Choosing Psychiatric Medications for Patients with Metabolic Concerns

Key Points

• Psychiatric medication choices profoundly affect metabolic health and should be a primary consideration, not an afterthought
• Many effective psychiatric medications are weight-neutral or even promote weight loss
• Antipsychotic-induced weight gain can and should be prevented or treated aggressively, not accepted as inevitable
• Switching from weight-gaining to weight-neutral medications is often successful when done carefully
• Proactive metabolic monitoring and intervention prevent serious complications
• The goal is psychiatric stability AND metabolic health, not one at the expense of the other

One of the most frustrating patterns I see in psychiatric practice is the acceptance of medication-induced weight gain as an inevitable tradeoff for mental health improvement.

A patient comes in on an antipsychotic that’s working beautifully for their bipolar disorder or schizophrenia. Their psychotic symptoms are controlled. Their mood is stable. But they’ve gained 60 pounds in a year. They’ve developed prediabetes. Their self-esteem is shattered. They’re experiencing new physical health problems and side effects from the weight gain.

This is unacceptable.

We have options. We have weight-neutral psychiatric medications for most conditions. We have strategies for preventing and treating medication-induced weight gain. We have ways to maintain psychiatric stability while addressing metabolic health.

The idea that we must choose between mental health and metabolic health is false. We can and should pursue both simultaneously.

Let me walk you through how I approach psychiatric medication selection and management for patients with metabolic concerns. This isn’t just about avoiding weight gain – it’s about choosing medications that support overall health while effectively treating psychiatric conditions.

The Metabolic Impact of Psychiatric Medications: What We Know

Before discussing specific medications, let’s understand the scope of the problem.

Antipsychotics are the worst offenders. Second-generation (atypical) antipsychotics cause significant weight gain and metabolic dysfunction in many patients. The mechanisms include:

• Antagonism of histamine H1 receptors, which increases appetite
• Antagonism of serotonin 5-HT2C receptors, which affects satiety signaling
• Effects on hypothalamic regulation of appetite and metabolism
• Insulin resistance independent of weight gain
• Changes in fat distribution favoring visceral adiposity
• Alterations in lipid metabolism

The magnitude varies dramatically by medication. Olanzapine and clozapine are the worst, with average weight gains of 10-15 pounds or more over 10 weeks in clinical trials. Real-world weight gains are are sometimes much higher – 40, 50 lbs over longer periods.

Risperidone and quetiapine are intermediate. Aripiprazole and ziprasidone are much more weight-neutral. Lumateperone and cariprazine appear relatively weight-neutral based on available data.

Antidepressants vary widely. Some antidepressants cause weight gain, others are weight-neutral, and some promote weight loss.

SSRIs show variable effects. Paroxetine is the most likely to cause weight gain – significant in many patients. Citalopram and escitalopram cause modest weight gain in some patients. Sertraline and fluoxetine are more weight-neutral, with fluoxetine sometimes causing slight weight loss initially.

The mechanism for SSRI-related weight gain isn’t entirely clear but likely involves effects on appetite regulation, possibly histamine receptor effects for some (paroxetine), and metabolic changes.

Mirtazapine causes significant weight gain in many patients, likely due to strong H1 antagonism. Average weight gain is 7-10 pounds over several months, but some patients gain much more.

Tricyclic antidepressants (TCAs) generally cause weight gain, with amitriptyline, nortriptyline, and imipramine being particularly problematic.

MAOIs can cause weight gain, though this varies by specific medication and individual.

Bupropion is weight-neutral or causes slight weight loss. It’s the only antidepressant consistently associated with weight loss rather than gain.

Mood stabilizers present challenges.

Lithium causes weight gain in many patients – average around 10-15 pounds, but highly variable. Some patients gain much more.

Valproate (Depakote) causes significant weight gain – often 10-20+ pounds. It’s particularly problematic for metabolic effects.

Carbamazepine causes modest weight gain in some patients.

