Psychotropic drug-induced change of weight: a review

Objective and methods: Mainly based on a MEDLINE search until april 2005, data from clinical studies with antidepressants, mood stabilizers/anticonvulsants and neuroleptics were scanned for information about change of weight. Results: Among antidepressants amitryptiline and nortriptyline have the highest incidence of gain in weight followed by imipramine. Maprotiline and mirtazpapine have a moderate weight increasing potential. SSRI (except paroxetine) and MAOI had no or only slight weight inducing effects. In contrary, bupropion was associated with weight reduction. Regarding mood stabilizers and anticonvulsants, a marked gain in weight with lithium and valproate was reported frequently. With gabapentin and vigabatrin a slight to moderate gain in weight was found. Minor changes of weight were found with carbamazepine and lamotrigine. Treatment with topiramate and felbamate reportedly lead to weight loss. The atypical neuroleptics clozapine and olanzapine were frequently related to a strong gain in weight followed by risperidone. Stable weight was found with aripiprazole and ziprasidone. A gain in weight is less frequent with older/typical neuroleptics. Conclusion: Beside some methodological restrictions like inconsistent information of weight changes (e.g. percent vs. mass) and the small sample of available long term studies, this review specifies the incidence of weight changes for commonly used psychotropic drugs and might be helpful to look for alternatives.