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Mental Health Which antipsychotics have low weight gain

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ross46

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May 11, 2013
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hey there

What i want your opinion on is which antipsychotics have low weight gain for most people and also have tolerable side effects. I've read that abilify has low weight gain but can either be the bees knees or absolutely hell. So what other options are out there?

A bit of background. I am a 21 year old white male currently taking olanzapine 15mg (Zyprexa), Amitriptyline (Amitrip, elavil) 100mg, pregablin (lyrica), paracetomol 4g daily, transtec 70 microg/ hour patches and just started 5mg oxycodone prn. The pain medication i take for chronic (5 years) back pain. they have done x rays, MRI's and blood tests and can't find a cause so it has just been put down to mechanical pain (would love any ideas on what this could be!). The olanzapine, amitriptyline and pregablin (amitriptyline and pregablin I'm taking partly due to pain partly due to mental health) i am taking for mixed anxiety and depressive disorder, panic disorder, borderline persoality traits and voices ( i also have periods where i black out and identify myself as "Hyde" and become highly aggressive to the point I've threatened people with knives and said pretty disgustingly freaky things, thinking DID/ MPD).

I was originally tried on multiple SSRI's and SNRI's but reacted badly with the docs suspecting serotonin syndrome, I've tried mirtazapine when i was young but it didn't improve much. i was tried on seroquel but it made me way too drowsy. I've tolerated olanzapine well, i like the sleepiness at night, it doesn't cause too many problems during the day and it has controlled my symptoms rather well. My only problem is weight gain! since starting the seroquel (9 months) and the olanzapine (2 years up to now) i have put on nearly 5 stone. i used to be 5'7" and 120 pounds, now im the same height and 200 pounds of pure blubber. So i'm seeing the pdoc in a couple of weeks and i wanted a couple of options to ask him about which could work with less weight gain. I've tried going to the gym and i haven't lost more than 4 pounds in 6 months. I've heard this is due to olanzapine decreasing your metabolism?

Any help would be appreciated

Thanks, Ross
 
Anti-psychotics tend to increase prolactin levels, this causes men to grow boobs and accumulate fat on their torso. Anti-psychotics also give people a voracious appetite due to their action on a certain serotonin receptor (I don't recall which at the moment but medications such as mirtazepine do this as well.) I just got back on olanzapine from Abilify because abilify isn't covered by my health insurance and it was prohibitively expensive. I switched to Abilify because of the prolactin increase from olanzapine and the weight gain. People do have widely varying experiences on it, it made me feel like a zombie but most people seem to have favorable results on it.

Since I can't stay on Abilify I started working out more to counter the weight gain and taking diindolylmethane which prevents testosterone from being converted to estrogen and destroys more active forms of estrogen. It seems to be countering the prolactin increase, not so much the weight gain but adequate exercise and watching my diet are working for that. Abilify definitely has the best side effect profile so it's worth the try. Olanzapine is very effective and it doesn't seem very intrusive on the mind, it's too bad about the other side effects.
 
I didn't realise there was a specific mechanism that caused me to end up with moobs. just thought it was me getting fat from the olanzapine. So you found abilify too sedating but did it actually help with your mental state? May i ask what the reason is for you needing anti psychotics? i would be willing to try another type f medication that isn't an antipsychotic but i dont know of any. Are the older type anti psychotics any better than the atypicals? Thankyou for your reply. Stay safe
 
Out of the atypicals Ziprasidone aka Geodon/Zeldox and Risperidone are perhaps the least likely to cause weight gain. Haldol is actually rated the least likely to cause weight gain but as that's a very old and very nasty typical anti-psychotic that is a very potent D2 receptor antagonist you really don't want to go that route. The Typicals are really no better or worse then the Atypicals in terms of side effects or how well they work although anti-psychotics with Atypical effects (this means more Serotonin antagonism as opposed to Dopamine Antagonism) do tend to work better on negative symptoms and also Depression. Or atleast that's the case with low to medium potency Typical anti-psychotics. High potency Dopamine D2 receptor antagonist's such as Haldol and Clopixol of course cause the worst in terms of movement disorder side effects but due to their negligible effect on the H1, Serotonin and Muscarinic receptor don't cause much in the way of weight gain.