Lamotrigine is relatively weight-neutral – one of the better options for bipolar disorder from a metabolic perspective.

Anxiety medications are generally weight-neutral. Benzodiazepines don’t typically cause weight gain directly. Buspirone is weight-neutral. Gabapentin sometimes causes weight gain. Pregabalin can cause weight gain in some patients.

ADHD medications are generally weight-neutral or suppress appetite. Stimulants (methylphenidate, amphetamines) often cause appetite suppression and slight weight loss. Atomoxetine is weight-neutral. Viloxazine appears weight-neutral. Bupropion (also used off-label for ADHD) is weight-neutral or causes slight weight loss.

The metabolic consequences extend beyond weight. Medication-induced weight gain isn’t just cosmetic. It leads to:

• Increased risk of type 2 diabetes
• Worsening lipid profiles
• Increased cardiovascular risk
• Sleep apnea
• Joint problems
• Worsening depression and anxiety from body image distress
• Reduced quality of life
• Medication nonadherence when weight gain becomes intolerable

These consequences are serious and affect both physical and mental health profoundly.

Medication Selection Philosophy: Metabolic Effects Are Primary Considerations

For any psychiatric condition, I ask: What are the effective treatment options, and among those options, which have the most favorable metabolic profile?

This doesn’t mean I always choose the most weight-neutral option. Sometimes there are compelling reasons to use a medication with more metabolic risk. But metabolic effects are part of the primary decision-making, not something I consider only if the patient complains about weight gain later.

For depression in patients with metabolic concerns:

My first-line choice is almost always bupropion. It’s effective for depression, weight-neutral or causes slight weight loss, helps with energy and focus, doesn’t cause sexual side effects. For patients with both depression and obesity, it’s ideal.

The main limitation is that bupropion doesn’t help anxiety – it can sometimes worsen anxiety initially. For pure depression or depression with low energy, it’s excellent. For anxious depression, I need other strategies.

If bupropion isn’t appropriate or sufficient, I consider SSRIs, choosing carefully. Sertraline or fluoxetine are my preferences within this class from a metabolic perspective. I avoid paroxetine in patients with weight concerns.

I rarely use mirtazapine in patients with obesity or metabolic concerns unless nothing else has worked and the sedating effects are specifically needed. The weight gain is too problematic.

For treatment-resistant depression in patients with obesity, I’m increasingly considering low-dose tirzepatide as an augmentation strategy rather than adding a second antidepressant that might worsen metabolic parameters.

For bipolar disorder:

This is more challenging because mood stabilizers are essential, and many cause weight gain.

Lamotrigine is my preferred mood stabilizer from a metabolic perspective. It’s weight-neutral and effective for bipolar depression and maintenance. The limitation is it’s not helpful for acute mania.

For acute mania, if an antipsychotic is needed, I choose carefully. Aripiprazole or cariprazine are my preferences – effective for mania with much less metabolic risk than olanzapine or risperidone.

Lithium is sometimes necessary and highly effective. The weight gain is problematic but often less severe than with valproate or antipsychotics. If someone needs lithium for mood stabilization, we use it but monitor metabolic effects carefully and use proactive interventions to minimize weight gain.

I avoid valproate in patients with obesity whenever possible. The weight gain and metabolic effects are too significant.

For anxiety disorders:

Most anxiety medications are weight-neutral, which makes this easier.

SSRIs (again, preferring sertraline or fluoxetine over paroxetine), SNRIs, buspirone, gabapentin, even benzodiazepines when appropriate – none of these typically cause significant weight gain.

For anxious depression, I often use sertraline or escitalopram. If someone has both anxiety and binge eating or obesity, low-dose tirzepatide can be helpful for the anxiety-eating connection while we use weight-neutral psychiatric medications.

For ADHD:

This is straightforward from a metabolic perspective. Stimulants and non-stimulant ADHD medications are generally weight-neutral or cause appetite suppression.

Bupropion is sometimes used off-label for ADHD, particularly in adults with comorbid depression. This provides dual benefits without metabolic concerns.

