ABSTRACT
Clozapine is one of the second generation antipsychotics most commonly associated with serious metabolic side effects including weight gain. Unexpectedly, weight loss can also be seen as a rare side effect of clozapine. The mechanism underlying clozapine induced weight loss is not clearly understood. Several factors including certain brain areas, neurotransmitters, neuropeptides and genetic variants were identified to play a role in weight loss associated with clozapine. In some patients who were reported to have a significant weight loss (13.5-50% of body weight) with clozapine, weight loss might not be associated with any underlying physical disorder. Weight loss may be due to the patients' engagement in diet and exercise after clinical improvement, pharmacodynamic effects of clozapine, or other medical problems such as gastrointestinal tract hypomotility caused by clozapine. Some case reports suggested that clozapine-associated weight loss might be a sign of poor response to clozapine. Clinicians should keep in mind the fact that a specific group of patients may lose weight during clozapine treatment. In this case report, possible causes of weight loss due to clozapine use is discussed. We also discussed the possible relationship between clozapine dose and weight loss which has not drawn attention in previous case reports.
Subject(s)
Antipsychotic Agents/adverse effects , Clozapine/adverse effects , Schizophrenia/drug therapy , Weight Loss , Humans , Male , Middle AgedABSTRACT
A significant proportion of patients with schizophrenia receiving clozapine remain with partial response. In this group of patients findings regarding addition of various psychotropics to ongoing clozapine treatment for augmentation are controversial. In this review, literature regarding the efficacy and safety of adjunctive agents in clozapine resistant schizophrenic patients is examined. Augmentation agents added to clozapine in treatment resistant schizophrenic patients consist of antipsychotics, antidepressants, mood stabilizers, other agents (eg. omega 3 fatty acids and glutamatergic agents) and electroconvulsive therapy (ECT) in this review. The number of controlled studies evaluating augmentation of clozapine in schizophrenia patients are highest for risperidone and lamotrigine add on treatments. However, the results of recent meta-analyses studies do not support any benefit of either agent as adjunct to clozapine treatment. Some evidence regarding the success of clozapine augmentation with amisulpride, aripiprazole, mirtazapine, omega 3 fatty acids and ECT have been obtained which needs further clinical investigation. Current findings from relevant clinical studies point that theses studies have limitations of small sample size, variable definitions of clozapine resistance, heterogenity of outcome measures and methodological designs and that sufficient evidence does not yet exist regarding the success of various adjunctive treatments for clozapine resistant patients.