Discuss about the Olanzapine Psychotropic Medication and Weight Gain.
Olanzapine, formerly known as Zyprexa is a US Food and Drug Administration (FDA)-approved antipsychotic medication for the treatment of bipolar disorder and schizophrenia disorders. Olanzapine, which falls in the category of thienobenzodiazepine is a dopamine antagonist medicine marketed and manufactured by the Eli Lilly and Company Pharmaceautical Company. Before going generic in 2011, the medicine had already gained popularity because it had realized a total sale of $4.7 billion globally and $2.2 billion within the US alone (Correll, Sikich, Reeves & Riddle 2013). Although the medicine has been credited with the treatment of bipolar and schizophrenia disorders, Olanzapine has been faulted because of several side effects such as weight gain on the users. This paper presents a critical analysis of the effects of Olanzapine on weight gain. It focuses on how the medication causes weight gain and goes ahead to analyze how the situation can be managed and prevented.
Despite the fact that Olanzapine has been glorified for being effective in causing insignificant extrapyramidal impacts and mental impairments on the bipolar and schizophrenia patients, it has been associated with a number of side effects such as weight gain. A large number of patients using the drug have reported weight gain. In fact, the medicine has a higher incidence of weight gain. Its users often complain of at least 7% increase in the body weight. According to previous research, the medicine causes weight gain because of its H1 receptor or potent 5-HT2C receptor (Brunner, Tohen, Osuntokun, Landry & Thase 2014).
When an individual uses the medicine, the body weight increases. Although it is one of the most important psychiatric drugs in the market, Olanzapine has been proved to be one of the most troublesome medications when it comes to weight gain. Since the rate of weight gain varies from each person, it might not be possible to exactly estimate the accurate amount of weight gained as a result of the drug usage. Various factors such as lifestyle, medication regimen, and genetic profile play a significant role in determine the rate of weight loss in each person. Nevertheless, scientists have found out that the average Olanzapine-induced weight gain ranges from 61 lbs to 13 lbs within a period of 2 years. Research has established that the Olanzapine because of the several metabolic changes in introduces to the body of the users. These include the following:
Appetite Increase: One of the changes introduced into the body by Olanzapine is increase in appetite. Scientific research has proven that the use of the medication makes people to feel so hungry and then eat a lot of food. Sometimes, the rate of hunger is so high to the extent that individuals are compelled to eat every now and then (Brunner, Tohen, Osuntokun, Landry & Thase 2014). In fact, the situation can be worse to the extent that it forces people to wake up in the middle of the night to look for some food to eat. By encouraging people to eat a lot, the medication directly contributes to weight gain since a person with such an appetite might not have time to make a choice on food, but bumps on anything so long as it can address the problem of ravaging hunger.
Blood Sugars: When used to treat the psychiatric disorders, Olanzapine can contribute to the rise in the level of glucose in the blood. The rise in the level of blood sugar brings changes in body metabolism that eventually results in weight gain. Failure to regulate the level of blood sugar in the body obviously leads to increase in body weight. So, if this persists, an individual can be affected by diabetes (Amiaz, Rubinstein, Czerniak, Karni & Weiser 2016). Meaning, Olanzapine is a medication that has a potential of causing diabetes to those who are using it. There is a direct relationship between blood sugar and body weight. In fact, the problem of blood sugars, if not addressed in time, can result into obesity.
Fat Build-Up: One of the functions of the body is to store fat. Fatty acids are important components of diet because they play a significant role in supplying the body with the energy required to at all times. Although the body has a mechanism for fat storage, it changes during medication because of the influences of Olanzapine (Tohen 2015). As established by the previous researchers, the presence of Olanzapine changes the way in which fat is stored in the body in different ways. First, it leads to the storage of large quantities of fat. Besides, it changes the storage points to unusual body parts such as breasts rather than the ordinary storage parts. All these result into increase in the body weight.