For psychotic disorders and severe bipolar disorder:

This is the most challenging area because antipsychotics are often essential, and the most effective antipsychotics for severe symptoms (clozapine, olanzapine) cause the most severe metabolic effects.

When antipsychotics are necessary, I choose the most metabolically favorable option that will be effective for the specific presentation. Aripiprazole, cariprazine, ziprasidone, lumateperone – these are my first-line choices when appropriate for the clinical situation.

If someone needs olanzapine or clozapine because nothing else controls their symptoms, we use it. But we implement aggressive metabolic prevention and intervention strategies from day one. Metformin, potentially low-dose tirzepatide, intensive lifestyle support, very close metabolic monitoring.

The goal is never to just accept massive weight gain as inevitable. We’re proactively preventing and treating it while maintaining psychiatric stability.

When to Switch Medications: The Risk-Benefit Calculation

Many patients come to me already on psychiatric medications causing metabolic problems. The question becomes: should we switch to more metabolically favorable options?

When switching makes clear sense:

The medication is causing significant weight gain or metabolic dysfunction, AND the psychiatric condition is stable or could reasonably be managed with a different medication with better metabolic profile.

For example: Someone stable on paroxetine for depression who’s gained 25 pounds. Switching to bupropion or sertraline makes sense. The new medication can treat depression effectively while being more metabolically favorable.

Someone on low-dose risperidone for mood stabilization in bipolar disorder who’s gained 40 pounds. If their mood has been stable, trying to transition to lamotrigine plus a small amount of aripiprazole or continuing lamotrigine alone might maintain stability with better metabolic outcomes.

When switching is more complicated:

The psychiatric condition is severe or recently unstable, OR previous medication trials have failed and the current medication is the first thing that’s worked.

Someone with schizophrenia who’s tried multiple antipsychotics and only achieved stability on olanzapine. Switching to aripiprazole might destabilize them. Here, we have a more difficult risk-benefit calculation.

In these cases, I usually don’t switch immediately. I stabilize their metabolic health on the current medication using proactive interventions (metformin, low-dose tirzepatide, intensive lifestyle support). Once their metabolic parameters are improving and they’re psychiatrically stable, we might cautiously try transitioning to a more weight-neutral antipsychotic.

But if the olanzapine is the only medication that’s kept them out of the hospital, and we can manage their metabolic health adequately with interventions, continuing olanzapine while aggressively treating metabolic effects might be the best option.

How I approach medication switches:

Careful, gradual, with close monitoring. I don’t abruptly stop one medication and start another.

Typical approach: Start the new medication at a low dose while continuing the old medication. Gradually increase the new medication while slowly tapering the old one. Monitor psychiatric symptoms closely throughout.

Have a plan for what we’ll do if symptoms worsen during the transition. Sometimes this means increasing the new medication faster. Sometimes it means slowing or stopping the taper of the old medication. Sometimes it means going back to the old medication and trying different metabolic interventions instead.

I’m transparent with patients about the risks of switching. Psychiatric destabilization is possible. We need close monitoring and good communication about any symptom changes.

But I’m also clear that staying on a medication causing severe metabolic dysfunction has its own serious risks. Diabetes, cardiovascular disease, worsening mental health from weight gain – these aren’t trivial. We’re weighing risks and benefits in both directions.

Success rates vary:

For depression medications, switching is usually quite successful. Bupropion, sertraline, and escitalopram are all effective antidepressants. Most patients can transition between them without major problems.

For mood stabilizers, success depends on the specific situation. Transitioning from lithium to lamotrigine, or adding lamotrigine while reducing lithium, often works well for maintenance treatment. Transitions involving antipsychotics for bipolar disorder are more variable.

For antipsychotics in schizophrenia or severe bipolar disorder, success is less predictable. Some patients transition beautifully from risperidone or olanzapine to aripiprazole and maintain stability with better metabolic outcomes. Others destabilize and need to return to the more metabolically problematic medication.

