How to manage my daughter’s weight gain from antipsychotic pills?

Question

Hello doctor,

My 26-year-old daughter was diagnosed with schizophrenia 18 months ago after a psychotic break during her last college semester.

She is on Risperidone 4 mg twice daily, which controls her hallucinations and paranoid delusions, but the side effects are severely affecting her life.

Since starting Risperidone, she has gained 45 pounds and now weighs 210 pounds, and her prolactin level is 87, causing her periods to stop completely.

Her psychiatrist warned that high prolactin from antipsychotics can lead to bone loss and infertility, which terrifies her as she wants to have children someday.

She has also developed insulin resistance, with a fasting glucose of 118 and HbA1c of 6.3.

A switch to Aripiprazole led to breakthrough psychotic symptoms within a week, and the weight gain is causing severe depression, making her avoid leaving the house or seeing friends.

Are there antipsychotic medications for schizophrenia that do not cause as much weight gain or hormonal problems?

We are also concerned about her physical health deteriorating while managing her mental health and want to know if she can have a normal pregnancy in the future.

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

Thank you for your query. I understand that it must be very difficult to see your daughter struggling with schizophrenia and the side effects of antipsychotic medications.

Do not change her medications abruptly; if switching is needed, Aripiprazole can be added to Risperidone with a gradual taper, as sudden dose reduction may cause relapse.

Work on lifestyle modifications, including regular walking, physical exercise, and balanced calorie intake.

A nutritionist can help create a structured meal and calorie plan. Metformin can also be considered, as it helps control weight and improve blood sugar and glucose metabolism.

Other antipsychotic medications that are weight-neutral and do not increase prolactin include Lurasidone, Ziprasidone, and Cariprazine, but the same rule applies: gradually taper off one medication while slowly introducing another.

Schizophrenia itself can contribute to weight gain, elevated prolactin levels, and glucose intolerance, so lifestyle modifications are crucial.

Psychological and social therapies, such as cognitive behavioral therapy for psychosis, social skills training, and occupational therapy, are important and should not be overlooked. Screen for depression and other hormonal imbalances as well.

A gynecologist can help manage her menstrual cycle and monitor thyroid hormones, estrogen, and progesterone levels for a holistic approach.

Thanks and regards.