Food Cravings: As already highlighted, Olanzapine increases appetite. While it may be an ordinary desire for food by some people, others might experience a high level of hunger. When this happens, they develop a high demand of food. Once an individual has a craving desire for food, they can end up eating anything they come across without considering whether it is appropriate or not (Daurignac, Leonar & Dubovsky 2015). Some people even develop a craving desire for the foods that they have never been using before. This kind of behavior can result into weight gain for those who resort to consuming too much sugars and carbohydrates because of the use of Olanzapine.
Taste Improvement: Olanzapine does not only cause food craving and boost appetite, but also improves tastes. When an individual’s taste incredibly increases, they get the urge for more food and tend to eat a lot. However, this may expose one to weight gain because the more the taste improves, the higher the chances of consuming certain food products that can make one vulnerable to weight gain. For example a person who eats a lot of sugary foods after using the drug is likely to experience increase in body weight. So, in this case, it is only those who adopt a proper diet that can minimize the chances of weight gain even if they notice a change in their taste (Kloiber, Domschke, Ising, Arolt, Baune, Holsboer & Lucae 2015). Otherwise, they might find it hard to regulate the kinds of foods to eat in response to the improved taste.
Social Eating: One of benefits of Olanzapine is that it gives people an opportunity to address the psychiatric disorders and become sociable just like the rest of the normal people. Should this happen, one becomes quite interactive with many people, a social behavior that might lead them to go out on picnics and celebrations in which large portions of food are consumed (Zheng, Li, Tang, Xiang, Wang & de Leon 2015). Unfortunately, this results into weight gain because of the likelihood of overuse of unhealthy diets. It is always not easy for the people in a celebratory mood to make a proper choice of the kind of foods to eat. So, in this case, it becomes inevitable to tame weight gain since the main focus is on the quantity, not quality of the food eaten.
Gut Bacteria: Every human being has gut microbiome because of the important role it plays in the digestive system. One way through which the Olanzapine result into increased body weight is because of the manner in which it affects the normal functioning of the gut bacteria. When used in the body, Olanzapine disrupts and seriously interferes with the metabolic activities of the body. Such disruptions bring changes that make it difficult for the metabolic system to function and check on the weight (Kloiber, Domschke, Ising, Arolt, Baune, Holsboer & Lucae 2015). This makes the individuals who are using the drug to become unable to control their body weight since every body system is not operating in the way it ought to.
Hormones: When used to treat the mental disorders, Olanzapine is known to be having a direct impact on the body hormones. This happens mainly because the drug has been associated to the fluctuation in the level of various body hormones. Should that happen, body weight can increase. For instance, when used for some time, the drug can lead to the fluctuation of the levels of a hormone called prolactin which is known to be having a direct impact on the levels of testosterone in the body (Zheng, Li, Tang, Xiang, Wang & de Leon 2015). By altering the levels of these hormones, Olanzapine contributes to the occurrence of weight gain by the drug user. For a normal functioning of the body, these hormones should always be stable without unnecessary fluctuations.
Increased Thirst: Apart from causing hunger, Olanzapine has been attributed to making the users thirsty. Even if thirst should be ordinarily addressed by drinking water many people might be tempted to resorting to flavorful liquid food products like soup, soda, or juice to use in quenching the thirst instead of water. Once a person using the medication starts using these food products to quench thirst, it may develop to be a normal habit (Biedermann, Fleischhacker, Kemmler, Ebenbichler, Lechleitner & Hofer 2014). The more this is done, the higher the chances of increasing the body weight because such flavors have food contents such as sugars that negatively impact on the body metabolism process.
Metabolism: Olanzapine also contributes to weight gain by altering the normal functioning of the body. Precisely, when used in the body to treat the mental disorders, the drug leads to a decrease in the rate of metabolism. The lowering of body metabolism has a potential of increasing body weight because it makes it challenging for all the body mechanisms to operate in a normal way (Almandil, Liu, Murray, Besag, Aitchison & Wong 2013). Metabolic activities in the body should always run in the right speed without any interference. So, when it is lowered, a drug user can get higher chances of increasing the body weight even if all the other measures such as healthy diet are observed.
