There has been a notable increase in antipsychotic prescriptions for children and adolescents over the past 30 years. Despite therapeutic benefits, antipsychotic treatments are often associated with significant side effects including rapid weight gain and metabolic dysregulation, which can lead to long-term health issues. A recent study by Rogdaki and colleagues investigated the physiological effects of antipsychotic medications on children and adolescents with neuropsychiatric and neurodevelopmental conditions.

The study employed a network meta-analysis approach, analyzing data from 47 randomized controlled trials (RCTs) that included a total of 6500 participants (mean age 13.29 years old). Primary outcomes included changes in body weight, BMI, fasting glucose, cholesterol levels, triglycerides, prolactin, heart rate, systolic blood pressure (SBP), and QT interval corrected for heart rate (QTc).

Key findings included significant weight gain and BMI increase with haloperidol, clozapine, olanzapine, quetiapine, risperidone, and paliperidone treatment, while molindone was associated with weight loss. Olanzapine and quetiapine significantly increased total cholesterol and triglycerides levels. Risperidone and paliperidone were associated with substantial increases in prolactin levels. Finally, quetiapine was linked to notable increases in heart rate and systolic blood pressure.

Researchers concluded that children and adolescents often exhibit increased weight gain and decreased metabolic function in response to antipsychotic treatments, with the important exception of molindone. The study emphasizes the need for updated treatment guidelines for these medications in the context of children and adolescence and recommend tailored antipsychotic treatment approaches to minimize adverse health outcomes.

Reference:
Rogdaki M et al. Lancet Child Adolesc Health. 2024;8(7):510-521.. Abstract.