Almost all antipsychotics
result in weight gain.
Meta-analysis
Maarten Bak
Department
2
Severe Mental Illness
Health
Department
3
People with SMI decease at a younger age
Department
Munk-Laursen 2014 Ann Rev Clin Psych
4
In SMI life expectancy is shortened
Man
Female
Department
Nordentoft 2013 PlosOne
5
Risks of severe physical problems in SMI
GAP =General Australian population
Department
Gladigau 2014 IMJ
6
Physical problems & SMI: review
Department
De Hert 2011 World Psych
7
DM-II
MetS
Department
Heald 2010 Eur Psych
8
CVD
risico
Department
McLean 2014 Schiz Res
9
People with Schizophrenia decease
at a younger age
Department
Munk-Laursen 2014 Ann Rev Clin Psych
10
Treatment of physical problems & SMI
OR
Meta-analysis of treatment with:
Antiviral compounds, ACE-blockers, β-blockers, anticoagulants
and Cholesterol decreasing medication
Department
Mitchell 2012 BJP
11
Severe Mental Illness
Health
Department
Medication
12
Mortality risk & AP
Largely explained by reduced risk of suicide
Department
Tiihonen 2009 Lancet
13
Mortality
and
medication
Department
Tenback 2012 J Clin PsyPharm
14
Monitor side effects
Metabolic
Other
Body weight changes
Movement disorders
BMI
Cardiovascular disorders
Waist circumference
Sexual problems
Glucose
Lipids
Department
Antipsychotic monitor (APM)
15
Department
16
Department
Monitor volksgezondheid 2015 + AP Monitor 2016
17
Department
Monitor volksgezondheid 2015 + AP Monitor 2016
18
First review: AP associated with weight gain
Department
Allison et al, 1999 Am J Psych
19
Weight change: meta-analysis
Study duration: 4-12 wks
Compared with haloperidol
Department
Leucht 2009 Lancet
20
BMI changes in first episode
schizophrenia
Department
Tarricone 2010 Psychol Med
21
Are all AP associated with weight gain?
Are AP-naive patients more at risk?
Is duration of AP-use related with more weight gain?
Department
22
Flow chart
Department
Bak 2014 PlosOne
23
Figure 2. Weight change (in kg) per period per antipsychotic medication.
Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A MetaAnalysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112
Department
24
Figure 3. Weight change (kg) per period only including AP-naive samples.
Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A MetaAnalysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112
Department
25
Figure 4. BMI change per period.
Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A MetaAnalysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112
Department
26
Figure 5. BMI change in AP naive patients per time period.
Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A MetaAnalysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112
Department
27
Figure 6. Proportion of weight increase per antipsychotic per time period.
Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A MetaAnalysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112
Department
28
Figure 7. Proportion of weight increase in AP naïve.
Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A MetaAnalysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112
Department
29
Figure 8. Proportion of weight reduction.
Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A MetaAnalysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112
Department
30
Table 1. Metaregression of weight changes per period.
Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A MetaAnalysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112
Department
31
Table 2. Metaregression of weight changes per period in drug-naive patients.
Bak M, Fransen A, Janssen J, van Os J, Drukker M (2014) Almost All Antipsychotics Result in Weight Gain: A MetaAnalysis. PLoS ONE 9(4): e94112. doi:10.1371/journal.pone.0094112
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0094112
Department
32
Is diagnosis a factor?
P R IS M A 2 0 0 9 Flo w D ia gra m
Eligibility
437 papers
Records identified through database
searching
(n = 1290 Pubmed)
(n = 2109 Embase)
Additional records identified through
other sources
(n = 20 )
Records after duplicates removed
(n = 3419)
Screening
Data period:
1960 – 2015
Identification
1960-2014
Records screened
(n =2070 )
Full-text articles assessed for
eligibility
(n = 892)
Records excluded
(n = 1178 )
Full-text articles excluded, with
reasons
(n = 463)
Previously presented data
Data not given per AP
Relative data
No crude data
Included
Studies included in
qualitative synthesis
(n = 437)
Department
Studies included in
quantitative synthesis (metaanalysis)
(n = 437)
33
No med
Light med
Moderate med
Severe med
<6
6-16
1638
>38
<6
6-16
1638
>38
<6
6-16
1638
>38
<6
6-16
1638
>38
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Aff
0.29
1.64
0.27
-0.81
-1.03
-0.98
9.54
-5.13
-0.2
-0.23
-0.1
-1.09
-0.53
-0.17
-1.77
1.14
Cog
0.37
-1.92
-4.75
Sz
Psy
NAO
0.46
-0.1
Add
-1.27
-2.0
2.97
No
0.34
Rest
-0.98
Department
-0.8
0.52
-0.9
-1.51
34
Remt “reward” systeem
D2  blokkade negatieve
feedback  Leptine stijgt 
Appetite stijgt
Department
Vergroot honger
gevoel en eetlust
 Meer voedsel intake
35
Intake changes in
rats after AP use
Department
Kaur & Kulkarni 2002 PNBP
36
Conclusion
• All antipsychotics result in weight gain
• Three risk groups
– Limited: aripiprazol, amisulpride,
ziprasidone
– Moderate: haloperidol, risperidon,
paliperidon, quetiapine
– Severe: olanzapine & clozapine
• Weight gain is not associated with
diagnosis
Department
37