The key is trying when the potential benefit is significant, monitoring closely, and having a good plan for managing problems if they arise.

Preventing Antipsychotic-Induced Weight Gain: Proactive Strategies

Since antipsychotics are often necessary for severe mental illness, and they cause the most significant metabolic problems, preventing weight gain from the start is crucial.

The evidence supports proactive intervention.

Studies of metformin initiated at the same time as antipsychotics show it prevents much of the weight gain that would otherwise occur. Starting metformin with the antipsychotic is more effective than waiting until significant weight gain has already happened.

The same principle applies to lifestyle interventions. Intensive behavioral weight management started at antipsychotic initiation prevents more weight gain than starting after weight has already increased.

My approach when starting an antipsychotic with high metabolic risk:

I have a conversation about metabolic risks before starting the medication. Not to scare the patient, but to be transparent about what we’re dealing with and our plan to manage it.

I establish baseline metabolic parameters: weight, waist circumference, blood pressure, fasting glucose and lipids, inflammatory markers.

I implement intensive lifestyle support from the start. This might involve working with a dietitian, exercise support, stress management. Not as an afterthought, but as an integral part of treatment from day one.

I consider starting metformin simultaneously with the antipsychotic for patients at high risk of metabolic complications. If someone is already overweight or obese, has prediabetes or family history of diabetes, or has previously experienced significant weight gain on psychiatric medications, starting metformin makes sense.

For some patients, I consider starting low-dose tirzepatide (2.5 mg weekly or less) simultaneously with the antipsychotic. This is more aggressive prevention, but for someone with obesity and high metabolic risk starting olanzapine, it might prevent the 40-50 pound weight gain that would otherwise occur.

I monitor closely – weight and metabolic parameters every 2-4 weeks initially. If weight starts increasing significantly despite interventions, I intensify efforts immediately. I don’t wait for 6 months and 40 pounds.

The prevention strategy depends on the specific medication:

For olanzapine or clozapine (the highest-risk medications), I implement intensive prevention. Metformin or low-dose tirzepatide, intensive lifestyle support, very close monitoring.

For intermediate-risk medications like risperidone or quetiapine, I use lifestyle support and close monitoring, adding metformin if weight gain begins.

For lower-risk medications like aripiprazole, I use lifestyle support and monitoring but might not start metformin unless weight gain occurs.

The goal is preventing the massive weight gain, not just accepting it and trying to manage consequences.

Treating Established Medication-Induced Weight Gain

Many patients come to me having already gained significant weight on psychiatric medications. What then?

First question: Should we switch the medication?

As discussed above, if the psychiatric condition is stable and there’s a reasonable alternative medication with better metabolic profile, switching makes sense.

But if switching isn’t feasible or hasn’t succeeded, we treat the weight gain aggressively while maintaining the necessary psychiatric medication.

Metformin is standard of care.

Multiple studies show metformin produces modest weight loss (5-10 pounds on average) and prevents further weight gain in patients on antipsychotics. It also improves insulin sensitivity and reduces diabetes risk.

I use metformin at 500 mg twice daily or 1000 mg once daily (extended-release) in most patients with antipsychotic-induced weight gain. It’s safe, inexpensive, and evidence-based.

The limitation is that metformin’s weight effects are modest. For someone who’s gained 60 pounds, metformin alone isn’t sufficient.

Low-dose tirzepatide is increasingly my approach for significant weight gain.

For patients with substantial antipsychotic-induced weight gain (30+ pounds) who haven’t responded adequately to lifestyle interventions and metformin, I use low-dose tirzepatide.

My typical approach is 2.5 mg weekly, sometimes even less initially. Combined with comprehensive lifestyle support and continuation of the necessary antipsychotic, this often produces 15-25 pound weight loss over 6-12 months – enough to significantly improve metabolic parameters and quality of life without destabilizing psychiatric symptoms.

The antipsychotic continues to manage their psychosis or mood disorder. The tirzepatide addresses the metabolic consequences. Both medications are necessary for comprehensive treatment.

