all in my stomach hips bum and thighs. I food prep all my dinners i do medium sized portions of chicken breast, mushrooms, capsicum, brussel sprouts and avocado but for breaky I will have two or three boiled eggs with a coffee dont really eat lunch I just eat lots of fruit and will have a can of tuna. quetiapine I feel makes you crave carbs and sugar I wake up at 4am and feel so hungry that my stomach hurts so I end up eating 4weetabix with alot of sugar if not that I binge out on carbs till I finally feel full if I dont have sugar the medication gives me the shakes bad. If you can be stupidly strict and have ridiculous self control then its possible to lose weight im actually starting to feel scared that I will put on alot more down the track because fighting that constant feeling of hunger is the most tormenting and hardest feeling. We cant just go to the gym and be on diets and expect to lose weight because we no were gonna binge out on the wrongs food and gain back all the weight then all our hard work is all for nothing.
I have been on anti psychotic drugs for over 10 years (brands have varied from Olanzapine and Risperidone to my current Amisulpride). I have always eaten very healthily and resist cravings for sweet foods (the Olanzapine – Risperidone period). Until I started taking anti- pshychotics, I was always very conscientious about healthy weight and fitness levels and had a small to middle ranged build. I am 5ft 4” (164cn) My body weight over this 10 year period has doubled, from 10 stone to 20 stone despite a calorie intake of 800 approx. per day and swimming 26 lengths of the swimming pool daily. The only advice I received from the psychiatrists was – ”yes it does SEEM like it is having an affect on your weight – try putting less in your plate”. It seems like a weight gain of 1st a month and at one stage 2 stone a month on Olanzapine is within ‘ normal acceptable range’ to a doctor or psychiatrist. To me this is hiorrendous. It has taken me 10 years and a doctor who actually listened to my worries seriously without casting me off with the usual scripted rubbish for the matter to be taken seriously. I have had tests with an endochronologist to see if there are any undermining health matters but all have come back clear. On Olanzapine and Risperidone, my cholesterol levels also went from 4 to 8, which I have reduced now through statins and diet and a change of drug to Amisulpride to a normal 3.4. There must be a reason why doctors will not acknowledge the weight gain at such a dangerous level is actually caused by anti-psychotics. I find mostly that eating any carbs, fats and sugar at all, even the smallest amounts, causes me major weight gain and adds to bloating and my ever destended belly which a heavily pregnant woman would be proud of. My flat stomach is now destended and over hanging. None of this is down to food and yet one of the solutions now being offered is bariatric surgery. I have enough will power to deny myself or resist food without needing an operation to reduce or bypass my stomach. The only other solution at present seems to be a tier 3 weight management programme. This is diet and exercise etc. I am going to be referred to this group as a matter of hoop jumping, hoping they will come up with a solution, although I am not sure what else I can do to change my diet. Maybe my exercise will have to increase more. If this sounds familiar to anyone reading this or anyone can come up with a much needed solution or ideas to help I would be forever grateful.
Hi I’ve been on lots of different antipsychotic medications for bipolar 1 . I’ve desperately tried to come off over the years but failed. I cut out sweets , crisps , cakes biscuits and chocolate for 4 years ! Still I’m not bak to my 10/12 size I should be ! I believe that they should make a pill that doesn’t make you so hungry or hold onto the fat ! It seems simple enough to me ! They’ve made a vaccine for COVID in a year what about us in the system and on medication for these mental illnesses are we to be forgotten as usual !!! This cannot continue anymore I’m in tears messaging this – I’m so unhappy with my weight it’s a painful place emotionally to be . I do a 2 hour physical job x5 times a week. Surely I’m a tryer surely I’m determined to speak to the western world on this awful situation we are left with .
I used to drink risperidone for several years and gain A HELL LOT OF WEIGHT. I had to quit it because I started feeling extremely depressed about my looks. (I’ve always been a perfectionist when it comes to body and desired to have as skinny body as possible). Now I changed to haloperidol and it works other away around: I have barely any appetite and eat enough to keep me alive. Yet there’s another thing: risperidone gave me little to no EPS, but haloperidol is worse on EPS… (it is really bad for an artist whose hands must be in full control), but I’d rather be unable to draw than look like a whale.
I am on anti depressants and gained weight from these. My weight is still up but stable. My dr wants to start me on Seroquel for GAD and panic attacks but I’m worried about additional weight gain. I read on some other pages that if you have already experienced some weight gain from medication you might be lucky and not experience it again with the introduction of another medication. Can you please let me know?
Did you find any truth to this? I put on weight with olanzapine and looking into trying mirtrazapine now that i’ve lost most of the weight but terrified because of potential weight gain
I’ve been taking Seroquel for 6 months for Bipolar Type 1 in combination with Lamictal. While I experienced SIGNIFICANT positive effects after starting the Seroquel, I’ve also developed serious GI issues. I’ve been hospitalized twice for lower intestine obstructions, have had numerous enimas, and generally suffer from constipation. I have also gained a significant amount of weight, and feel constantly bloated in my stomach. I can go an entire day without eating, and I will still feel extremely bloated and uncomfortable. My psychiatrist has suggested a few times now that I could switch to a different medication, given that the negative side effects are seeming to out wight the positive side effects I initially experienced (virtually no hypomania, little to no depressive episodes, and very regular sleep), but she has also offered little to no advice as to which other medication would be best to switch to. I’m also truly concerned that my symptoms will return if I were to switch. Right now, just feeling very confused as to how I should proceed….
