Quetiapine-related weight loss: Report of a rare adverse effect

• Main Authors: Nicodemus Okwudili K Obayi, David HN Nweke, Edidiong Idio, Darlington Okey, Cletus Ozibo
• Format: Article
• Language: English
• Published: Edizioni FS 2018-07-01
• Series: Journal of Health and Social Sciences
• Subjects: Antipsychotics; quetiapine; switch-over; weight loss
• Online Access: http://journalhss.com/wp-content/uploads/jhss32_185-190.pdf
• ISSN: 2499-2240; 2499-5886

Quetiapine is a second-generation antipsychotic that has been reported to be associated with moderate weight gain. Nevertheless, weight loss that is an infrequent adverse effect of quetiapine has been reported in a few cases of patients who were ab initio started on quetiapine or who gained weight during previous antipsychotic treatment but who lost weight when shifted to quetiapine. We report the case of a 28-year old quarry worker being treated for bipolar affective disorder. Due to unbearable muscle rigidity, she was switched from haloperidol to olanzapine. She gained about 26 kg over 12 months. Her repeated complaints about the weight gain and threats to stop all medications if nothing was done led to her being switched over to quetiapine. Within two months of this switch-over, she gained 1 kg before she gradually started losing weight and by the sixth month, she dropped from 85 kg to 67 kg despite eating well. Unsatisfied with the weight loss, she was switched to aripiprazole. Over few months, she gained up to 3 kg. She had remained mentally stable and functional, and also maintained roughly 70 kg over a year. Though weight gain could occur in virtually every antipsychotic, weight loss has been recorded in very few cases. The mechanism by which quetiapine causes weight loss is not certain. Some proposed mechanisms include paradoxical suppression of appetite, induction of deterioration in insulin resistance, induction of hypoglycaemia, as well as mere switching from a high-risk to a low-risk antipsychotic. Our patient had different experiences with three atypical antipsychotics: she gained excessive weight with olanzapine, lost significant weight with quetiapine, and maintained a normal weight with aripiprazole. Weight changes should be monitored on patients taking antipsychotics. Most of the time clinicians are concerned about weight gain but not weight loss. We recommend that clinicians should pay attention to weight loss as well.