Out of all the anti-psychotics i have tried i have found Olanzapine and Thorazine/Largactil to be the most tolerable in terms of side effects and work the best. As i can't afford Olanzapine and my doc doesn't script Typical anti-psychotics i am stuck on the 3rd best for me now which is Quetiapine. I never got much in the way of any weight gain from any of them but Olanzapine and Clozapine get the worst reps for causing weight gain out of the Atypicals. Quetiapine can be pretty bad too though generally not nearly as bad as Olanzapine. Basically it's a crap shoot to figure out which ones you can tolerate.
 
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Thankyou for your detailed input. So what type of side effects would be common with Ziprasidone and Risperidone? i spoke with my new GP about changing antipsychotics and his opinion is that i could change and end up worse off than sticking with the olanzapine which works relatively well for sleeping, even though i still get some breakthrough mental health problems. i had to discontinue quetiapine because the sedation was too much whereas it's manageable in olanzapine. money is not a problem as i am from the UK and we only have to pay a small amount towards our prescritpions. i am currently on amitriptyline and i tolerate it well. i am taking 100mg with the 15mg of olanzapine. has anyone got any experience with high doses of amitriptyline as i could take away the antipsychotic and increase the amitriptyine? thanks
 
Risperidone is worse than olanzapine for man boobs. Abilify wasn't too sedating, it just made me feel blank. I was on it for a short while and have speculated that since the olanzapine had built up in my system and hadn't been allowed to clear my system, the effects may have stacked. People tend to find it more stimulating.

As far as not being potent d2 antagonists, with the least likelyhood of having long term serious side effects. I think abilify and olanzapine are the best anti-psychotics to take (in my own opinion) olanzapine is not a strong antagonist and abilify is a partial agonist with the least likelyhood of causing weight gain and prolactin increase. They are the least invasive as far as still having mental clarity. The other anti-psychotics worry me. I may try abilify again after letting the olanzapine clear my system for a week if my doctor can get a bunch of free samples for me.
 
Hi there. Mental clarity is important for me as i am studying at university so i would need that, not the fog i had with seroquel. if abilify is less likely to increase weight and increase prolactin levels, as well as being better for mental clarity i will ask the pdoc's opinion on that. Has anyone got any opinions against abilify or a reason that it might not be a good idea to switch? i'm saying it a lot in this thread but thank you everyone
 
Unfortunately, the antipsychotics associated with less weight gain, also tend to be less effective. These include Abilify, Rexulti, and Latuda. It's a cost-benefit thing.
 
ross46 said:
Thankyou for your detailed input. So what type of side effects would be common with Ziprasidone and Risperidone? i spoke with my new GP about changing antipsychotics and his opinion is that i could change and end up worse off than sticking with the olanzapine which works relatively well for sleeping, even though i still get some breakthrough mental health problems. i had to discontinue quetiapine because the sedation was too much whereas it's manageable in olanzapine. money is not a problem as i am from the UK and we only have to pay a small amount towards our prescritpions. i am currently on amitriptyline and i tolerate it well. i am taking 100mg with the 15mg of olanzapine. has anyone got any experience with high doses of amitriptyline as i could take away the antipsychotic and increase the amitriptyine? thanks
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I have never taken Zeldox/Geodon but i have taken Risperidone for maybe 2 years on and off in the past and compared to how well Olanzapine worked it sucked. It sucks compared to Quetiapine in treating my Bipolar actually. Also Risperidone being a high potency D2 antagonist raises prolactin levels quite abit and can cause man boobs. I luckily never got this side effect (if i did i would have stopped the meds) but then again i was rarely on more then 3mg's a day. It's also not sedating per se like Quetiapine or Olanzapine are but unlike these drugs it does cause a zombie effect in alot of people. I got this at 3mg's and above a day pretty much where as i never experienced this side effect from Quetiapine or Olanzapine even at high doses. This is again due to Risperidone's lack of affinity for the H1 and Muscarinic receptors and it's high affinity for the D2 receptor. Some people do find Risperidone to be a good med though and i have known people on it for years without any major side effects.

