Atypical antipsychotics and weight gain.

This article reviews what is known about weight gain associated with the use of atypical antipsychotics and focuses on relative liability for weight gain with the different agents, correlates of weight gain, putative mechanisms, and management strategies. Data on weight gain from short- and long-term studies with the different atypical antipsychotics are presented. A number of sociodemographic variables--including patient age, ethnicity, and baseline weight--that may have a correlation with weight gain with atypical antipsychotics are considered. Mechanisms that may be involved in antipsychotic-induced weight gain are discussed, including the role of monoamine activity, histamine antagonism, muscarinic receptors, reproductive hormones, other neurotransmitters, insulin, neuropeptides, cytokines, uncoupling proteins, the peroxisome proliferator-activated receptor, and genetic factors. Treatment of antipsychotic-induced weight gain involves the use of exercise and nutritional counseling as well as pharmacological strategies.