Inactivity: When used as a drug, olanzapine can make an individual to be physically inactive. The level of inactivity is fastened by the side effects of the drug such as sleepiness, drowsiness, and fatigue. Physical inactivity can be dangerous when an individual is still under medication because, amongst other effects, it slows the rate of body metabolism (Simpson, Glick, Weiden, Romano & Siu 2014). A physically inactive individual is likely to gain weight because of lack of ability to burn calories.
Although olanzapine use has a potential of increasing body weight, it should be noted that the extent of weight gain is not constant because it varies depending on individual unique factors such as lifestyle, dosage, length of medication period, and the effects of other medications used alongside olanzapine. Dosage, for example, has a direct impact on weight gain. Drug users are expected to use a recommended dose of 20 mg. however, when this is surpassed, one is likely to gain weight because the higher the dosage, the higher the chances of gaining weight (Evers, van Vliet, van Vugt, Scheurink & van Dijk 2016). Lifestyle, on the other hand, impacts on the rate of weight gain because it is higher in those who have unhealthy lifestyles such as poor diet, less sleep, and lack of physical exercises. When it comes to the duration of drug use, it should be noted that the longer the period, the higher the chances of gaining weight because of tolerance.
The fact that olanzapine impacts on the body weight do not imply that such psychotropic-induced weight gain cannot be managed. However, it should be acknowledged that the situation can be handled if appropriate strategies are put in place to manage and prevent it. These are discussed herein:
First and foremost, olanzapine-induced weight gain can be minimized and eliminated by making a proper choice of the drug. It can be advantageous if the weight gain-inducing medications are avoided at all costs. When a patient seeks for medical prescription from a psychiatrist, the clinician should thoroughly assess the patient before coming up with the most appropriate psychotropic drug that can help the patient to prevent weight gain. For instance, when given an option of selecting from Ziprasidone, Paroxetine, aripiprazole, mirtazapine or bupropion; the latter should be preferred because it does not increase body weight (Montgomery, Treuer, Ye, Xue, Wu, Liu, Kadziola, Stensland & Ascher-Svanum 2014). Proper choice of medication can help a patient to address the challenge of weight gain and deal with it in a timely manner.
Secondly, the problem of weight gain can be dealt with by switching drug usage in the course of treatment. Since there are many alternative medications, a patient should not be compelled to stick to one particular drug if it is not effective in meeting all the conditions of antipsychotic medications (Simpson, Glick, Weiden, Romano & Siu 2014). A. So, when the use of olanzapine is found to have resulted into unnecessary weight gain, its usage should be stopped forthwith before a more suitable alternative medication is gotten. However, when switching a patient from one medication to another, the clinician should ensure that all the challenges that might arise as a result of drug interactions, relapse, withdrawal as well as additive adverse effects are addressed without exposing the patient to further dangers.
Last, but by no means the least, olanzapine-triggered weight gain can be addressed by the provision of non-pharmacologic interventions to psychiatric patients. When it is discovered that the use of olanzapine can inconvenience the patient by increasing the body weight, the clinician is free to resort to the use of non-pharmacological interventions such as exercise programs, nutrition counseling, and cognitive and psychological therapy. If properly utilized, these interventions can help in preventing weight gain or reduce the chances of weight gain for those who are already under psychotropic medications (Almandil, Liu, Murray, Besag, Aitchison & Wong 2013). Lifestyle changes, diet usage and physical activities are known to be the remedial measures for weight gain. A patient who is adequately guided on these areas can learn how to battle psychiatric disorders without necessary gaining weight.
