Antipsychotics in Kids, Weight Gain, and Parental Worries
May 8, 2008 by Kristina Chew, PhD
Filed under Adolescence, Charlisms, Education, Health, Medicine, Parenting, Psychiatry, Sensory, clothes
The decision to put an autistic child on medication is never easy for a parent to think about. When the medications in question are antipsychotics (like Risperdal) and antidepressants (like Zoloft), and when the child is disabled and has little or no language to explain how he feels while on the meds, a parent has to proceed with caution. Weight gain is a frequently reported side effect of taking Risperdal and a new study on the use of antipsychotic medications in children indicates that taking these drugs results in an almost immediate increases in body mass index (BMI) and triglyceride levels, as reported in the May 7th WedMD. John Newcomer, MD, the Washington University School of Medicine in St. Louis, presented preliminary research from a study of children taking Zyprexa, Risperdal, or Abilify at the annual meeting of the American Psychiatric Association:
So far, 50 children ages 7 to 18 have completed the 12-week study. The children suffer from a wide range of ailments, including autism and pervasive developmental disorder. They were prescribed one of three medications: Zyprexa, Risperdal, or Abilify.
“Virtually 100% of the kids exposed to the medications had some degree of increase in body fat,” Newcomer tells WebMD.
Specifically, the kids were in the 64th percentile of BMI for their age at the start of the study. By 12 weeks later, they were in the 77th percentile on the growth curve, he says. And their triglyceride levels shot up 20 points.
Preliminary results suggest Zyprexa causes the greatest changes in body fat and lipids, and Abilify the least.
Charlie started taking Zoloft for anxiety a few years ago, after we noted to his pediatric neurologist that he sometimes head-banged because he was anxious and fretful. A year later, Charlie started taking Risperdal, as his self-injurious and aggressive behaviors were increasing, and to the point that he was becoming dangerous to others, and to himself. Almost immediately after starting the Risperdal, Charlie’s appetite increased significantly and he gained a significant amount of weight, to the point that he was not able to swim as well and seemed sometimes to be physically uncomfortable from being heavier.
We went out of our way to make sure that Charlie got some physical exercise every day, such as swimming and biking, and made sure there were lots of fruits and vegetables around the house (Charlie developed his love of watermelon and frozen edamame around this time). We have been able to keep Charlie on low doses of both medications thanks to finding him a good school program, which has taught him to deal with his anxiety and worries in other ways besides self-aggression. An attempt to take Charlie off Zoloft resulted in an almost immediate increase in aggression and anxiety.
There really is no magic pill and things still happen out of the blue. For instance, yesterday morning, Jim was getting Charlie ready to catch the bus; Jim said something like “let’s put on this cool new sweatshirt” and it was bang bang bang, and I was running to get ice out of the freezer. Jim got Charlie down the stairs crying very loudly; I held the ice on his forehead and he knocked it out of my hand. We stowed the new, lightweight hooded sweatshirt from my mom in Charlie’s backpack and the bus pulled up.
“Transitioning out of the winter coat,” I said to the bus driver, who nodded (she’s noted that, despite the rising temperatures, Charlie has been insistent on wearing his heavy blue fleece coat with the hood pulled all the way over his head.)
When I got to work, I had an email from Charlie’s teacher: Red mark, crying crying. I wrote back about what had happened and another email came around 11.30: Rough day, Charlie would not seem to get something out of his mind.
As I drove home, I remembered: The night before, I had washed Charlie’s blue fleece coat. I had hung it over a kitchen chair to finish drying, which meant that the coat was not in its usual (reassuring) spot in the living room. Which meant that Charlie concluded, he no longer had his coat. I called Jim who immediately said, “Wow, I felt odd when I didn’t see the coat this morning!”
Charlie came off the bus wearing his new, lighter blue sweatshirt. I had placed his fleece coat on a chair and he went over to it and dropped it on the floor, just so. He quietly agreed to put on the new sweatshirt when we went for a walk. It has a kangaroo style pocket in the front and he walked with both hands in it, pulling down the sweatshirt so that the hood was right over his head, and his smiling face.
Jeff Stimpson
Jill Cornfield
It was rainy here this morning and Matt went to school in long sleeve shirt and light jacket. It was hard to go back to long sleeves after wearing short sleeves for many days.
When it hit 95 twice last week he wore shorts to school and he tried to pull them down all the way like pants.
We keep extra pants, shirt and socks in backpack and I on warmer days I put in shorts but sometimes the aide just does not change him thinking it is not cold and I walk into classroom and feel so warm.
I also read about Risperdal causing early puberty in girls and boys. Matt was on liquid Risperdal for almost a year and has been on Geodon capsules for several years now.
Hello friends -
If nothing else, it is evidence of a gut-brain axis!
