Certain mental health conditions can benefit from antipsychotic medications. But along with symptom relief can come unexpected side effects—like weight gain.

Antipsychotic medications can help improve symptoms of psychosis that may significantly impair daily life, such as hallucinations, delusions, or disorganized thinking.

Like all medications, side effects are possible. Antipsychotic weight gain is a real concern for many people taking these prescriptions.

Antipsychotic medications, particularly second-generation antipsychotics, such as Zyprexa and Abilify, cause weight gain for many people.

Taking an antipsychotic, however, doesn’t mean you undoubtedly will experience weight gain.

A 2021 meta-analysis of 58 clinical trial articles found patients receiving antipsychotics for the first time were the most susceptible to weight gain.

Though long-term patients switching between antipsychotic medications also experienced mild increases.

In a narrative review examining the use of antipsychotics in children, experts noted rapid antipsychotic weight gain was repeatedly documented.

And a person’s cardiometabolic risk compounded over time when antipsychotics were started in childhood.

What is metabolic risk?

Metabolic risk isn’t limited to weight gain.

It can be any process in the body that involves metabolism—how your body obtains and utilizes energy from what you eat.

Conditions associated with metabolic risk include:

  • obesity
  • low HDL cholesterol
  • high blood pressure
  • elevated blood sugar
  • high blood triglycerides

Over time, these risk factors can evolve into conditions such as diabetes, stroke, or coronary heart disease.

Experiencing three or more metabolic conditions is what’s known as metabolic syndrome.

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Which antipsychotics are associated with weight gain?

According to the National Alliance on Mental Illness (NAMI), second-generation antipsychotics have been the most closely associated with antipsychotic weight gain.

Examples of second-generation antipsychotics include:

Of these, meta-analysis data from 2018 upholds previously seen trends that olanzapine carries the highest rates of antipsychotic weight gain.

Clozapine has also been recognized as a prescription with more pronounced metabolic side effects—including weight gain— compared to other antipsychotic drugs. But clozapine isn’t noted as the main contributing factor to weight gain.

Do any antipsychotic drugs not cause weight gain?

Among second-generation antipsychotics, ziprasidone is one of the most widely recognized prescriptions that may not cause antipsychotic weight gain.

If you’re switching off a current antipsychotic, amisulpride and aripiprazole may not affect weight and might result in some weight loss.

While second-generation antipsychotics are the go-to for many mental health conditions, first-generation antipsychotics may have a lower chance of experiencing weight gain.

Examples of first-generation antipsychotics include:

  • haloperidol (Haldol)
  • loxapine (Loxitane)
  • perphenazine (Trilafon)
  • droperidol (Inspsine)
  • chlorpromazine (Thorazine)

First-generation antipsychotics are still used in certain situations. But they come with a higher incidence of extrapyramidal side effects, otherwise known as nerve conditions that can significantly impair motor function.

May antipsychotics affect appetite and weight in other ways?

While antipsychotics are often associated with weight gain, you can experience other side effects that may impact your appetite and weight.

Antipsychotic medications can also cause digestive symptoms, such as:

  • vomiting
  • nausea
  • constipation

If digestive symptoms make eating or keeping food down challenging, you may notice weight loss or other weight fluctuations.

The way antipsychotics work in your body may make it challenging to lose weight while taking your prescription.

A 2021 study investigating the mechanisms behind antipsychotic weight gain found that shared genetic pathways between obesity and mental disorders may underlie why treatment is linked to weight gain.

In the study, researchers demonstrated that influencing genes prevented weight gain in rodent models being administered the antipsychotics risperidone and olanzapine.

That doesn’t mean weight loss is impossible.

In 2014, researchers conducting a multisite, parallel two-arm randomized controlled trial found weight loss while taking antipsychotic medications was successful through lifestyle interventions such as:

  • physical activity
  • a high blood pressure-oriented diet
  • moderate calorie restriction

Weight gain isn’t something to be ashamed of.

As the “Health at Every Size” principle suggests, healthy habits and positive well-being are more important than what size pants you wear.

If you’re concerned about antipsychotic weight gain or feel it’s in your best interests to manage weight changes from your prescription, these tips may help.

Combination therapy

In 2016, a meta-analysis of 12 published studies confirmed that taking metformin with antipsychotic medications could help manage weight gain.

Metformin belongs to a class of drugs called biguanides. It works by helping moderate the amount of glucose in your bloodstream.

When you have too much glucose in your bloodstream, your body often stores it in fat cells.

Blood sugar control

You don’t need a prescription to start managing blood glucose levels.

Avoiding foods high in carbohydrates and sugars can have similar mitigating effects as a prescription like metformin.

Common foods you can avoid that are high in carbohydrates include:

  • fruit juice
  • ice cream
  • white rice
  • cake
  • cookies
  • soda
  • candy
  • chips
  • white bread
  • refined grains
  • foods high in sugar

Limiting carbohydrates can be counterproductive in some situations and should only be done after a discussion with your healthcare team.

The DASH diet

The dietary approaches to stop hypertension (DASH) diet is a potential dietary intervention for antipsychotic weight loss.

While this is a high blood pressure-oriented diet, it’s designed to be balanced enough to become a lifelong way of eating.

The DASH diet involves:

  • eating vegetables, fruits, and whole grains
  • limiting sugar-sweetened foods and beverages
  • limiting foods with high saturated fats (full-fat dairy products, tropical oils, fatty meats)
  • focusing on fat-free or low fat fish, nuts, vegetable oils, poultry, and dairy products

Before starting the DASH diet, your healthcare team can discuss the pros and cons with you to determine if it’s a viable option for antipsychotic weight gain control.

Cognitive behavioral therapy (CBT)

CBT is a way to identify unhelpful behaviors and beliefs and restructure them into something positive.

If you use food as a coping mechanism, for example, CBT can help you develop new ways to meet the stresses of everyday life.

Other forms of behavioral therapy can support you in goal-setting, improve your concept of well-being, and encourage efforts to monitor exercise and diet.

Growing awareness

It can be easy to miss the little ways calories and food decisions infiltrate daily life.

Improving your awareness of what, when, and why you eat might help you crack down on unhelpful habits.

Keeping a journal, for example, can help you identify patterns in eating, exercising, and overall stress coping that may benefit from new approaches.


Exercise offers more than just a caloric deficit.

Exercise can promote glycemic control and reduce the risk of certain metabolic conditions, like cardiovascular disease.

If you find it challenging to meet a goal of 30-45 minutes of moderate exercise daily, you can break your activity down into more manageable time frames.

Three 10-minute brisk walks a day may be all it takes to see a significant improvement in your health.

It’s common to experience antipsychotic weight gain.

This weight gain doesn’t mean you’re unhealthy; it isn’t a reason to discontinue your medications.

Dietary interventions, behavioral modification, and exercise efforts can all help you fight back against those extra pounds.

If you don’t feel lifestyle changes are working, you can speak with your healthcare team about professionally-guided support options and new medications that may make a difference.