Changes in Body Weight and Psychotropic Drugs: A Systematic Synthesis of the Literature

<div><h3>Introduction</h3><p>Psychotropic medication use is associated with weight gain. While there are studies and reviews comparing weight gain for psychotropics within some classes, clinicians frequently use drugs from different classes to treat psychiatric disorders.</p> <h3>Objective</h3><p>To undertake a systematic review of all classes of psychotropics to provide an all encompassing evidence-based tool that would allow clinicians to determine the risks of weight gain in making both intra-class and interclass choices of psychotropics.</p> <h3>Methodology and Results</h3><p>We developed a novel hierarchical search strategy that made use of systematic reviews that were already available. When such evidence was not available we went on to evaluate randomly controlled trials, followed by cohort and other clinical trials, narrative reviews, and, where necessary, clinical opinion and anecdotal evidence. The data from the publication with the highest level of evidence based on our hierarchical classification was presented. Recommendations from an expert panel supplemented the evidence used to rank these drugs within their respective classes. Approximately 9500 articles were identified in our literature search of which 666 citations were retrieved. We were able to rank most of the psychotropics based on the available evidence and recommendations from subject matter experts. There were few discrepancies between published evidence and the expert panel in ranking these drugs.</p> <h3>Conclusion</h3><p>Potential for weight gain is an important consideration in choice of any psychotropic. This tool will help clinicians select psychotropics on a case-by-case basis in order to minimize the impact of weight gain when making both intra-class and interclass choices.</p> </div

Antidepressant Ranking and Effect on Body Weight (ranked from most weight gain to weight loss).

<p>Sources of funding: D  =  direct funding from a pharmaceutical manufacturer; U  =  unfunded or unknown funding *controversy in the ranking table.</p

Weight gain caused by typical and atypical antipsychotics and flunarizine (drugs not ranked due to insufficient data).

<p>Unless specified, %  =  % gaining >7% body weight. Sources of funding: D  =  direct funding from a pharmaceutical manufacturer; I  =  indirect funding (where authors had research funds); U  =  unfunded or unknown funding.</p

Change in weight caused by anxiolytics (Not ranked).

<p>U  =  unfunded or unknown funding; NA  =  not able to assess.</p

Change in weight caused by mood stabilizers (Ranked most to least weight gain).

<p>Sources of funding: D  =  direct funding from a pharmaceutical manufacturer; I  =  indirect funding (where authors had research funds).</p

The Hierarchical strategy for selection of reports.

<p>The Hierarchical strategy for selection of reports.</p

MAOI ranking (ranked from most to least weight gain).

<p>U  =  unfunded or unknown funding.</p