Intensive lifestyle intervention is always part of the plan.

Medications alone aren’t sufficient. We need dietary support focusing on whole foods, reducing ultra-processed foods, stabilizing blood sugar. Exercise support appropriate to current fitness level. Stress management. Sleep optimization.

All the foundational pieces we’ve discussed throughout this series apply here, perhaps even more importantly when someone’s fighting against medication-induced metabolic dysfunction.

Sometimes combining approaches works best.

Metformin PLUS low-dose tirzepatide PLUS the necessary antipsychotic PLUS intensive lifestyle support. This multi-pronged approach addresses the severe metabolic effects of high-risk antipsychotics while maintaining psychiatric stability.

Monitoring remains crucial.

We’re watching both metabolic parameters and psychiatric symptoms. Weight, blood pressure, glucose, lipids, inflammatory markers to track metabolic improvement. Mood, psychotic symptoms, sleep, functioning to ensure psychiatric stability.

If psychiatric symptoms worsen, we adjust. Maybe we need to increase the antipsychotic dose. Maybe we need to add another psychiatric medication. We maintain stability while addressing metabolic health.

Special Considerations for Different Patient Populations

Patients with eating disorders:

Medication choices are particularly important here. I avoid medications with high weight gain risk in patients with binge eating disorder – the weight gain can worsen the eating disorder.

For patients with anorexia nervosa who need psychiatric medication, I’m careful with medications that suppress appetite (like stimulants or bupropion in high doses). Some weight gain might actually be needed.

For patients with bulimia, I use medications that don’t worsen binge eating. Fluoxetine at high doses (60 mg) is FDA-approved for bulimia and can be helpful.

Patients with diabetes:

These patients absolutely need endocrinology managing their diabetes. I provide parallel integrative medicine care.

For psychiatric medication selection, I’m even more cautious about metabolic effects. Someone with diabetes doesn’t need additional metabolic challenges from psychiatric medications.

If an antipsychotic is necessary, metformin is definitely part of the plan, and I’m more likely to use low-dose tirzepatide early rather than waiting for more weight gain.

Patients with cardiovascular disease:

Metabolic effects matter even more. Weight gain, lipid changes, blood pressure increases from psychiatric medications can worsen cardiovascular risk.

I’m very thoughtful about medication choices and aggressive about metabolic interventions.

Children and adolescents:

Antipsychotic-induced weight gain in youth is particularly concerning. It affects development, increases lifelong metabolic risk, impacts self-esteem at vulnerable ages.

I’m even more conservative about antipsychotic use in young people. When necessary, I choose the most metabolically favorable options possible and implement intensive prevention strategies from the start.

Older adults:

Metabolic complications from weight gain are serious in older adults. Falls risk increases with obesity. Diabetes management is more challenging. Cardiovascular risk is higher.

But medication changes are also riskier in older adults. I’m thoughtful about whether switching is worth the risk of psychiatric destabilization.

Often the best approach is continuing necessary medications while aggressively managing metabolic effects.

The Role of Functional Medicine in Medication Management

Within my integrative practice, functional medicine principles inform medication management.

Testing reveals why someone might be more vulnerable to medication-induced weight gain:

Elevated baseline inflammation makes weight gain worse. Someone with CRP of 8 starting an antipsychotic will likely gain more weight than someone with CRP of 1.

Gut dysfunction, hormonal imbalances, existing insulin resistance – all these make medication-induced weight gain worse.

Addressing these underlying factors before starting high-risk medications, or as soon as possible after starting them, can mitigate weight gain.

The comprehensive approach matters:

Someone starting olanzapine with concurrent gut healing protocols, anti-inflammatory nutrition, stress management, hormone optimization, and low-dose tirzepatide may gain 5 pounds instead of 50 pounds.

The medication is necessary for their psychosis. The integrative approach prevents the massive metabolic consequences.

This is why comprehensive care changes outcomes.

