'Massive' weight gain in kids on atypicals

Another study joins the stack of research linking aytpical antipsychotics to fast-and-furious weight gain. Published today in the Journal of the American Medical Association, the study found that youngsters added 8 percent to 15 percent to their body weight in less than 12 weeks on the drugs. Kids on Eli Lilly's Zyprexa gained an average of 19 pounds at a rate of one-and-a-half pounds per week; patients using Zyprexa's sister meds gained an average of 10 to 13 pounds. In fact, not one of the 257 kids in the study didn't gain weight.

Even though psychiatrists know that this class of drugs--including Zyprexa, Abilify (Bristol-Myers Squibb), Risperdal (Johnson & Johnson) and Seroquel (AstraZeneca)--are linked to weight gain, they were shocked by the numbers. "The weight gain is much larger than we thought," lead author Dr. Christoph Correll told the Wall Street Journal. "It's massive." One doctor told the Associated Press that he could actually see kids grow between appointments.

The study has several implications. One, it's more evidence that the atypicals, once considered vastly superior to first-generation antipsychotics because of a "favorable" side-effect profile, may not be that much better, just different. Rather than risking tardive dyskinesia and akathisia as patients using first-gen antipsychotics are, patients on atypicals risk major weight gain and metabolic changes.

Two, it's hard data illuminating differences among the atypicals. "It's by far the best documentation of not just weight gain and metabolic changes but also suggesting there might be differences among the drugs," Dr. Judith Rapoport, chief of the child psychiatry branch at the National Institute of Mental Health, told the New York Times. 

Three, it may give regulators reason to refuse pediatric indications for Zyprexa and Seroquel, the two meds not now approved for that use. Finally, it could change prescribing habits. Correll hopes so, at least; he told the NYT, "People should think twice before they actually prescribe the medications." Whatever the eventual effects, the study is sure to touch off more debate on the already hotly debated meds.

- see the WSJ story
- check out the coverage in the NYT
- read the AP article
- get an excerpt from an accompanying JAMA editorial

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