So says this report published this week in the Archives of General Psychiatry.
According to the report, nearly 9% of patients started on antidepressants were also started on antipsychotics - an increase of 40% compared to 1996.
Of all the drugs out there there are perhaps none more uniformly detrimental to weight than the newest generation of antipsychotics where it's not even remotely abnormal to see patients gain 20-60lbs within a year of initiation.
Unfortunately these results don't surprise me at all as in my experience it's not just for depression where antipsychotics are inappropriately prescribed without considering the inevitable weight related consequences as they've also found favour with some physicians as sleep aids.
Bottom line?
Antipsychotics should be used to treat psychosis - and if someone's going to use them to augment therapy with an antidepressant or for another off label use they'd better darn well have exhausted every other possible treatment strategy.
Mark Olfson, MD, MPH; Steven C. Marcus, PhD (2009). National Patterns in Antidepressant Medication Treatment Archives of General Psychiatry, 66 (8), 848-856
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As a dietitian at a mental health facility I get a lot of referrals for weight gain related to antipsychotics. Gaining 20-100 lbs in a year is often significantly detrimental to mental health. If an antipsychotic is indicated, which one to use should be carefully considered, and appropriate monitoring afterwards is essential.
ReplyDeleteMirtazapine, a non-antipsychotic antidepressant, is becoming increasingly popular and it also seriously increases weight. In the UK standard practice seems to be to add mirtazapine to the first antidepressant if the first antidepressant doesn't work. All in all the average weight of depressed people has got to be rising...
ReplyDeleteNeuroskeptic,
ReplyDeleteNo doubt Remeron is a mess of a drug for weight - though at least it's an onlabel use of the drug to prescribe it for depression.
That said, when patients come to see me on Remeron not having tried other medications (or perhaps only one SSRI or SNRI) I can't help but question the thought processes of the MDs who've prescribed it to folks who already find weight to be a struggle and consequently already have dramatic weight related co-morbidity.
Mirtazapine is becoming increasingly popular and it also seriously increases weight. In the UK standard practice seems to be to add mirtazapine to the first antidepressant if the first antidepressant doesn't work.
ReplyDelete