De Riddhita, Prasad Femin, Stogios Nicolette, Burin Luisa, Ebdrup Bjørn H, Knop Filip K, Hahn Margaret K, Agarwal Sri Mahavir
Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.
Institute of Medical Science, University of Toronto, Toronto, ON, Canada.
Expert Opin Pharmacother. 2023 Sep-Dec;24(16):1823-1832. doi: 10.1080/14656566.2023.2254698. Epub 2023 Sep 11.
Psychotropic medications, especially antipsychotics, have been consistently shown to cause weight gain in individuals with severe mental illness (SMI), a population inherently challenged by poor physical health. Consequently, compared to the general population, this contributes to an increased cardiometabolic burden, including the risk of type 2 diabetes, dyslipidemia, and hypertension. Furthermore, comorbid obesity leads to treatment nonadherence, decreased quality of life, and increased risk of relapse, posing a challenge in the management of mental health. To address this, emerging agents investigated in the general population with potential to mitigate weight gain were explored to assess translatability to the SMI population.
A literature search was conducted including agents approved for the management of obesity in the general population, along with upcoming agents under investigation in phase III trials with weight loss properties.
Metformin and topiramate along with lifestyle interventions are commonly prescribed for weight gain in individuals with SMI; however, their weight loss potential is modest at best. This review identified tirzepatide and cagrilintide-semaglutide among others as promising agents for adjunctive pharmacological management of weight gain.
精神药物，尤其是抗精神病药物，一直被证明会导致重症精神疾病（SMI）患者体重增加，而这一人群本身就面临着身体健康不佳的挑战。因此，与普通人群相比，这会增加心脏代谢负担，包括患2型糖尿病、血脂异常和高血压的风险。此外，肥胖合并症会导致治疗依从性降低、生活质量下降以及复发风险增加，给心理健康管理带来挑战。为解决这一问题，研究了普通人群中具有减轻体重增加潜力的新型药物，以评估其对SMI人群的适用性。
进行了文献检索，包括已被批准用于普通人群肥胖管理的药物，以及正在进行III期试验且具有减肥特性的待研究新药。
二甲双胍和托吡酯以及生活方式干预通常用于治疗SMI患者的体重增加；然而，它们的减肥潜力充其量也很有限。本综述确定替尔泊肽和卡格列净-司美格鲁肽等药物是有望用于辅助药物管理体重增加的药物。
