Consequências metabólicas do uso de antipsicóticos em pacientes com obesidade
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Aug 7, 2025
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Resumo
Objetivo: Analisar as consequências metabólicas associadas ao uso de antipsicóticos em pacientes com obesidade, com ênfase nas alterações como ganho de peso, resistência à insulina, dislipidemias e risco de desenvolvimento de síndrome metabólica, considerando os diferentes perfis de antipsicóticos e suas implicações na saúde metabólica desses indivíduos. Métodos: Trata-se de uma revisão integrativa da literatura, com artigos de 2020 a 2025, nos idiomas português e inglês e com texto completo disponível. A questão norteadora foi: Quais são as consequências metabólicas associadas ao uso de antipsicóticos em pacientes com obesidade?. A pesquisa foi realizada em junho de 2025, nas bases de dados: Biblioteca Virtual em Saúde (BVS), Serviços da National Library of Medicine (PUBMED) e Caribe em Ciências de Saúde (LILACS), utilizando os Descritores em Ciências da Saúde (DeCS) em inglês: Antipsychotic Agents, Obesity, Body Weight,Insulin Resistance e Metabolic Syndrome, combinados com operador booleano “AND”. Resultados: Foram analisados nove artigos que atenderam aos critérios de inclusão e exclusão, evidenciando principais consequências metabólicas: o ganho de peso, a resistência à insulina e o risco de síndrome metabólica. Considerações finais: O estudo reforça a importância do monitoramento contínuo e de estratégias terapêuticas integradas. A heterogeneidade dos estudos se apresenta como limitação à generalização dos resultados.
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Como Citar
NevesD. M. T., NunesL. S., Holanda FilhoJ. L. de A., MarquesR. S. G., AraújoA. H. M., SantosA. C. F. R., AraújoG. M. de, Batista NetoJ. C., AquinoA. C. M. R. de, & LucenaA. B. de. (2025). Consequências metabólicas do uso de antipsicóticos em pacientes com obesidade. Revista Eletrônica Acervo Saúde, 25(8), e21231. https://doi.org/10.25248/reas.e21231.2025
Seção
Revisão Bibliográfica
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Referências
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2. ALHASANI DM, et al. Metabolic Syndrome among Patients Taking Atypical Antipsychotics: A Comparative Cross-Sectional Study at Erada and Mental Health Complex in Taif, Saudi Arabia. Psychopharmacology Bulletin, 2024; 54(4): 35-44.
3. ALKHOLY R, et al. The impacts of antipsychotic medications on eating-related outcomes: A mixed methods systematic review. PLoS ONE, 2025; 20(2).
4. ALVAREZ-JIMÉNEZ M, HETRICK SE, GONZÁLEZ-BLANCH C, GLEESON JF, MCGORRY PD. Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry. 2008;193(2):101-107.
5. BAPTISTA T, et al. Obesity and related metabolic abnormalities during antipsychotic drug administration: mechanisms, management and research perspectives. Pharmacopsychiatry, 2002; 35(6): 205-219.
6. BAZO-ALVAREZ JC, et al. Efeitos do tratamento prolongado com antipsicóticos no peso corporal: um estudo de coorte baseado na população. Journal of Psychopharmacology, 2020; 34(1): 79-85.
7. BERNARDO M, et al. Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies. Advances in Therapy, 2021; 38(5): 2491-2512.
8. CHEN A, et al. Antipsychotics and the microbiota. Current Opinion in Psychiatry, 2020; 33(3): 225-230.
9. CORFITSEN HT, DRAGO A. Impacto das vias moleculares da biologia do desenvolvimento enriquecidas no ganho de peso induzido por antipsicóticos. Farmacogenética e Genômica, 2020; 30(1): 9-20.
10. DE R, et al. The impact of weight gain on antipsychotic nonadherence or discontinuation: A systematic review and meta-analysis. Acta Psychiatr Scand, 2025; 151(2): 109-126.
11. DEUTCH AY. Liraglutide for the Treatment of Antipsychotic Drug-Induced Weight Gain. JAMA Psychiatry, 2017; 74(11): 1172-1173.
