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Volume 4: No. 3, July 2007

LETTER TO THE EDITOR
Medical Treatment and Weight Gain

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Suggested citation for this article: McGinn E. Medical treatment and weight gain [letter to the editor]. Prev Chronic Dis [serial online] 2007 Jul [date cited]. Available from: http://www.cdc.gov/pcd/issues/2007/
jul/07_0081.htm.

To the Editor:

“Addressing the Obesity Epidemic: A Genomics Perspective” in your April 2007 (1) issue speaks of the importance of considering all aspects of obesity. However, one aspect overlooked in the article is weight gain associated with medical treatment. Many classes of drugs are associated with weight gain that leads to overweight or obesity; these include atypical antipsychotic drugs, lithium, some antidepressant drugs, some antiepileptic drugs, and some steroids. Other drugs are associated with fat redistribution (e.g., some drugs for HIV/AIDS).

In addition to increasing weight, atypical antipsychotic drugs increase risk for hyperglycemia (as noted in a black-box label required by the Food and Drug Administration [FDA]), and they are associated with lipid dysregulation (2). Atypical antipsychotic drugs induce excitation and hypomania or mania, adverse effects never reported for the older versions of typical antipsychotic drugs (3). Some atypical antipsychotic drugs are also noncardiac QTc-interval–prolonging drugs and are associated with increased sudden cardiac death (4).   

Atypical antipsychotic drugs are widely used off-label. The FDA issued a Public Health Advisory warning of a 60% to 70% increased risk for mortality among elderly people with dementia being treated with atypical antipsychotic medications (5). From 1993 through 2002, prescriptions for atypical antipsychotic drugs for American children increased 500% (all off-label); 85% of those prescriptions were for nonpsychotic conditions (6). The public health implications of wide off-label use of this class of drugs merits more study.

Eileen McGinn, MPH
Student
Hunter College of the City University of New York
Brookdale Center for Healthy Aging and Longevity
New York, NY

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References

1. Newell A, Zlot A, Silvey K, Ariail K. Addressing the obesity epidemic: a genomics perspective. Prev Chronic Dis [serial online] 2007 Apr.
2. Newcomer JW. Metabolic considerations in the use of antipsychotic medications: a review of recent evidence. J Clin Psychiatry 2007;68 Suppl 1:20-7.
3. Rachid F, Bertschy G, Bondolfi G, Aubry JM. Possible induction of mania or hypomania by atypical antipsychotics: an updated review of reported cases. J Clin Psychiatry 2004 Nov;65(11):1537-45.
4. Straus SM, Sturkenboom MC, Bleumink GS, Dieleman JP, van der Lei J, de Graeff PA, et al. Non-cardiac QTc-prolonging drugs and the risk of sudden cardiac death. Eur Heart J 2005;26(19):2007-12.
5. Public health advisory: deaths with antipsychotics in elderly patients with behavioral disturbances. Rockville (MD): Food and Drug Administration; 2005.
6. Olfson M, Blanco C, Liu L, Moreno C, Laje G. National trends in the outpatient treatment of children and adolescents with antipsychotic drugs. Arch Gen Psychiatry 2006;63(6):679-85.

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