Solutions to Resolve Antipsychotics Leading to Diabetes

It may seem that the solution is to put everyone with psychosis on Geodon and Abilify at first and then move to the more risky antipsychotics if needed. And in fact, that is what Dr. William Wilson, M.D., Professor of Psychiatry and Director, Inpatient Psychiatric Services Oregon Health and Science University recommends.

"I try to start at the bottom with the low metabolic risk drugs," says Dr. Wilson. "I then work my way up- so I start with Abilify, Geodon and Risperdal. I do this with bipolar disorder and schizophrenia, but it's not always possible as some drugs are sedating and some are agitating."

People respond to antipsychotics very, very differently. Some may get a great deal of relief from a drug with a low diabetes risk, while it may be ineffective for others. There is a trade-off. What if an antipsychotic drug with high diabetes risk is truly the best drug for someone? For example, Zyprexa has a very high metabolic syndrome risk and yet it's one of the most effective drugs for agitated psychosis as it has a strong sedating effect before it starts to work effectively. In contrast, Abilify has no known diabetes risk and yet it can be agitating and take time to work in the system.

If someone is acutely psychotic, it's easy to see why Zyprexa may be the first choice. Psychosis can significantly impair a person's ability to function on a basic level in society. Thus, dealing with the psychosis must come first and the risk of diabetes may have to come second.

But if a person is already on a high risk antipsychotic and has gained weight around the stomach, what are the solutions?

Diet and exercise are always the first step in treating weight gain associated with an antipsychotic. It may be possible to get the weight, especially around the stomach to a reasonable level so that a person can continue a medication that works for them. However, since this is not always possible, there are two options that a person can try along with weight management and exercise changes:

1. Talk with your prescriber about Metformin (glucophage), a drug used to help monitor type 2 diabetes blood sugar levels. Recent research has shown a connection between starting Metformin along with a high risk antipsychotic in order to minimize weight gain. This is still in the beginning stages but is definitely something to discuss with your healthcare professional.

2. Switching Antipsychotic Medications: The most effective way to reduce weight gain and thus metabolic syndrome risk from a high-risk antipsychotic is by switching to a less risky antipsychotic. Dr. Peter Weiden, Professor of Psychiatry, University of Illinois at Chicago, writes, "Switching to Geodon or Abilify is the most direct and effective way to reverse weight gain induced by other second-generation antipsychotics (atypicals)."

The problem, as always, is about access to healthcare. Switching takes time and careful monitoring until the person is stabilized on the new drug. It takes a commitment that may not always be possible if the person is psychotic or they are in social services. Dr. Weiden also notes that reducing the dosage isn't effective as it can lead to relapse. Not everyone is a candidate for switching, but it should always be explored if antipsychotic weight gain puts a person at risk for diabetes.