Atypical antipsychotics are often associated with detrimental metabolic changes that may influence treatment adherence, quality of life, and mortality. In this meta-analysis, the authors investigated the benefits of switching from one antipsychotic to another with less propensity for metabolic changes. Switching from another antipsychotic to either aripiprazole or ziprasidone was associated with weight reduction and improvement in other metabolic parameters whereas switching to olanzapine or clozapine was associated with weight gain and worsened metabolic outcomes. In contrast, switching to amisulpride, paliperidone, risperidone, quetiapine, or lurasidone had no effect on weight, with the exception of switching from olanzapine to lurasidone, which was associated with weight loss (Figure). These data suggest that, in addition to lifestyle changes and/or augmentation with a weight loss agent such as metformin, switching from another antipsychotic to ziprasidone or aripiprazole (and perhaps from olanzapine to lurasidone) may ameliorate the metabolic effects often seen in patients with psychiatric issues.
Figure. Metabolic Consequences of Switching to Another Antipsychotic
FGA: first generation (conventional) antipsychotic); SGA: second generation (atypical) antipsychotic
Siskind D et al. Schizophr Bull 2021; Epub ahead of print. Abstract