Last October, we published a table on mood stabilizer side effects that raised an understandable alarm among astute readers. The table, which was based on a 2020 meta-analysis, suggested that aripiprazole (Abilify) has a greater chance of causing weight gain than quetiapine (Seroquel). What the table failed to specify was that the figures were based on long-term maintenance studies. In the short-term trials, quetiapine ranked right behind olanzapine for its propensity to increase BMI, while aripiprazole had a non-significant effect.
Mood stabilizers are intended for long-term use, which is why we decided to focus on the long-term data. However, there are far more short-term trials than long-term ones, so we are less confident in these results. In this meta-analysis, the difference between aripiprazole and quetiapine was based on only 3 bipolar maintenance trials (n = 773). Things become more certain when we expand that population to all psychiatric patients, as Maarten Bak and colleagues did in 2014 (Bak M et al, PLoS One 2014;9(4):e94112). Pulling together 11 trials that lasted at least 9 months, Bak found similar rates of weight gain for aripiprazole and quetiapine, both in terms of the rate of clinically significant (> 7%) weight gain (1 in 5 for both meds, compared to 1 in 25 for placebo) and the absolute increase in BMI.
Look out for long-term weight gain in your patients. Most of what we know about this side effect comes from short-term trials, and those may not tell the whole story.
Behavioral activation came about in the 1990’s as a challenge to the CBT model of depression. The basic strategy behind this therapy blends well with brief medication visits, and we explain how to use it in this professional guide.