Standard psychiatric practice: Start olanzapine, patient gains 50 pounds, develop diabetes, psychiatrist says “unfortunate but necessary,” patient feels terrible and stops medication, psychiatric relapse occurs.

Integrative approach: Start olanzapine with comprehensive metabolic protection from day one, patient gains 5 pounds or maintains weight, psychiatric symptoms controlled without metabolic devastation, long-term adherence and stability achieved.

Monitoring Guidelines: What, When, How Often

Proper monitoring prevents serious metabolic complications and allows early intervention.

Baseline before starting any psychiatric medication with metabolic risk:

• Weight and waist circumference
• Blood pressure
• Fasting glucose and hemoglobin A1c
• Lipid panel
• High-sensitivity CRP
• Liver function tests

For comprehensive functional medicine approach, I also assess gut health, hormones, nutrient status as discussed in previous articles.

Intervention thresholds:

Weight gain of 5% or more triggers intervention. For a 200-pound person, that’s 10 pounds. I don’t wait for 40 pounds to act.

Any metabolic abnormality (elevated glucose, worsening lipids, elevated blood pressure) triggers intervention even without significant weight gain.

Patient distress about weight gain, even if not yet 5%, warrants discussion and potentially earlier intervention.

The key is proactive monitoring and early intervention, not reactive crisis management after severe problems develop.

Patient Communication: Having Honest Conversations

Patients need honest information about metabolic risks of medications.

Before starting a medication with metabolic risk:

I explain what the risks are. For olanzapine: “This medication is very effective for your symptoms, but it causes significant weight gain in most patients – often 20, 30, even 50 pounds or more if we don’t intervene proactively.”

I explain our plan for prevention. “We’re not just going to accept that weight gain as inevitable. Here’s what we’re going to do to prevent or minimize it…”

I’m clear about the importance of the medication for their psychiatric condition while being equally clear about the importance of preventing metabolic consequences.

I present realistic expectations. Perfection isn’t possible. If olanzapine causes 50 pounds weight gain without intervention, maybe our interventions keep it to 10-15 pounds. That’s still a success even though it’s not zero weight gain.

During treatment:

I check in about weight at every visit. Not in a judgmental way, but acknowledging it’s important and we’re monitoring it together.

If weight gain is occurring despite interventions, I’m honest about it and we problem-solve together. What additional strategies can we implement? Should we intensify current interventions? Is a medication switch worth considering?

I validate any distress about weight gain. It’s not vanity. Weight gain affects health, mobility, self-esteem, and quality of life. Patient concerns are legitimate and deserve serious attention.

The therapeutic relationship matters:

Patients need to feel comfortable discussing weight concerns without judgment. If they’re afraid I’ll be dismissive or tell them it’s not important compared to mental health, they won’t bring it up until they’re deeply distressed and considering stopping their medication.

Creating an environment where metabolic health is explicitly part of our shared treatment goals leads to better communication and outcomes.

The Bottom Line: We Can Do Better

The standard of accepting massive medication-induced weight gain as an inevitable consequence of psychiatric treatment is unacceptable.

We have weight-neutral medication options for most psychiatric conditions. We have effective strategies for preventing and treating medication-induced metabolic dysfunction. We have the knowledge and tools to maintain psychiatric stability while supporting metabolic health.

What we need is a shift in mindset. Metabolic effects aren’t minor side effects to be mentioned briefly and then ignored. They’re serious health consequences that deserve the same attention we give to psychiatric symptoms.

The framework should be: How do we achieve psychiatric stability while maintaining or improving metabolic health? Not: How do we achieve psychiatric stability regardless of metabolic consequences?

For patients starting psychiatric medications with metabolic risk: implement aggressive prevention strategies from day one.

For patients already experiencing medication-induced weight gain: intervene aggressively rather than accepting it as permanent.

For patients needing medications with unavoidable metabolic risk: provide comprehensive metabolic support and monitoring to minimize harm.

