What AP is best to avoid weight gain/anhedonia

Medications
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Im changing meds next week when pdoc is back

Any idea which ap ?

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Abilify is considered one of the more weight neutral AP’s

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Based on clinical trials and meta-analyses, the best antipsychotics to avoid both significant weight gain and anhedonia are generally considered to be cariprazine (Vraylar), aripiprazole (Abilify), lurasidone (Latuda), and ziprasidone (Geodon).

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These medications are known for being “weight-neutral” or causing very low amounts of weight gain, and they often help improve motivation and mood rather than causing emotional blunting.

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Top Choices by Profile

  • Cariprazine (Vraylar): Often considered a premier option, particularly for bipolar depression or negative symptoms (like lack of pleasure/anhedonia) in schizophrenia. It is a partial dopamine D3/D2 receptor agonist with higher affinity for D3, which helps with motivation and mood. It has minimal, if any, effect on weight in many studies.

  • Aripiprazole (Abilify): Known for being weight-neutral and is often used to reverse weight gain caused by other antipsychotics. It is a partial agonist that can improve alertness and reduce anhedonia.

  • Lurasidone (Latuda): Demonstrates some of the lowest weight gain liability among all antipsychotics. It is particularly useful for bipolar depression.

  • Ziprasidone (Geodon): Highly weight-neutral but must be taken with a substantial meal (350+ calories) to be effective.

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Summary of Comparison

Antipsychotic Weight Gain Risk Anhedonia/Motivation
Cariprazine Low (negligible) High (effective for negative symptoms)
Aripiprazole Low High (can reduce anhedonia)
Lurasidone Very Low Good for bipolar depression
Ziprasidone Low (weight neutral) Moderate

Important Considerations

  • Akathisia: Aripiprazole and cariprazine can cause akathisia (internal restlessness), which some people may find distressing.

  • Individual Response: While the medications above are statistically better for weight, individual responses can vary.

  • Avoid: Clozapine (Clozaril) and Olanzapine (Zyprexa) generally cause the highest weight gain.

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Disclaimer: Antipsychotic medication must be managed by a psychiatrist. Switching medications requires careful titration to prevent relapse of symptoms.

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Mh won’t allow me back on abilify because of weight gain and obsessive behaviour shopping on it

I wish i could it is a good drug

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I have mostly used cariprazine on a low dose. It is supposed to be activating partial agonist and pretty benign on some respects. But I don’t find it miraculous or anything, just least bad option. And indeed the akathisia can be distressing and annoying, at least in the beginning. Good thing is that it stays in the system quite well and dose is low, maybe some folks get better response in relation to negative symptoms. And it shouldn’t cause those compulsive symptoms I guess.

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Thats Vraylar

I suggested vraylar or latuda to my nurse and she’s going to discuss with psychiatrist and get back to me next week. Fingers crossed it is better than what im on now

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I find just forcing yourself to go walking helps with weight gain and prevents sitting on the sofa feeling negative. It’s especially good if you can go with a friend…

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I am currently on lurasidone (the Latuda generic) and I ended up gaining 20 pounds within 4 months of being on it. I can’t seem to get the weight off, even though I am on a low carb diet.

However, I feel it helps my positive symptoms of psychosis without blunting my emotions too much.

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I would trade the weight gain to have some emotions back and feel less paranoid

20 pounds may come off gradually @Vinegar and its easier losing weight in the summer

Fingers crossed for you!

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Thanks @Ducky

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You know duckey we fight a very similar fights against Schizophrenia. You know the only antipsychotic that lived up to my expectation is good old Clopixol depot 400 mg every 3 weeks.
I’m in the process of coming off of my Seroquel. Just another of the newer antipsychotics that disappointed me.

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Yes @Relaxe clopixol is a good med. This morning i have decided to stick with the clopixol despite anhedonia. I just cant afford to risk changing meds. Thankyou

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