A very interesting read indeed. I have Bipolar and on Quetiapine, this is medication number 8 for me and I’m feeling really good for once. I’ve missed taking them for two days and didn’t sleep until I took them on day three, so without them I don’t think I’d sleep often. I suffer with extreme hypersexuality which since increasing them to 100mg has almost all gone, I finally feel like a normal person in that way, which im crazy thankful for. I’ve managed to lose 16lbs in 5months since taking them, only from eating very healthy and working out. I don’t seem to have a big appetite like I use to and because the medication is working for once I’ve changed my bad emotional relationship with food.
Losing weight is crazy hard, before Quetiapine I could easily drop 2-4lbs a week if i really pushed myself at the gym and cut carbs.. now I’m lucky if i lose a pound a week. Since Quetiapine food doesn’t taste as great as it use to and I can happily just have a coffee and a sandwich a day but thats not healthy so I try to get in my daily calories still. I’m on weight watchers so I’m keeping an eye on everything..Some weeks I gain some weeks I lose..Its so frustrating eatting right and working out but still gaining! But I really want to be happy and still get to goal and try to be healthy and fit.. time will pass whether I try to lose weight or not, I’d rather keep pushing forward and make changes even if it takes me longer then most 🙂 x
I took 50mg for one week for insomnia, i was 69 kg and i become 74 kg after one week. Now after stopping it for a montg i am 77kg. Side effect like metabolic syndrom does not go away very quickly.
Pls help me i from 51 have 77 kg. Im so bad. Pls tell me way how to stop my eating habit and apetit. I take haldol and ariprizol. Here there are no such many antipsihotici to chacge them. Im from small vountry. My life is mess.
I’ve been on zyperxa for about 6 year’s now and the cravings have gone away i only eat twice aday now, dinner and snack before bed and still don’t loose Weight I am 110kg I’ve noticed I put on 5kg every 6 months over the past 3 years at my dr’s, I always lost weight on sericual and always put weight on on respiridone and zyperxa, I work out for weeks and gain the weight back in a couple of days so I gave up on trying, I’ve been dealing with schitzaphrenia since 2010 it has been easier to deal with and overcome the illness, then it was the weight gain, the weight has been just as stressful as my schitzaphrenia , the voices stop but the weight doesn’t go away and it’s depressing, I would like to go back on sericual but it doesn’t work as well for me as zyprexa, also the zyperxa, sericual and respiridone has taken a toll on my body, I have type 2 diabetes, high blood pressure and high cholesterol and I am only 29, even had liver damage 18 months ago, but Dr hasn’t said anything about it at last 2 appointments, and I don’t drink or do drugs, only accasionly and always messes with my medication.
I was searching for answers and was really glad to find this website. My son has been on aripiprozole since 2013 and before that he was on olanzopine. He has gained a huge amount of weight and his doctor doesn’t seem to care about that. I had to actually beg this doctor to test my son for diabetes and to monitor his weight. My son tries really hard to loose the weight but is getting discouraged. I’ve read where the drug Metformin can help to loose weight. Could this be an option for him?
Hi Jaycee, I’m taking aripiprazole as well and have gained a lot of weight too, I tried Metformin and didn’t lose weight but just had a lot of gas for some reason. It might not be the same for your son but I just thought I’d let you know my experience with it. My dad is recommending I take cannabis oil instead of Abilify. So I might give that a go. Hope this helps.
i was on rexulti twice, once for five months another for 9 months. DOCS say that it is a newer improved version of abilify without the side effects. That is complete non-sense. It is a dangerous medication. I gained thirty five pounds on it and it doubled my cholesterol both times. I am now on a statin. Before taking anti-psychotics, make sure you talk to two different professionals. OFTEN, one doctor will say one thing while another will contradict the first opinion. These doctors don’t even know the real side-effects of these medications. They can be dangerous.
Which pill reverses the effects to my brain and body from mainly invega and depakote? I had gained weight and it changed my hypothalamus I think.
I’m on olanzapine and I’ve gained weight though it’s been a blessing for me, I work out 5 days a week and I’m solid muscle now at 100kg, you just need to eat right and work out. Even doing 3 days a week works well the drug does something when you work out and boosts muscle gain. If someone is saying they can’t because of the drug they’re lying to themselves. My schizophrenia is bad really bad but it’s all gone now I sleep better am more focused and just more happy to be alive. Calling this drug dangerous or bad just places unnecessary stigma on the drugs and you should all know better. I hope this helps people just starting the drug, don’t be ashamed be ready for change keep active and strive for happiness it’s all up to you!!