Kidding aside, can anyone give me an overview of the mechanism behind anti depressants / antipsychotics and weight gain?
We have been trying to transition Matty to summer items too. We have been successful with the jacket. Shorts have been another story. He happily puts them on for me. Five minutes later he is in his room throwing sweats over them. Our temps are now in the 80’s so he needs to adjust soon or we will be dealing with heat rash!
There is a girl in the Special Olympics that is on anitpsychotics. She has a general good mood every time I see her. She did gain weight due to her medications, which also make her “jittery” (her words). Because of the weight gain, she now has Type II diabetes. Most diabetics will tell you “jittery” is one of their primary warning signs of hypoglycemia. So the antipsychotics have caused her to have medical conditions that may shorten her life and have created physiological effects making controlling her medical condition worse. Her mother told me that in the long run she doesn’t know if it is better or worse for her daughter in the long run to be on the medication.
Hi everyone!
I found this article, which says that they are narrowing in on a relationship between antipsychotics and weight gain.
It seems some classes of drugs are also capable of blocking receptor sites for histamine; and doing so results in an increase in another neurotransmitter that has been implicated in appetite.
http://www.medicalnewstoday.com/articles/62905.php
This article didn’t go into depth as to how blocking histamine resulted in an increase in the other chemical; I’m not sure if they know and didn’t include in a press style story, or just plain don’t know yet. Either way, interesting observations. I’d bet there are other sites that could be blocked, or attached to that could cause similar reactions.
OK!
- pD
Unfortunately, one does not have a lot of “choices” when seeking ways to help a child not have frequent and regular self-injurious behaviors. We have been fortunate in being able to watch Charlie’s diet and keep him very physically active.
I think I’ve got to be the only person on the planet who lost weight on Risperdal. But I wasn’t on it very long and am ridiculously active anyway…and my median blood sugar has never been higher than 90, ever.
Charlie’s dose just increased slightly and he has not been eating more—he’s tall and lanky these days.
Brendan definitely gained weight when we started him on seroquel 4 years ago to help him cope with OCD anxiety. There is no way he could function without it, although it has taken me a very long time to get over the idea that we’ll just “wean him off it” any day now… without it (& zoloft, & clonapin) he would not be able to function at all. Even with these meds he has “screaming fleas” (his name for anxiety attacks) nearly every day. The great thing is that he’s to the point developmentally where he is learning to deal with his anxiety by using strategies like distraction, deep pressure (from someone else or by pushing on a table), stress relievers like his “endless bubblewrap” gadget from Japan, worry beads, etc… I see the meds as having given him enough relief from the anxiety that he could learn these methods, & these are his best hope for managing life without meds… so it’s reciprocal.
We’ve made sure he gets regular exercise, eats a healthy diet & only gets potato chips (which he adores) as a special treat (but he does get to have them sometimes). We know that his triglycerides are elevated, as is his BMI, but his pediatrician has told us that she doesn’t worry nearly as much about kids with medicine-induced issues like these (compared to kids with the genetic tendencies) because they’ll go away when the medicine is discontinued. He is remarkably un-self-conscious about his weight & has no trouble wearing a swimsuit- which is great because his main physical activities are swimming & fencing.
An interesting thing Brendan’s psychiatrist told me recently is that, as he gets older, it’s likely that Brendan will need less seroquel (rather than gradually increasing the doses as we have over the past few years, to keep up with his growth). The reason is that the liver of a child processes the seroquel more efficiently than that of a teen & adult, so it doesn’t hang around in a child’s system as long as it does in an adult’s. He’s been on the same dosage for at least 6 months now, so we may be seeing the beginning of this phenomenon. It’s a big relief! But the biggest relief is watching Brendan slowly, but surely, get a handle on the anxiety…
Liz Ditz has been telling me to check out your blog for aeons, as she says your son is a lot like mine. It is good to read about your successes with Charlie’s weight management, and reassuring to see your methodical and cautious approach to medications. As for the jacket: very much understood. We are in a black shirt only phase right now. My son even tracks his classmates’ spare clothes stashes and will steal one of theirs if he has to.
@Shannon, Great to hear from you—loved meeting Liz last December! I’ve been checking in with Leelo for a while…..
@Lisa/Jedi,
Your last point about children needing a lower dose intrigues me. We upped Charlie’s dose just slightly and, to my surprise, there was increase in Charlie’s appetite, as there has been when we increased dosages in the past. Deep pressure helps Charlie a lot too—he still wraps himself in his fleece blankets soon after coming home.
I have four year old twins that are autistic and mrdd. The specialists, teachers, and others have mentioned meds. Originally I was totally against it but, lately due to their behavior getting worse i wonder if it may help them be able to go out in public better such as swimming, bowling….I would love to hear feedback.
thank you,
Jalayne