No. 94; December 2011
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Psychiatric medications can be very helpful, even life-saving, for some children and adolescents. However, some of these medications may lead to weight gain. The antipsychotic medications, in particular, have also been associated with problems controlling blood sugar, cholesterol and triglycerides. These changes can increase the risk of a child or adolescent developing diabetes and heart related problems. Parents should discuss the risks and benefits of specific medications with their child’s physician.

A comprehensive psychiatric evaluation by a qualified physician should be done before a child or adolescent is prescribed any of these medications.

Weight gain is possible with many medications. Some examples of medications that can lead to weight gain include:

  • Antipsychotics: such as aripiprazole (Abilify), chlorpromazine (Thorazine), clozapine (Clozaril), olanzapine (Zyprexa), pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon)
  • Mood stabilizers: such as lithium, valproic acid (Depakote/Depakene), carbamazepine (Tegretol)
  • Antidepressants: such as mirtazapine (Remeron), paroxetine (Paxil), imipramine (Tofranil)

At the start of treatment your child’s height and weight should be measured. Their BMI (Body Mass Index) can be calculated and adjusted for their age and gender. This provides you and your child’s psychiatrist with baseline information so that any changes can be followed over time.

It is very important to let your child’s doctor know if your child or family members have problems with diabetes, blood sugar, cholesterol, triglycerides, or heart disease. To make treatment with these medications as safe as possible, your child’s psychiatrist or physician will weigh them and order certain laboratory tests from time to time.

When on these medications appetite can increase. Children and adolescents may also not recognize when they are full. The following tips and ideas can help both prevent and manage medication-related weight gain in children and adolescents:

Dietary guidance:

  • Use portion control for all food at meals and snacks – measure and limit size of portions (example – pour out an amount of snack rather than eating out of box or bag)
  • Use more healthy food choices (example - fresh fruits and vegetables for snacks)
  • Limit snacks and junk food
  • Substitute low calorie for higher calorie snacks (example – pretzels instead of chips/nuts)
  • Drink several large glasses (or bottles) of water throughout the day
  • Limit sugar containing beverages (sodas, juice, etc.)
  • Have other family members be understanding and supportive (example – don’t eat high calorie foods in front of the child or teen)

Tips for meals

  • Schedule regular meal times
  • Plan menus – limit fast food
  • Use meal time for the family to talk – don’t just eat and run
  • Sit down to eat – don’t stand and eat
  • Chew all food more slowly
  • Avoid eating in front of the TV
  • Remember: portion control (measure and limit size of portions)

Tips to increase activity level

  • Limit time spent sitting watching TV, on the computer or playing video games
  • Increase walking – walk after each meal, wear a pedometer to make it fun
  • Use stairs instead of elevators
  • Encourage exercise and sports involvement
  • Use forms of activities that are fun and interesting (playing outdoors, riding bikes, rollerblading, swimming, bowling, dancing, etc.)

Following these tips can limit weight gain when taking psychiatric medications and help reduce the risk of serious medical problems.

If weight gain continues to be a problem for your child, speak to your health care provider.

For additional information see Facts for Families:
#52 Comprehensive Psychiatric Evaluation
#21 Psychiatric Medication for Children Part I – How Medications Are Used
#29 Psychiatric Medication for Children Part II: Types of Medication
#51 Questions to Ask About Psychiatric Medications
#79 Obesity in Children and Teens

See also: Your Child (1998 Harper Collins) / Your Adolescent (1999 Harper Collins)

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