Antipsychotics May Heighten Diabetes Risk in Young People
Children and adolescents with behavior disorders who were treated with antipsychotic drugs for 12 weeks experienced clinically significant gains in body fat and decreases in insulin sensitivity, according to a study published online in JAMA Psychiatry.
Antipsychotics are commonly used to treat attention-deficit/hyperactivity disorder (ADHD) in children who do not improve with stimulant medications.
“Antipsychotic medications can be helpful for many as a treatment for behavior disorders,” said Ginger E. Nicol, MD, the study’s first author and an associate professor of child psychiatry at Washington University in St. Louis, Missouri. “But we know these drugs also have side effects involving fat gain and insulin resistance, important precursors to diabetes and cardiovascular disease. Our results underscore the need for greater vigilance regarding side effects when prescribing these medications.”
The study randomized 144 children, aged 6 through 18, with disruptive behavior disorders to 12 weeks of treatment with 1 of 3 antipsychotics: aripiprazole, olanzapine, or risperidone.
Researchers used dual-energy X-ray absorptiometry (DEXA) scans to measure whole body fat before, during, and after treatment. Magnetic resonance imaging (MRI) scans gauged subcutaneous and visceral fat in the abdomen at baseline and after treatment, and insulin sensitivity was also measured at baseline and study end.
“At the start of the study, about 30% of the youths in our sample were overweight or obese, which is exactly the same rate we see in the general population,” said John W. Newcomer, MD, study principal investigator and a professor of integrated medical science at Florida Atlantic University’s Charles E. Schmidt College of Medicine, Boca Raton, Florida. “But after only 12 weeks of treatment, the rate of those considered overweight or obese had risen to 46.5%. We essentially went from 1 in 3 children meeting criteria for being overweight or obese to 1 in 2 meeting criteria.”
Olanzapine was associated with the largest increases in body fat, according to the study, although fat gain with the other 2 drugs was also significant. DEXA scans revealed about half the gain was water, and half was new fat.
“We knew these drugs were causing weight gain, but we didn’t know how much of that gain was fat,” said Dr. Newcomer, who serves as an adjunct psychiatry professor at Washington University. “We also knew that children taking antipsychotics had an increased risk of diabetes. But until now, no one had connected those dots through a pathway involving increases in body fat and decreases in insulin sensitivity.”
Nicol GE, Yingling MD, Flavin KS, et al. Metabolic effects of antipsychotics on adiposity and insulin sensitivity in youths: a randomized clinical trial. JAMA Psychiatry. 2018 June 13;[Epub ahead of print].