I was on Amitriptyline for about 2 years for both the nerve pain i have as well as the Depression i get. It also worked really well as a sleep aid and unlike most sedating drugs i actually felt more alert the next day after taking it. I also found it to be one of the few anti-depressants that actually work :) . I ended up on 150mg's a day of Amitriptyline along with 400mg's of Quetiapine and unlike the Seroquel the sedation from Amitriptyline doesn't go away after only a week so it's quite good as a long term sleep aid. I would say definitely give it a try. Most people don't notice any anti-depressant effect until they hit atleast 50mg's a day and for me 100mg's was about the magic number.

I was also on another Tricyclic anti-depressant called Trimipramine which along with being even more sedating then Amitriptyline is also a sort of Atypical anti-psychotic by itself. It was weak anti-psychotic effects (weaker then the low potency Typical anti-psychotic Periciazine) but i believe it did show some promise in treating Bipolar Depression especially. I found it to work really well and not only is it a great sleep aid but it actually improves your sleep and also you dreams as it has a positive effect on your dreams. Depressing dreams can be a big trigger for me so needles to say i was pleased with a med to improve that.
 
Have them test you for the antigen, HLA-B27, with respect to your back pain.

The sleep aid, Halcion, would seem appropriate given the facts as you've stated them.

I know of no antipsychotics that don't carry weight gain. Counter it by eating filling foods that aren't bad for you, and establish and commit to an exercise routine.
 
Hi there. They did test me for HLA-B27 as of the top of my head thats the antigen that is linked in ankylosing spondylitis? if it is then they definitely did test me. Took them a year though! was doing some research and walked in and asked why i'd never had bloodtests and the doctor just went "shit! you should have been tested months ago".

Now i'm really on the fence as to come off olanzapine and increase my amitriptyline to 150+, but then if my psychosis and voices are still bad then they'll cause me a problem but i dont know the extent until i come off the olanzapine. Or... i can switch to abilify which could help with the weight gain, but might not be as effective. I've read that abilify can make people almost jittery and cause a condition where you can't sit down and also being linked with permanent movement disorders. Are these side effects common? you can never tell from a PI leaflet as my oxycodone says "1-100, euphoria" pretty much everyone will get that side effect so PI leaflets can be useless. Would rather hear it from an experienced bluelighter
 
I think your referring to Akathesia and yes Abilify is one of the worst atypicals for causing it. High potency Typicals such as Haldol and Clopixol and Pimozide are generally the worst offenders for causing it but Abilify is gaining a bad rap among the Atypicals for causing it. I think Risperidone is still perhaps abit worse but i'm not sure.
 
yes it was Akathesia i was thinking of. With abilify is it likely to continue after discontinuing it for a long time afterwards or does it normally go away when you stop taking it? thanks, just this could be a dealbreaker for me as i have anxiety as it is and Akathesia would not help in the slightest
 
Ligaturd said:
Anti-psychotics also give people a voracious appetite due to their action on a certain serotonin receptor (I don't recall which at the moment but medications such as mirtazepine do this as well.)
Click to expand...

I don't have a particularly large appetite - I eat pretty normal sized meals and don't often snack between meals. I still gained weight on antipsychotics. The weight gain is caused by changes to your insulin response and resting metabolic rate, not necessarily eating more food.

Since I can't stay on Abilify I started working out more to counter the weight gain and taking diindolylmethane which prevents testosterone from being converted to estrogen and destroys more active forms of estrogen. It seems to be countering the prolactin increase, not so much the weight gain but adequate exercise and watching my diet are working for that. Abilify definitely has the best side effect profile so it's worth the try. Olanzapine is very effective and it doesn't seem very intrusive on the mind, it's too bad about the other side effects.
Click to expand...