12. DIAS PC, et al. Obesidade e políticas públicas: concepções e estratégias adotadas pelo governo brasileiro. Cadernos de Saúde Pública, 2017; 33(7): e00006016.
13. ECHEVESTE-NAVARRETE J, et al. Trajectory of the body mass index of children and adolescents attending a reference mental health center. Journal of Pediatric Endocrinology and Metabolism, 2024; 37(6): 559-568.
14. ELLINGER LK, IPEMA HJ, STACHNIK JM. Efficacy of metformin and topiramate in prevention and treatment of second-generation antipsychotic-induced weight gain. Ann Pharmacother, 2010; 44(4): 668-679.
15. FRANCISCA H. Antipsicóticos de primeira e segunda geração: impacto ponderal e o papel da abordagem nutricional. 2024.
16. GAO YN, OLFSON M. National trends in metabolic risk of psychiatric inpatients in the United States during the atypical antipsychotic era. Schizophrenia Research, 2022; 248: 320-328.
17. GROSU C, et al. Associations between antipsychotics-induced weight gain and brain networks of impulsivity. Transl Psychiatry, 2024; 14(1): 162.
18. GUPTA S, SONG X. Real-World Analysis of Antipsychotic Drugs' Effect on Weight Gain: An EHR Application. AMIA Annu Symp Proc, 2024; 2023: 961-968.
19. HEGDE NC, et al. Pharmacological interventions for antipsychotic-induced weight gain in schizophrenia: A network meta-analysis. Gen Hosp Psychiatry, 2024; 90: 12-21.
20. KRILL RA, KUMRA S. Metabolic consequences of second-generation antipsychotics in youth: appropriate monitoring and clinical management. Adolesc Health Med Ther, 2014; 5: 171-182.
21. KUJIPER G, MULDER H, EVENHUIS H, VISSER F, HOEKSTRA PJ. Effects of controlled discontinuation of long-term used antipsychotics on weight and metabolic parameters in individuals with intellectual disability. J Clin Psychopharmacol. 2013;33(4):520-524.
22. KUPPILI PP, NEBHINANI N. Role of Integrated and Multidisciplinary Approach in Combating Metabolic Syndrome in Patients with Severe Mental Illness. Indian J Psychol Med, 2019; 41(5): 466-471.
23. LIU C, et al. Dietary fiber and probiotics for the treatment of atypical antipsychotic-induced metabolic side effects: study protocol for a randomized, double-blind, placebo-controlled trial. Trials, 2021; 22(1).
24. LYU N, et al. Trajectories and predictors for the development of clinically significant weight gain in children and adolescents prescribed second generation antipsychotics. Journal of Child & Adolescent Psychopharmacology, 2024; 34(4): 201-209.
25. MALHOTRA AK, et al. Association between common variants near the melanocortin 4 receptor gene and severe antipsychotic drug-induced weight gain. Archives of General Psychiatry, 2012; 69(9): 904-912.
26. MIEDLICH SU, LAMBERTI JS. Connecting the dots: Understanding and addressing the metabolic impact of antipsychotic and antidepressant medications. Annals of the New York Academy of Sciences, 2025; 1546(1): 35-57.
27. MUTWALLI H, et al. Eating cognitions, emotions and behaviour under treatment with second generation antipsychotics: A systematic review and meta-analysis. Journal of Psychiatric Research, 2023; 160: 137-162.
28. PANIZZUTTI B, et al. Biological Mechanism(s) Underpinning the Association between Antipsychotic Drugs and Weight Gain. J Clin Med, 2021; 10(18): 4095.
29. TEIXEIRA PJR, ROCHA FL. Efeitos adversos metabólicos de antipsicóticos e estabilizadores de humor. Revista de Psiquiatria do Rio Grande do Sul, 2006; 28(2): 186-196.
30. TEMPLEMAN LA, REYNOLDS GP, ARRANZ B, SAN L. Polymorphisms of the 5-HT2C receptor and leptin genes are associated with antipsychotic drug-induced weight gain in Caucasian subjects with a first-episode psychosis. Pharmacogenetics and Genomics, 2005; 15(4): 195-200.
