Do Antipsychotics Cause Weight Gain? Plus 5 Tips for Managing It

Antipsychotics are a group of medications that treat mental health conditions such as schizophrenia, bipolar disorder, and treatment-resistant depression. Antipsychotics can be split into two classes: typical and atypical antipsychotics. These medications can be effective treatments, but they can also cause a number of side effects. Weight gain is one potential side effect.

It’s estimated that up to 55% of people taking antipsychotics gain a significant amount of weight. And studies suggest that people with obesity may be twice as likely to skip their antipsychotic doses because of weight gain concerns.

But not all antipsychotics carry the same risk of weight gain. So which ones are most likely to cause this side effect? And what can you do to manage or prevent weight gain while taking these medications?

What do antipsychotics do to the body?

Antipsychotics help balance the levels of certain chemical messengers in the brain. Most notably, they block the effects of dopamine. Typical antipsychotics block dopamine more strongly than atypical antipsychotics do. Antipsychotics also help balance levels of serotonin. Imbalances of dopamine and serotonin are believed to play a role in causing the symptoms of several mental health conditions.

Antipsychotics also block the chemicals histamine and acetylcholine. Blocking these chemicals doesn’t play a role in treating mental health conditions. But it does contribute to some common side effects of antipsychotic medications, such as constipation and dry mouth.

Do antipsychotics cause weight gain?

Yes, antipsychotics can cause weight gain. This is more common with atypical antipsychotics, but it’s possible with typical antipsychotics, too. Some antipsychotics within each class are more likely to cause weight gain than others. As we’ll discuss later, several have little to no effect on body weight for many people.

Weight gain with antipsychotics can happen quickly, sometimes within the first few weeks of starting the medication. However, this side effect can happen at any time while taking antipsychotics. It’s also possible to continue gaining weight throughout the time you’re taking the medication.

What factors contribute to weight gain while taking antipsychotics?

There are a few factors that contribute to weight gain while taking antipsychotics. For one thing, these medications can disrupt the body’s natural signals that tell your brain you’re full after eating. This can lead you to feel hungrier and eat more than your body needs. In addition, atypical antipsychotics may cause your body to create extra fat cells.

Every antipsychotic also has unique risks when it comes to weight gain. Some of them are more likely to cause weight gain than others.

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Antipsychotics that are more likely to cause weight gain include:

• Clozapine (Clozaril)

• Iloperidone (Fanapt)

• Olanzapine (Zyprexa)

• Paliperidone (Invega)

• Quetiapine (Seroquel)

• Risperidone (Risperdal)

Antipsychotics that tend to cause little to no weight gain include:

• Aripiprazole (Abilify)

• Cariprazine (Vraylar)

• Fluphenazine

• Haloperidol (Haldol)

• Lurasidone (Latuda)

• Ziprasidone (Geodon)

What other mental health medications cause weight gain?

Other mental health medications, such as certain mood stabilizers and antidepressants, can also cause weight gain. These include:

• Divalproex (Depakote)

• Lithium (Lithobid)

• Mirtazapine (Remeron)

• Nortriptyline (Pamelor)

• Paroxetine (Paxil)

5 tips to manage or prevent weight gain when taking antipsychotics

There are ways that you can help manage weight gain from antipsychotics. Everyone’s experience with weight gain is different, however. So be sure to discuss with your healthcare provider which weight management options would be best for you to try.

1. Follow a healthy diet

If you find that your antipsychotic is making you hungrier, try to make healthy choices when choosing meals and snacks. Keeping healthy options on hand and adding fruits or vegetables to your favorite meals can help make it easier to maintain a healthy diet. Small changes can go a long way if you stick with them.

2. Exercise regularly

Regular exercise may also help you manage weight gain from antipsychotics. Exercising has other health benefits, too, such as helping relieve symptoms of depression and anxiety. Experts recommend trying to get at least 20 minutes of activity daily. And even small things, like taking the stairs instead of the elevator, can add up over time.

3. Limit alcohol consumption

Alcohol can slow down the body’s ability to turn food into energy. And alcohol itself has extra calories that can contribute to weight gain. Cutting back on your alcohol consumption may make it easier to lose weight.

Keep in mind that alcohol and antipsychotics don’t mix well. Combining them can worsen side effects, including weight gain. It’s best to avoid drinking alcohol if you take antipsychotics.

4. Discuss medication options for weight loss

Weight loss medications may be an option if you’ve tried lifestyle changes without success. There are several options available that you can discuss with your healthcare provider. Some of these are prescribed off-label for weight loss (meaning they aren’t FDA-approved for that purpose). But research shows they may help people manage weight gain caused by antipsychotics.

These medications include:

• Metformin. Meformin is a diabetes medication that may help prevent weight gain from antipsychotics. It can also help some people lose weight that they’ve already gained. Studies show that metformin may cause an average weight loss of about 7 pounds (about 3.2 kg).

• Topiramate (Topamax). The seizure medication Topiramate (Topamax) is known to cause weight loss as a side effect. Some studies have found that it can help people taking antipsychotics lose an average of almost 12 pounds (about 5.3 kg).

• Aripiprazole. This antipsychotic has been found to help some people lose weight when combined with another antipsychotic. Studies have shown the addition of aripiprazole helped people lose more than 4 pounds (about 2.1 kg) on average.

• Liraglutide (Victoza, Saxenda). Liraglutide (sold under the brand names Victoza and Saxenda) is an injectable medication that is approved for Type 2 diabetes and weight loss. A review of several studies found that liraglutide helped people on antipsychotics lose nearly 12 pounds (about 5.3 kg) on average.

5. Switch antipsychotics

As mentioned earlier, there are antipsychotics that usually cause little to no weight gain. In some cases, your healthcare provider may suggest switching to an antipsychotic with a lower risk of weight gain. Possible alternatives may include ziprasidone or lurasidone.

Lybalvi (olanzapine/samidorphan) may be another option. This medication combines the antipsychotic olanzapine with a medication that reduces the risk of weight gain. You may still gain weight with Lybalvi, but the amount gained will likely be less than if you take olanzapine alone.

If other methods for managing weight gain haven’t worked, you might talk to your healthcare provider about switching antipsychotics. But you should be aware that switching medications comes with a risk of symptoms worsening or coming back. This may not be the best option, especially if your current antipsychotic works well for managing your mental health condition.

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Written by:

Victoria Dadebo, PharmD, BCPS

Victoria Dadebo is a freelance pharmacy writer who began contributing to GoodRx in 2022. She has experience in both community and hospital settings, and she is furthering her pharmacy training to specialize in mental health.

Edited by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

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