I saw an endocrinologist the other day about my amisulpride-related elevated prolactin. She put me back on the contraceptive pill (essentially as hormone replacement therapy) to support bone density and preventing ovarian atrophy, but said there was otherwise no urgency around high prolactin levels.
 
i've been reading through some literature regarding abilify and found this paper regarding TD from abilify. The patient discussed was on duloxetine and it states;

"Her dose was a moderate 15 mg/day, but duloxetine probably influenced a mild inhibition of liver enzyme cytochrome P450 (CYP 2D6), allowing elevated aripiprazole blood levels. (Aripiprazole is a substrate for this liver enzyme metabolic system.)"

i am on a transtec patch (70μg/h) and i also take oxycodone for breakthrough pain. will these drugs interact with abilify, and if so what would be the result? I've tried finding information but maybe i'm not looking in the right places. Thanks
 
I take Geodon and have not gained weight from it. It gives me a great night's sleep and I'm not sedated during the day. You have to eat 500 calories when you take it for it to work. I'm very thin and Geodon has definitely not increased my appetite or messed with my metabolism.

In the past, I have taken Abilify and Seroquel. I had akathesia with Abilify but my doctor added Cogentin and it completely made that side effect go away. I gained no weight on Abilify but it was too sedating for me.

Seroquel was also weight neutral for me. It was extremely sedating so I quit taking it.

Lithium caused weight gain for me - forty pounds! I lost those pounds after discontinuing it. Geodon is the best fit for me.

My doctor said that he will not prescribe Zyprexa to ANY of his patients because it is notorious for weight gain.

I hope that helps. I am willing to give a new med a few weeks to try and have found a lot of initial side effects to go away. I will not take any meds that cause ongoing sedation or cause weight gain.

I currently take Lamictal, Lexapro, Wellbutrin, Geodon, Klonopin and Adderrall for bipolar 1 with occasional psychotic features. This is the best med combo for me. A lot of meds but years of trial and error has left this as what helps me.

Good luck and take care.
 
Hi rainyday107. Wish my psychiatrist had that attitude with zyprexa!. since going on elavil, seroquel and zyprexa (on seroquel first, discontinued, then zyprexa for two years, but started taking 50mg seroquel with zyprexa to help me sleep) i have put on a whopping 70 pounds! this has reduced to 54 when i stopped the 50mg of seroquel. i also didn't know you could take extra medication to stop the akathisia, will have to ask about that. i doubt any antipsychotic could cause that much weight gain. i'm hoping that the zyprexa has changed my body so much to cause weight gain that if abilify does cause it, it will still lead to me losing weight.

Also will my chances of developing akathisia be lower because i'm on pregablin which apparently can help with it? thanks
 
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Hi ross, I'm not familiar with pregablin so I can't comment on that. I can tell you I had an extreme case of Akathesia - it was the worst side effect I've ever experienced. The next week, I had an appointment with my doctor and told him about the akathesia. He said "why didn't you call me?!" lol

He said he rarely adds a med to counter the side effects of another med, but he promptly wrote an rx for Cogentin. I filled it and it almost immediately got rid of the akathesia. I was SO relieved. Never had a med kick in that fast and I don't recall any side effects.

Take care.
 
ross46 said:
i've been reading through some literature regarding abilify and found this paper regarding TD from abilify. The patient discussed was on duloxetine and it states;

"Her dose was a moderate 15 mg/day, but duloxetine probably influenced a mild inhibition of liver enzyme cytochrome P450 (CYP 2D6), allowing elevated aripiprazole blood levels. (Aripiprazole is a substrate for this liver enzyme metabolic system.)"

i am on a transtec patch (70μg/h) and i also take oxycodone for breakthrough pain. will these drugs interact with abilify, and if so what would be the result? I've tried finding information but maybe i'm not looking in the right places. Thanks
Click to expand...

The really simple answer is that the inhibitory action of the duloxetine and the burprenorphine will increase the levels of Abilify and Oxycodone in your blood, because they're not being metabolised as effectively as they should be. However, there has to be quite a strong inhibitory action for the effect to be clinically significant. If the effect is mild, it shouldn't be an issue, but just be careful with your doses and don't increase them without good medical supervision. Make sure you're only redosing your oxy when you're supposed to, too, as it may stay in your system for longer than it would on someone who wasn't taking duloxetine.

If you're concerned about it, talk to your doctor. They're often not great with knowing about drug/drug interactions, but the doctor will know how they work and will be able to let you know if you need to be worried.
 
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