31. WU H, et al. Antipsychotic-Induced Weight Gain: Dose-Response Meta-Analysis of Randomized Controlled Trials. Schizophr Bull, 2022; 48(3): 643-654.
32. YANG Y, et al. Previous exposure to antipsicotic drug treatment is an effective predictor of metabolic disturbances experienced with current antipsychotic drug treatments. BMC Psychiatry, 2022; 22(1).
33. YE W, et al. Mechanism and treatments of antipsychotic-induced weight gain. International Journal of Obesity (London), 2023; 47(6): 423-433.
34. ZHANG JP, et al. Pharmacogenetic associations of antipsychotic drug-related weight gain: a systematic review and meta-analysis. Schizophrenia Bulletin, 2016; 42(6): 1418-1437.
35. ZIMMERMANN U, et al. Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res, 2003; 37(3): 193-220.
2. ALHASANI DM, et al. Metabolic Syndrome among Patients Taking Atypical Antipsychotics: A Comparative Cross-Sectional Study at Erada and Mental Health Complex in Taif, Saudi Arabia. Psychopharmacology Bulletin, 2024; 54(4): 35-44.
3. ALKHOLY R, et al. The impacts of antipsychotic medications on eating-related outcomes: A mixed methods systematic review. PLoS ONE, 2025; 20(2).
4. ALVAREZ-JIMÉNEZ M, HETRICK SE, GONZÁLEZ-BLANCH C, GLEESON JF, MCGORRY PD. Non-pharmacological management of antipsychotic-induced weight gain: systematic review and meta-analysis of randomised controlled trials. Br J Psychiatry. 2008;193(2):101-107.
5. BAPTISTA T, et al. Obesity and related metabolic abnormalities during antipsychotic drug administration: mechanisms, management and research perspectives. Pharmacopsychiatry, 2002; 35(6): 205-219.
6. BAZO-ALVAREZ JC, et al. Efeitos do tratamento prolongado com antipsicóticos no peso corporal: um estudo de coorte baseado na população. Journal of Psychopharmacology, 2020; 34(1): 79-85.
7. BERNARDO M, et al. Real-World Data on the Adverse Metabolic Effects of Second-Generation Antipsychotics and Their Potential Determinants in Adult Patients: A Systematic Review of Population-Based Studies. Advances in Therapy, 2021; 38(5): 2491-2512.
8. CHEN A, et al. Antipsychotics and the microbiota. Current Opinion in Psychiatry, 2020; 33(3): 225-230.
9. CORFITSEN HT, DRAGO A. Impacto das vias moleculares da biologia do desenvolvimento enriquecidas no ganho de peso induzido por antipsicóticos. Farmacogenética e Genômica, 2020; 30(1): 9-20.
10. DE R, et al. The impact of weight gain on antipsychotic nonadherence or discontinuation: A systematic review and meta-analysis. Acta Psychiatr Scand, 2025; 151(2): 109-126.
11. DEUTCH AY. Liraglutide for the Treatment of Antipsychotic Drug-Induced Weight Gain. JAMA Psychiatry, 2017; 74(11): 1172-1173.
12. DIAS PC, et al. Obesidade e políticas públicas: concepções e estratégias adotadas pelo governo brasileiro. Cadernos de Saúde Pública, 2017; 33(7): e00006016.
13. ECHEVESTE-NAVARRETE J, et al. Trajectory of the body mass index of children and adolescents attending a reference mental health center. Journal of Pediatric Endocrinology and Metabolism, 2024; 37(6): 559-568.
14. ELLINGER LK, IPEMA HJ, STACHNIK JM. Efficacy of metformin and topiramate in prevention and treatment of second-generation antipsychotic-induced weight gain. Ann Pharmacother, 2010; 44(4): 668-679.
15. FRANCISCA H. Antipsicóticos de primeira e segunda geração: impacto ponderal e o papel da abordagem nutricional. 2024.
16. GAO YN, OLFSON M. National trends in metabolic risk of psychiatric inpatients in the United States during the atypical antipsychotic era. Schizophrenia Research, 2022; 248: 320-328.
