Often prescribed in cases of early psychosis, antipsychotic medications can cause weight gain, requiring careful management of diet and lifestyle.
What is Psychosis?
The term early psychosis refers to the first episode of psychosis experienced by a person – most likely to occur in late adolescence or in early adult years.
People with psychosis have problems interpreting reality; the condition is characterised by changes to their perceptions, thoughts, beliefs and behaviours.
The life expectancy of people suffering from severe mental illness is 20 years less than the general population, largely due to higher rates of premature cardiovascular disease. This is common in individuals taking atypical antipsychotic medication as they are are likely to experience weight gain and develop metabolic syndrome.
What are Antipsychotic Medications?
Antipsychotic medications are a class of drugs that are used to help manage the symptoms of psychosis. An episode of psychosis can have symptoms including delusions, hallucinations and thought disturbances; antipsychotic medications work to alleviate these symptoms.
There are 2 classes of antipsychotic medication: typical (older type) and A-typical (newer type). The newer type are more commonly used as they tend to have less extrapyramidal side effects such as trembling or muscle stiffness.
Changes to Metabolism
Metabolic syndrome is a cluster of risk factors that indicate your risk of developing cardiovascular disease and diabetes.
There are five risk factors associated with metabolic syndrome. Waist circumference (abdominal obesity) is independently associated with the other risk factors, and is therefore a prerequisite risk factor for a diagnosis of metabolic syndrome.
According to the International Diabetes Federation, Metabolic Syndrome is defined as abdominal obesity plus any two of the following four risk factors:
- High triglycerides: Triglycerides are a type of fat found in the blood.
- Low HDL cholesterol: HDL is referred to as the “good” cholesterol. HDL takes the bad cholesterol from your arteries, reducing the risk of heart disease.
- High blood pressure: Blood pressure is the force of blood pushing against the walls of your arteries as your heart pumps. If this pressure rises and stays high over time, it can damage your heart and lead to plaque buildup.
- High fasting blood sugar: Mildly high blood sugar may be an early sign of diabetes.
It is estimated that around 20-25 per cent of the world’s adult population have metabolic syndrome; and those with metabolic syndrome are twice as likely to die from – and three times as likely to have – a heart attack or stroke compared with people without the syndrome.
For people with severe mental illness on antipsychotic medication, a recent systematic review identified a significantly increased risk of approximately 1.5x, when compared to the general population. Most antipsychotic medications carry this risk, however the risk is highest with clozapine and olanzapine.
Why Am I Gaining Weight?
Weight gain is a common side effect of antipsychotic medication, and young people with first episode psychosis commencing on antipsychotic medication are more prone to rapid adverse metabolic changes.
The cause of the weight gain has been attributed to:
- increased appetite and reduced feelings of fullness;
- increased cravings for sweet foods and drinks;
- a poor diet that has more calories and saturated fat, less fruits, vegetables and fibre, in conjunction with higher amounts of sedentary behaviours.
The weight gain occurs fastest in the first 12 weeks after starting on medication, with an average increase of 8kg during this time and progressing to 12kg over the first 2 years.
Managing Weight on Antipsychotics
Dietary intervention has been shown to help prevent, or at least minimise the amount of weight gain after starting on antipsychotics. A few simple things that will help are to:
- Limit soft drinks and juices;
- Avoid takeaway foods;
- Get moving – try to limit sedentary behaviour, get up and walk more.
An increased appetite and cravings are the biggest challenges normally experienced by people taking antipsychotic medication.
If you find that you are experiencing an increased appetite and/or reduced feelings of fullness, there are a few ways that you can try to manage these:
- Have protein at breakfast: Protein helps keep you feeling fuller for longer and can prevent you from eating more at other meals throughout the day. Some good ideas are oats with milk, yoghurt & fruit, eggs on toast or peanut butter or cheese on toast.
- Distract yourself: Cravings will generally pass so on some occasions it can be helpful to find ways to distract yourself, or delay giving into the craving. A few ways you can do this include going for a walk, cleaning your teeth, calling a friend, watching an episode of your favorite TV show, or writing down your health goals.
- Swap it! If you can’t distract or delay the craving, it’s a good idea to have some lower calorie options to substitute. Try air popped popcorn, fruit or vegetables, a glass of water or low fat milk, a small handful of nuts, roasted chickpeas, low fat yoghurt or rice cakes with peanut butter or Vegemite.
The Bottom Line
During this time it is important to monitor your weight, your diet and also metabolic changes associated with metabolic syndrome (waist circumference, blood pressure, triglycerides, cholesterol and blood sugar levels).
Weight gain and metabolic changes are common side effects of antipsychotic medication so it is important to be aware of any changes to your diet that might be occurring.
If you are experiencing any of these side effects, or would like help preventing them before they occur, consider making an appointment with me. I have had experience working with people in a similar situation and would be happy help you overcome this hurdle.
Author: Ashleigh Hamilton, BHlthSc (Nutr & Diet), MSc (Diet), APD.
Accredited Practicing Dietitian and Nutritionist, Ashleigh Hamilton, is passionate about a whole of body approach to health which encompasses both physical and mental aspects. She works with people to make lifestyle changes that will benefit their health for the future, using a range of counselling techniques including aspects of cognitive behavioural therapy, mindfulness and person-centred therapy.
To make an appointment with Brisbane Dietitian and Nutritionist, Ashleigh Hamilton, try Online Booking – Mt Gravatt or call Vision Psychology (Mt Gravatt) on (07) 3088 5422.
- Teasdale SB, Ward PB, Rosenbaum S, Watkins A, Curtis J, Kalucy M, et al. A nutrition intervention is effective in improving dietary components linked to cardiometabolic risk in youth with rst-episode psychosis. Br J Nutr (2016) 115:1987–93. doi:10.1017/S0007114516001033.