Recent years have brought much concern over the effects of antipsychotics on metabolic parameters in the youth population, especially since antipsychotics are often used off-label to treat a wide variety of issues (e.g., disruptive behavioral disorder) in children and adolescents. This 12-week study involving 144 antipsychotic-naïve participants (age 6 to 18 years) is the first of its kind to systematically and directly measure metabolic changes in response to treatment with commonly prescribed atypical antipsychotics (risperidone, olanzapine, and aripiprazole). The study authors measured total body fat by a direct process called dual-energy x-ray absorbptiometry (DXA), insulin sensitivity using hyperinsulemic clamps and labelled tracers, and abdominal adiposity using MRI and found that all 3 tested antipsychotics affected metabolic parameters, with olanzapine having the greatest effects (Figure). All 3 treatments were equally effective in improving therapeutic endpoints (in this case, improvements in irritability, aggression, and other behavioral issues). Given that increases in total body fat, reduced insulin sensitivity, and increased abdominal adiposity, especially at a younger age, can greatly increase the risk for type 2 diabetes as well as other serious cardiometabolic problems, great caution is warranted when prescribing these agents, especially off-label, in the youth population. The fact that all 3 treatments were equally efficacious but had varying degrees of adverse metabolic effects also advises careful risk-benefit analysis when choosing which antipsychotic may be best for the individual pediatric patient.
Reference:
Nicol GE et al. JAMA Psychiatry 2018;75(8):788-96. Abstract.
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