A breakdown of a new study clarifies which antipsychotic medications used to treat autism cause greatest weight gain.
For some patients with Autism Spectrum Disorder (ASD) the need for second generation antipsychotic (SGA) medications is clear.
“Many patients need these meds to help with very intense aggressive behaviors,” explained Logan Wink, of Cincinnati Children’s Hospital Medical Center.
“The behaviors can include severe tantrums, physical aggression, property destruction, injury to others and injury to self. While we always recommend behavioral therapy, for many individuals that is not enough. They need medicines, and medicines have side effects.”
One of those side effects is weight gain — sometimes quite significant. It was this understanding that led Wink and colleagues to undertake a first-of-its-kind study to determine which SGAs are the biggest weight-gain offenders.
A Weighty Issue
“This study was prompted by clinical experience, seeing a huge amount of weight gain in our patients with ASD,” Wink told ADVANCE. “More than half of my patients who are treated with an antipsychotic medication for behavior undergo a significant amount of weight gain — a lot of weight gain. It varies by person and age, but I personally have had patients who have gained 50 pounds, which is concerning to me as a clinician and certainly is of concern to their caregivers.”
autism weight gain obesity child Comorbidities associated with weight gain make this particularly worrisome.
“We worry about the development of diabetes and hyperlipidemia,” said Wink. “We’ve seen cases of fatty liver disease which has a significant negative long-term impact on health.
“Obesity can led to a reduction in activity level, exercise tolerance, development of sleep apnea, and poor cardiovascular outcomes,” she continued. “We have also observed gynecomastia — the development of abnormal breast tissues in response to risperidone-induced increase in the hormone prolactin, which can even lead to lactation.”
These physical side effects can place additional strain on some patients’ already fragile emotional state.
“We know there is already very high rate of depression and anxiety in high functioning adolescents with autism and certainly weight gain and body image plays into that,”Wink said.
The investigators reviewed medical charts of 202 patients between the ages of 2 and 20 treated at two large sub-specialty clinics. Each of these patients had been treated with one of five SGAs for a maximum of four years. The researchers compared side effects associated with the five SGAs and found that patients treated with Zyprexa (olanzapine) had the highest risk of weight gain. The two FDA-approved drugs – Risperdal (risperidone) and Abilify (aripiprazole) — also resulted in significant weight gain, but not quite as much as seen with olanzapine.
“During our study we realized that the group of patients who had already been prescribed olanzapine had the lowest body mass to begin with, so clearly our prescribers were using that drug in patients perceived to be better able to tolerate some weight gain,” noted Wink. “Heavier patients were often prescribed the drugs associated with the least amount of weight gain – Geodon (ziprasidone) and Seroquel (quetiapine).”
Wink hopes that providers will use the information confirmed through the study, published online in The Journal of Child and Adolescent Psychopharmacology, as a guide “. to appropriately choose a drug based on the characteristics of a patient. If at baseline an individual is already overweight, the best choice may be to choose a drug associated with less weight gain. If a patient is underweight, the drug that encourages weight gain is not bad choice. However, we do always recommend behavioral therapy and use of medications with with the greatest evidence-base as first line treatment.”
Of course, weight gain or not, weight-gain offending drugs may be necessary. Jeanne Schwarzer, MS, LPC, NCC, is the parent of a child with ASD. “If the choice is some weight gain or suicide, you go with weight gain. It’s a moot point if that’s the drug that works,” she commented.
“But not every drug works well on every person so you just need to find what helps so the child can function,” Schwarzer added.
“Worrying about side effects comes after you find out if it works on depression and anxiety, and then you see if the child can deal with the side effects. Weight gain, although not ideal, is secondary compared to suicidal ideation, constant nausea or increased aggression,” she said.
If there are safety concerns due to behavior, “treating aggression takes top priority,”agreed Wink. If a drug that causes weight gain is the only drug that helps the aggression, there can be pharmaceutical work-arounds.
“There are drugs that control for appetite and metabolism which are an option for managing weight gain. Metformin, a medicine initially for Type 2 diabetes, for example, may help to combat weight gain associated with antipsychotics in some patients,” she noted.
“Given this was a chart review, our results must be considered along with their limitations,” Wink advised. “We believe, however, that this study adds to the growing safety data regarding the use of SGAs and lays important groundwork for future controlled head-to-head analysis of SGA treatments in patients with ASD.”
- Yoon Y, Wink LK, et al. Weight gain effects of second-generation antipsychotic treatment in autism spectrum disorder. Journal of Child and Adolescent Psychopharmacology. July 2016. [Epub ahead of print, http://online.liebertpub.com/toc/cap/0/0]