Weight gain under antipsychotic and mood stabilizing treatment: a narrative review about mechanisms and future options.

backgroundPharmacological treatment for mental illness can paradoxically compromise physical health, with weight gain and related cardiovascular and metabolic diseases among its most concerning side effects. Understanding and mitigating the metabolic consequences of antipsychotic and mood stabilizing treatments is therefore crucial for improving long-term health outcomes in individuals with severe mental illness such as schizophrenia and bipolar disorder. This literature review focuses on the underlying mechanisms linking antipsychotics and mood stabilizers to weight gain in bipolar disorder. Current evidence on both pharmacologic and nonpharmacologic strategies to prevent this side effect is also addressed.

methodsA literature search was conducted from February-April 2025 using PubMed and Google Scholar. The electronic search was complemented by a manual search for additional articles in reference lists and previous reviews. Relevant reviews, cohort studies, meta-analyses and randomized controlled trials (RCTs) were reviewed.

resultsOur results support that different mood stabilizers and antipsychotics contribute to weight gain through distinct biological mechanisms, including metabolic dysregulation, appetite modulation, and hormonal changes. Nonpharmacologic interventions, such as dietary modifications, physical activity, cognitive and behavioral strategies, play a crucial role in counteracting medication-induced weight gain. Pharmacologic approaches, including adjunctive medications, offer potential in mitigating weight gain, but their effectiveness and safety profiles require further evaluation.

conclusionCustomized treatment plans tailored to each patient's needs, preferences, goals and circumstances should be considered for the treatment of antipsychotic and mood stabilizer-associated weight gain.