The goal is always psychiatric stability AND metabolic health. Both matter. Both deserve attention and intervention. Both can usually be achieved with thoughtful medication selection and comprehensive treatment.

This is part of what integrative metabolic psychiatry means. Not just treating psychiatric symptoms in isolation, but addressing the whole person – mental health, metabolic health, quality of life – with interventions that support all these domains simultaneously.

In our next article, we’ll explore the specific clinical picture of atypical depression – a subtype characterized by increased appetite, weight gain, and hypersomnia that has particular relevance for metabolic psychiatry. Understanding this subtype helps explain why some patients with depression struggle so much with weight and why certain treatment approaches are particularly effective.

References

1. Pillinger T, McCutcheon RA, Vano L, et al. Comparative Effects of 18 Antipsychotics on Metabolic Function in Patients With Schizophrenia, Predictors of Metabolic Dysregulation, and Association With Psychopathology: A Systematic Review and Network Meta-analysis. The Lancet Psychiatry. 2020;7(1):64-77.
   
2. Serretti A, Mandelli L. Antidepressants and Body Weight: A Comprehensive Review and Meta-Analysis. The Journal of Clinical Psychiatry. 2010;71(10):1259-72.
   
3. Alvarez-Jiménez M, González-Blanch C, Vázquez-Barquero JL, et al. Attenuation of Antipsychotic-Induced Weight Gain With Early Behavioral Intervention in Drug-Naive First-Episode Psychosis Patients: A Randomized Controlled Trial. The Journal of Clinical Psychiatry. 2006;67(8):1253-60.
   
4. Siskind DJ, Leung J, Russell AW, Wysoczanski D, Kisely S. Metformin for Clozapine Associated Obesity: A Systematic Review and Meta-Analysis. PloS One. 2016;11(6):e0156208.
   
5. Zheng W, Li XB, Tang YL, Xiang YQ, Wang CY, de Leon J. Metformin for Weight Gain and Metabolic Abnormalities Associated With Antipsychotic Treatment: Meta-Analysis of Randomized Placebo-Controlled Trials. Journal of Clinical Psychopharmacology. 2015;35(5):499-509.
   
6. Jacobson S, Margolese N, Margolese HC. GLP-1 Receptor Agonists as a Novel Solution for Antipsychotic-Induced Weight Gain in Severe and Persistent Mental Illness. Canadian Journal of Psychiatry. 2025;:7067437251386626.
   
7. Dayabandara M, Hanwella R, Ratnatunga S, Seneviratne S, Suraweera C, de Silva VA. Antipsychotic-Associated Weight Gain: Management Strategies and Impact on Treatment Adherence. Neuropsychiatric Disease and Treatment. 2017;13:2231-2241.
   
8. De Hert M, Detraux J, van Winkel R, Yu W, Correll CU. Metabolic and Cardiovascular Adverse Effects Associated With Antipsychotic Drugs. Nature Reviews Endocrinology. 2011;8(2):114-26.
   
9. Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M. Prevalence of Metabolic Syndrome and Metabolic Abnormalities in Schizophrenia and Related Disorders–A Systematic Review and Meta-Analysis. Schizophrenia Bulletin. 2013;39(2):306-18.
   
10. Correll CU, Sikich L, Reeves G, Riddle M. Metformin for Antipsychotic-Related Weight Gain and Metabolic Abnormalities: When, for Whom, and for How Long? The American Journal of Psychiatry. 2013;170(9):947-52.
    
11. Mizuno Y, Suzuki T, Nakagawa A, et al. Pharmacological Strategies to Counteract Antipsychotic-Induced Weight Gain and Metabolic Adverse Effects in Schizophrenia: A Systematic Review and Meta-Analysis. Schizophrenia Bulletin. 2014;40(6):1385-403.
    
12. Ventriglio A, Gentile A, Stella E, Bellomo A. Metabolic Issues in Patients Affected by Schizophrenia: Clinical Characteristics and Medical Management. Frontiers in Neuroscience. 2015;9:297.