Calls for weight-loss drugs like Ozempic to be subsidised for people with schizophrenia
Queensland researchers are calling for weight-loss medicines to be listed on the Pharmaceutical Benefits Scheme (PBS) for people with schizophrenia, after a trial found they didn't affect psychotic symptoms.
The team at University of Queensland said weight gain was a major side effect of common antipsychotic drugs, leading to an "epidemic" of obesity-related concerns for people with schizophrenia.
Professor of psychiatry and doctor at Metro South Health Service Dan Siskind said one of the most common complaints he had from patients was their "frustration" with gaining weight from their antipsychotic medications.
He said people with schizophrenia also faced physical health complications due to weight gain and obesity.
"We know about the common symptoms of schizophrenia like voices, paranoia [and] confused thinking," he explained.
"One thing that's not often talked about is that people with schizophrenia live about 20 years shorter than the general population, and that's not due to suicide.
According to the Mental Illness Fellowship of Australia, about 200,000 people are affected by schizophrenia nationwide.
Dr Siskind said there was a shared genetic link between sugar metabolism defects and schizophrenia, meaning poor diet and lack of exercise could be contributing factors, but said prescribed antipsychotic medications like clozapine could also be causing weight gain.
He said he's seen a small proportion of his patients stop their medications, while others have continued to deal with ongoing issues and considered stopping them.
"When people stop their medication, they get really unwell, they get re-hospitalised … and the weight gain causes a lot of stigma," he said.
As part of his work, Dr Siskind helped patients who experienced severe mental illnesses improve their diet and exercise, but said pharmacological interventions were also essential.
Community nutritionist Donni Johnston, who also worked with people with severe mental illnesses, agreed.
She said a range of factors influenced weight gain, including medications that might see people experiencing uncontrollable hunger and an insatiable appetite.
Ms Johnson explained socio-economic factors like a lack of education, or those living in residential care not having learned to cook, could also have an impact.
"I do a lot around encouraging people to make healthy choices, but it can be almost unfair on people when they're on medications that are causing such an increased appetite," she said.
But Ms Johnston stressed the importance of continuing to strive for a healthy diet, alongside medications.
"We know that having a healthy diet impacts our feelings of anxiety and depression and some of those symptoms of mental illness, but [it's] also really important in preventing chronic disease," she said.
A recent study led by Dr Siskind focused on semaglutide, the active component in weight-loss drugs sold under the brand names Ozempic or Wegovy.
Previously, people with schizophrenia had been excluded from clinical trials of Ozempic, he said, which meant it wasn't clear if the weight loss drug would interfere with other medications.
The 36-week investigator-led trial, involving 31 participants with schizophrenia, found those on Ozempic lost 13.5 per cent more of their body weight than those taking a placebo.
Many of the participants started off the study around the 100 kilogram mark.
"People were telling me about how comfortable and proud they felt," Dr Siskind said.
"I had one [person] who took up ice hockey after he lost all of the weight because he could get back on his skates."
He said the important finding from the study was that the weight-loss medications didn't increase psychosis, or impact the effect of antipsychotic medications as measured by blood levels.
No pharmaceutical companies were involved in the study.
In Australia, Ozempic is not listed on the Pharmaceutical Benefits Scheme (PBS) for weight loss for people with schizophrenia, which is something researchers are calling for.
Dr Siskind said many of his patients lived on the pension and didn't have the kind of disposable income necessary to afford the "quite expensive" medication otherwise.
A month's supply of Ozempic with a private prescription generally costs between $130 to $200 in Australia.
A spokesperson for the federal health department said weight gain as a side effect of medication was best managed by a patient's prescriber.
"Decisions to list new medicines on the PBS rely on pharmaceutical companies making applications to the Pharmaceutical Benefits Advisory Committee (PBAC)," the spokesperson said.
"The government cannot make a new PBS listing unless it has been recommended by the PBAC."
No medications are currently listed on the PBS with "weight management" as their intended use.
In a statement, Australian Medical Association Queensland president Dr Nick Yim said he welcomed any reviews and updates to the PBS, but said supplies of semaglutide continued to be a concern.
"We know [it] continues to be in short supply and improving access to it is an ongoing challenge," he said.
The research will be published today in Lancet Psychiatry.
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