Medication, Weight Gain and GI Hormones

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00384332
Recruitment Status : Completed
First Posted : October 6, 2006
Results First Posted : July 31, 2017
Last Update Posted : July 31, 2017
Eli Lilly and Company
Information provided by (Responsible Party):
Richard C. Shelton, Vanderbilt University

Brief Summary:
This is an 8 week study that compares two medications. One medication is olanzapine (5-20 mg daily) whereas the other medication is an orally disintegrating medication. Both medications are used to treat depressed bipolar patients. The main focus of this study is the comparison of these two medications on gastro-intestinal hormones and weight gain.

Condition or disease Intervention/treatment Phase
Bipolar Depression Drug: orally-disintegrating olanzapine Drug: regular olanzapine Phase 4

Detailed Description:

Olanzapine is undeniably one of the most effective treatments available for all phases of bipolar disorder. After FDA approval for bipolar mania, the drug became one of the most widely prescribed of treatments for this difficult-to-treat disorder. However, concerns about weight gain and the associated metabolic syndrome/type II diabetes have impacted the use of olanzapine.

In fact, weight gain is quite common with olanzapine. For example, in one large scale 8-week placebo-controlled trial of olanzapine in bipolar depression, the olanzapine-treated patients gained an average of 2.59 kg., while placebo patients lost an average of 0.47 kg. Further, weight gain can continue over an extended period of time, mounting to an average of about 6 kg. over one year. It should be noted, however, that in prior studies, no efforts have been made to limit weight gain. More recent data suggest that interventions such as dietary counseling are effective in either preventing or reversing weight gain.

Olanzapine is a potent antagonist of serotonin and histamine 1 receptors. Significant and potentially additive weight gain is associated with blockade of serotonin 2C and Histamine 1 receptors. In addition, serotonin and its receptors are significantly involved in the regulation of gastrointestinal (GI) - related hormone secretion. Animal studies suggest significant involvement of other serotonin receptors in the regulation of appetite, satiety, and GI-related hormones. However, the interplay of selective activation or inhibition of these receptor subtypes is complex, and difficult to distinguish from effects on activity and anxiety. Suffice it to say that activation or blockade of these receptors have differential effects on appetite, satiety, metabolic activity, as well as leptin, secretin, insulin, glucagon, ghrelin, neuropeptide Y, and cholecystokinin.

Weight gain and the corresponding metabolic syndrome represent a "deal killer" with regard to the treatment of most patients. However, one recent small study may be highly relevant to this discussion. De Haan et al. investigated the relative effects of standard olanzapine tablets to the orally-disintegrating form (Zydis) in adolescents and young adults who had gained weight with olanzapine. The group randomly assigned 18 patients to continuation olanzapine tablets or Zydis for a 16-week period. The Zydis-treated patients lost an average of 6.6 kg. while the continuation regular olanzapine group gained 3.7 kg. Although small, this study suggests a potential solution to the weight-gain problem associated with olanzapine.

Most of the pharmacological effects on weight and hormones are thought to be mediated centrally. However, De Haan et al. (de Haan L, et al. Psychopharmacology (Berl). 2004;175:389-390) proposed that at least some of the difference could be attributable to local effects in the GI tract. In particular, the site of absorption was suggested as a possible explanation, with the orally disintegrating form (Zydis) yielding less exposure of the pylorus to olanzapine than the standard Zyprexa tablets.

In this project we will treat 20 patients with bipolar disorder with olanzapine (a widely-used and FDA approved treatment for this condition); patients will be randomly assigned (1:1) to either standard Zyprexa tablets or orally disintegrating Zydis. We will measure symptom improvement and weight gain over the course of the study. Patients will be given dietary counseling prior to initiating either medication. In addition, we will contrast the effects of the treatments on GI-related hormones.

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 20 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: Orally-Disintegrating vs. Regular Olanzapine Tablets: Effects on Weight and GI Hormones
Study Start Date : January 2007
Actual Primary Completion Date : March 2010
Actual Study Completion Date : March 2010

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arm Intervention/treatment
Experimental: Arm 1
Orally disintegrating olanzapine
Drug: orally-disintegrating olanzapine
5 to 20 mg (daily) orally disintegrating olanzapine for approx.8 weeks.
Other Name: Zydis
Experimental: Arm 2
regular olanzapine
Drug: regular olanzapine
5-20 mg. olanzapine daily for approximately 8 weeks.
Other Name: Zyprexa

Primary Outcome Measures :
  1. Weight in Kilograms at Baseline, