Research indicates that newer antipsychotic medications can cause metabolic harm in young patients independently of weight gain, highlighting the need for improved monitoring and cautious prescribing practices.
A large study of children and teenagers taking newer antipsychotic medicines suggests that some of the metabolic harm linked to the drugs cannot be explained simply by weight gain. Writing in Nature Mental Health on Monday, researchers who followed 510 mostly antipsychotic-naive patients aged 4 to 17 for a year found that rises in cholesterol, fasting glucose and triglycerides were strongest with olanzapine and, to a lesser extent, risperidone, even after accounting for changes in body fat. That matters because earlier population work from Denmark found the added cardiometabolic risk associated with starting antipsychotics was greater in children and adolescents than in young adults, while Australian researchers have separately shown that routine checks for those side effects are often not happening.
The new paper arrives after years of warning signs from shorter studies. In 2018, a randomised clinical trial led by Washington University School of Medicine and Florida Atlantic University tracked 144 antipsychotic-naive young people aged 6 to 18 for 12 weeks and found significant gains in body fat alongside a drop in insulin sensitivity. Those drugs are not used only for psychosis. The Washington University team noted that, in practice, they are also prescribed to young people with attention deficit hyperactivity disorder who do not respond to stimulants, as well as to children with disruptive behaviour disorders.
What made that earlier trial especially influential was the way it measured harm. Rather than relying only on weight or body mass index, the researchers used dual-energy X-ray absorptiometry scans to measure whole-body fat and MRI scans to assess abdominal fat, including the visceral fat linked to later diabetes and cardiovascular disease. Measurements were taken before treatment, again after six weeks and then at 12 weeks. In the intention-to-treat sample, which had a mean age of 11.3 and was 68.1% male, the proportion of body fat rose by 4.12% with olanzapine, compared with 1.18% for risperidone and 1.66% for aripiprazole. At baseline, about 30% of participants were overweight or obese; by 12 weeks, that had climbed to 46.5%. The same study also found no sign that stimulant medicines offset the problem. As Ginger Nicol, the study’s first author, put it, “stimulants didn’t seem to make any difference.”
The latest Nature Mental Health study pushes the field on by asking a more clinically useful question: what goes wrong because a child accumulates fat, and what goes wrong because of the drug itself? That distinction is important for doctors and families, because the answer changes what needs monitoring. If a medicine can worsen lipids or fasting glucose even when visible weight gain is modest, a child who looks stable on the scales may still be developing trouble in blood tests. The new findings also fit a pattern seen in earlier work, in which olanzapine has repeatedly emerged as the drug with the heaviest metabolic burden, while aripiprazole has tended to look safer.
Longer-term population data point in the same direction. The 2025 Danish cohort study, published in World Psychiatry, included people with psychiatric diagnoses who began antipsychotic treatment between 2000 and 2021 at ages 6 to 31. Its main outcome was any cardiometabolic event, defined through either a first relevant hospital diagnosis or a prescription for associated treatment recorded in national registers. Although the absolute event rate was higher in young adults, the excess risk tied to antipsychotic exposure was significantly greater in children and adolescents than in matched peers with psychiatric disorders who were not given the drugs. The age at which treatment started also mattered for specific outcomes: the risks of metabolic syndrome and obesity were higher in those who began in childhood or adolescence, with analyses split between ages 6 to 11 and 12 to 17.
Set against that background, the monitoring picture looks poor. An Australian study published in August 2025 examined GP records from 2011 to 2017 and found children and adolescents on antipsychotics were rarely checked often enough for obesity, blood pressure, cholesterol or glucose problems. Only 10.4% had their weight monitored at least three times in the first year after starting treatment, far short of the seven to nine checks recommended in guidelines. Monitoring of total cholesterol and blood sugar at recommended levels was lower still, at 0.6% and 0.9%. The researchers found that patients prescribed antipsychotics received, on average, only an extra half visit in which any metabolic measure was recorded. Julie Klau, the lead author, called the figures stark: “These monitoring levels are unacceptably low”. Her team also highlighted prolactin, a hormone that risperidone can raise in more than 30% of patients, as another under-checked risk during puberty.
None of this means the medicines have no place. The 2018 trial was conducted in children with serious behavioural difficulties, and the researchers stressed that clinicians are often dealing with crises in which rapid treatment can help stabilise a child and keep them functioning at school and at home. But the balance of benefit and harm depends on choosing carefully and checking properly. Earlier JAMA Psychiatry reporting found olanzapine produced greater increases in body fat than risperidone or aripiprazole without delivering a larger improvement in psychiatric symptoms. The Danish authors, looking at the broader population burden, argued that antipsychotic prescribing in young people should be confined to on-label or medically unavoidable situations where possible, with lower-risk options favoured and metabolic abnormalities tackled early.
The paper also lands during a period in which developmental psychiatry is paying closer attention to risks that accumulate early in life. In July 2026, the same journal published a study led by Laura Glynn that added a five-item unpredictability questionnaire to standard adverse-childhood-experiences screening across 19 paediatric clinics in California and linked both measures to mental health diagnoses in about 30,000 children. That work dealt with adversity rather than medication, but the overlap is instructive: whether the risk comes from a child’s environment or from a necessary treatment, the message is that young patients cannot be treated as smaller versions of adults. Their bodies, as well as their minds, require follow-up designed for development rather than afterthoughts once problems appear.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
