Clozapine and Weight Gain
Mr. A and Mr. B were 19-year-old monozygotic (zygosity determined with microsatellite markers [4]) twins concordant for the paranoid type of schizophrenia (per DSM-IV). Before initiation of treatment with antipsychotics, both had a body mass index of 25.2 kg/m2 (Mr. A: 93 kg/192 cm; Mr. B: 92 kg/191 cm). Mr. A, whose antipsychotic treatment was initiated with risperidone (up to 5 mg/day) at age 17.4 years, gained 17 kg during an 11-month period. Mr. B was first treated at age 17.6 years with classic antipsychotics (haloperidol, chlorprothixene, and clopenthixol) for 2 months, during which time he gained 2 kg. Because of an insufficient clinical response, the twins were switched to clozapine (maximal daily doses: 500 mg and 450 mg, respectively), which they had been taking for the past 16 and 22 months, respectively.With clozapine treatment, Mr. A, who was pretreated with risperidone, gained approximately 20 kg within 9 months. In contrast, Mr. B gained almost 40 kg within 14 months. Both twins maintained a steady body weight of about 132 kg for more than 6 months. Currently, the twins weigh 131 kg (body mass index of Mr. A: 35.5 kg/m2) and 132 kg (Mr. B: 36.2 kg/m2), respectively. Weight gain since the initiation of antipsychotic treatment has totaled 38 kg and 40 kg, respectively. After initiation of clozapine therapy, both twins developed binge eating episodes (two to three per week) that fulfilled the DSM-IV research criteria for binge eating disorder as evaluated by the Questionnaire on Eating and Weight Patterns (5). Both twins reported frequent hunger, consumption of large quantities of food, and lessened satiation.
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