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Abstract

Obesity is a growing problem in the child and adolescent population, and physicians are increasingly looking for new, safe, and effective interventions. Particularly concerning is the trend of overweight children being increasingly prescribed psychotropic medications, particularly atypical antipsychotics, that can lead to further weight gain. In recent years, pharmacologic treatment for weight has been considered for severe and refractory cases. We present two cases of obese adolescents who achieved weight loss with the addition of zonisamide, an anticonvulsant. The first case is a morbidly obese adolescent male who had remarkable weight loss during 3 months of inpatient hospitalization. The patient initially had a dramatic weight loss from 301 kg to 213.4 kg. This could be attributed to many factors, including the addition of appetite suppressing medications (topiramate and methylphenidate) as well as a structured environment and monitored nutritional intake. However, his weight loss plateaued. The addition of zonisamide correlated with an additional weight loss for a final weight of 202.76 kg, which is an additional 10.64 kg. We present a second case of an obese adolescent who initially presented to an inpatient psychiatric unit with a high-BMI of 37.8 (126.8 kg). He was started on zonisamide and a steady decrease in weight and BMI was noted through four months of outpatient follow-up, with his most recent BMI being 31.7 (106.2 kg). We discuss the potential use of zonisamide for weight loss in obese adolescents, particularly in patients who are prescribed psychotropic medications. We also consider the potential risks and benefits in this patient population.

Biography

Michael Shapiro is completing his Child Psychiatry Fellowship at the University of Florida. He served as chief fellow during his last year, and was named a Child PRITE © Fellow by the American College of Psychiatrists.