Gewichtsveränderungen unter Therapie mit Psychopharmaka

Zusammenfassung

Einleitung: Es wird ein Überblick über Gewichtsveränderungen unter Therapie mit den gebräuchlichsten Psychopharmaka gegeben. Methodik: Basierend auf einer Medline-gestützten Literaturrecherche bis 4/2005 wurden Studienergebnisse hinsichtlich Gewichtsveränderungen durch Antidepressiva, Stimmungsstabilisierer/Antikonvulsiva und Antipsychotika übersichtlich zusammengestellt. Ergebnisse: Unter den Trizyklika und Tetrazyklika sind Amitriptylin und Nortriptylin die Substanzen mit der höchsten Wahrscheinlichkeit für Gewichtszunahmen. SSRI erwiesen sich, mit Ausnahme von Paroxetin, das zu leichten Gewichtsanstiegen führt, als gewichtsneutrale Substanzen. Bei Einnahme von MAO-Hemmern ist - mit Ausnahme von Phenelzin, ebenfalls nicht mit deutlichen Gewichtszunahmen zu rechnen. Valproat und Lithium sind in der Gruppe der Stimmungsstabilisierer/Antikonvulsiva die Substanzen mit dem höchsten Potenzial für Gewichtszunahmen. Felbamat und Topiramat waren mit ausgeprägter Gewichtsreduktion verbunden. Clozapin und Olanzapin induzieren häufig starke Gewichtszunahmen, gefolgt von Risperidon. Quetiapin scheint mit nur geringen Gewichtszunahmen verbunden zu sein. Unter Aripiprazol und Ziprasidon kann mit relativ stabilem Gewicht gerechnet werden. Unter klassischen Antipsychotika, die insgesamt geringere Gewichtszunahmen aufweisen als die atypischen, erwies sich Thioridazin als die Substanz mit dem größten Risiko für eine Gewichtszunahme. Mit Pimozid dagegen wurden Gewichtsreduktionen beobachtet. Schlussfolgerung: Die Beurteilung von Gewichtszunahmen wird dadurch erschwert, dass sie zumeist nur als nicht näher quantifizierte Nebenwirkung in den Studien miterfasst wurden, die Gewichtsangaben nicht vereinheitlicht sind und bei einigen Substanzen Langzeitstudien fehlen. Gewichtszunahme ist eine häufig beobachtete und belastende Begleiterscheinung der Therapie mit Psychopharmaka. Einige Substanzen bieten jedoch gewichtsneutrale Alternativen.

Abstract

Objective: The purpose of this study is to give a systematic review of change of weight associated with commonly used psychotropic drugs. Methods: Mainly based on a MEDLINE-supported review until April 2005, data from clinical studies with antidepressants, anticonvulsants, mood stabilizers and neuroleptics were scanned for change of weight during treatment. Results: Among antidepressants amitryptiline and nortriptyline have the highest incidence of weight gain followed by imipramine. Maprotiline and mirtazapine have an intermediate weight increasing potential. SSRI (except paroxetine) and MAOI had no or only slight weight inducing effects. In contrary, bupropion was associated with weight reduction. Regarding mood stabilizers and anticonvulsants, a marked gain in weight with lithium and sodium valproate was reported frequently. With gabapentin and vigabatrin a slight to moderate gain in weight was found. Minor changes of weight were found with carbamazepine and lamotrigine. Treatment with topiramate and felbamate reportedly lead to weight loss. The atypical neuroleptics clozapine and olanzapine were frequently related to a strong gain in weight followed by risperidone. Quetiapine has intermediate effects. Stable weight was found with aripiprazole and ziprasidone. A gain in weight is less frequent with older/typical neuroleptics. Conclusion: Beside some methodological restrictions like inconsistent information of weight changes (e. g. percent vs. mass) and the small sample of available long term studies, this review specifies the incidence of weight changes for commonly used psychotropic drugs and might be helpful to look for alternatives.

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