17. GROSU C, et al. Associations between antipsychotics-induced weight gain and brain networks of impulsivity. Transl Psychiatry, 2024; 14(1): 162.
18. GUPTA S, SONG X. Real-World Analysis of Antipsychotic Drugs' Effect on Weight Gain: An EHR Application. AMIA Annu Symp Proc, 2024; 2023: 961-968.
19. HEGDE NC, et al. Pharmacological interventions for antipsychotic-induced weight gain in schizophrenia: A network meta-analysis. Gen Hosp Psychiatry, 2024; 90: 12-21.
20. KRILL RA, KUMRA S. Metabolic consequences of second-generation antipsychotics in youth: appropriate monitoring and clinical management. Adolesc Health Med Ther, 2014; 5: 171-182.
21. KUJIPER G, MULDER H, EVENHUIS H, VISSER F, HOEKSTRA PJ. Effects of controlled discontinuation of long-term used antipsychotics on weight and metabolic parameters in individuals with intellectual disability. J Clin Psychopharmacol. 2013;33(4):520-524.
22. KUPPILI PP, NEBHINANI N. Role of Integrated and Multidisciplinary Approach in Combating Metabolic Syndrome in Patients with Severe Mental Illness. Indian J Psychol Med, 2019; 41(5): 466-471.
23. LIU C, et al. Dietary fiber and probiotics for the treatment of atypical antipsychotic-induced metabolic side effects: study protocol for a randomized, double-blind, placebo-controlled trial. Trials, 2021; 22(1).
24. LYU N, et al. Trajectories and predictors for the development of clinically significant weight gain in children and adolescents prescribed second generation antipsychotics. Journal of Child & Adolescent Psychopharmacology, 2024; 34(4): 201-209.
25. MALHOTRA AK, et al. Association between common variants near the melanocortin 4 receptor gene and severe antipsychotic drug-induced weight gain. Archives of General Psychiatry, 2012; 69(9): 904-912.
26. MIEDLICH SU, LAMBERTI JS. Connecting the dots: Understanding and addressing the metabolic impact of antipsychotic and antidepressant medications. Annals of the New York Academy of Sciences, 2025; 1546(1): 35-57.
27. MUTWALLI H, et al. Eating cognitions, emotions and behaviour under treatment with second generation antipsychotics: A systematic review and meta-analysis. Journal of Psychiatric Research, 2023; 160: 137-162.
28. PANIZZUTTI B, et al. Biological Mechanism(s) Underpinning the Association between Antipsychotic Drugs and Weight Gain. J Clin Med, 2021; 10(18): 4095.
29. TEIXEIRA PJR, ROCHA FL. Efeitos adversos metabólicos de antipsicóticos e estabilizadores de humor. Revista de Psiquiatria do Rio Grande do Sul, 2006; 28(2): 186-196.
30. TEMPLEMAN LA, REYNOLDS GP, ARRANZ B, SAN L. Polymorphisms of the 5-HT2C receptor and leptin genes are associated with antipsychotic drug-induced weight gain in Caucasian subjects with a first-episode psychosis. Pharmacogenetics and Genomics, 2005; 15(4): 195-200.
31. WU H, et al. Antipsychotic-Induced Weight Gain: Dose-Response Meta-Analysis of Randomized Controlled Trials. Schizophr Bull, 2022; 48(3): 643-654.
32. YANG Y, et al. Previous exposure to antipsicotic drug treatment is an effective predictor of metabolic disturbances experienced with current antipsychotic drug treatments. BMC Psychiatry, 2022; 22(1).
33. YE W, et al. Mechanism and treatments of antipsychotic-induced weight gain. International Journal of Obesity (London), 2023; 47(6): 423-433.
34. ZHANG JP, et al. Pharmacogenetic associations of antipsychotic drug-related weight gain: a systematic review and meta-analysis. Schizophrenia Bulletin, 2016; 42(6): 1418-1437.
35. ZIMMERMANN U, et al. Epidemiology, implications and mechanisms underlying drug-induced weight gain in psychiatric patients. J Psychiatr Res, 2003; 37(3): 193-220.