Conclusion
Olanzapine has been approved by the FDA because of its ability to treat bipolar disorder and schizophrenia disorders. If properly used, the medication can help in addressing the cognitive, behavioral and psychological challenges posed by the disorders. However, as much as much as Olanzapine is commended for its contributions, a lot of caution should be taken because of its side effects notably weight gain, which results from the drug’s effects on appetite, hormones, thirst, fat build-up, and metabolism. Nevertheless, the problem of weight gain can be dealt with by avoiding the drug, switching its usage and application of non-pharmacological interventions. Hence, when using the medication, it is recommended to weigh its pros and cons before determining if it is really appropriate for the intended treatment.
References
Almandil, N.B., Liu, Y., Murray, M.L., Besag, F.M., Aitchison, K.J. and Wong, I.C., 2013. Weight gain and other metabolic adverse effects associated with atypical antipsychotic treatment of children and adolescents: a systematic review and meta-analysis. Pediatric Drugs, 15(2), pp.139-150.
Amiaz, R., Rubinstein, K., Czerniak, E., Karni, Y. and Weiser, M., 2016. A Diet and Fitness Program Similarly Affects Weight Reduction in Schizophrenia Patients Treated with Typical or Atypical Medications. Pharmacopsychiatry, 49(03), pp.112-116.
Biedermann, F., Fleischhacker, W.W., Kemmler, G., Ebenbichler, C.F., Lechleitner, M. and Hofer, A., 2014. Sibutramine in the treatment of antipsychotic-induced weight gain: a pilot study in patients with schizophrenia. International clinical psychopharmacology, 29(3), pp.181-184.
Brunner, E., Tohen, M., Osuntokun, O., Landry, J. and Thase, M.E., 2014. Efficacy and safety of olanzapine/fluoxetine combination vs fluoxetine monotherapy following successful combination therapy of treatment-resistant major depressive disorder. Neuropsychopharmacology, 39(11), pp.2549-2559.
Correll, C.U., Sikich, L., Reeves, G. & Riddle, M., 2013. Metformin for antipsychotic-related weight gain and metabolic abnormalities: when, for whom, and for how long?. American Journal of Psychiatry, 170(9), pp.947-952.
Daurignac, E., Leonard, K.E. & Dubovsky, S.L., 2015. Increased lean body mass as an early indicator of olanzapine-induced weight gain in healthy men. International clinical psychopharmacology, 30(1), pp.23-28.
Evers, S.S., van Vliet, A., van Vugt, B., Scheurink, A.J. and van Dijk, G., 2016. A low TSH profile predicts olanzapine-induced weight gain and relief by adjunctive topiramate in healthy male volunteers. Psychoneuroendocrinology, 66, pp.101-110.
Kloiber, S., Domschke, K., Ising, M., Arolt, V., Baune, B.T., Holsboer, F. and Lucae, S., 2015. Clinical risk factors for weight gain during psychopharmacologic treatment of depression: results from 2 large German observational studies. The Journal of clinical psychiatry, 76(6), pp.802-808.
Montgomery, W., Treuer, T., Ye, W., Xue, H.B., Wu, S.H., Liu, L., Kadziola, Z., Stensland, M.D. & Ascher-Svanum, H., 2014. Does participation in a weight control program also improve clinical and functional outcomes for chinese patients with schizophrenia treated with olanzapine?. Neuropsychiatric disease and treatment, 10, p.1287.
Simpson, G.M., Glick, I.D., Weiden, P.J., Romano, S.J. and Siu, C.O., 2014. Randomized, controlled, double-blind multicenter comparison of the efficacy and tolerability of ziprasidone and olanzapine in acutely ill inpatients with schizophrenia or schizoaffective disorder. American Journal of Psychiatry.
Tohen, M., 2015. Psychotropic Agents and the Prediction of Weight Gain. The Journal of clinical psychiatry, 76(11), pp.1474-1475.
Zheng, W., Li, X.B., Tang, Y.L., Xiang, Y.Q., Wang, C.Y. & de Leon, J., 2015. Metformin for weight gain and metabolic abnormalities associated with antipsychotic treatment: meta-analysis of randomized placebo-controlled trials. Journal of clinical psychopharmacology, 35(5), pp.499-509.
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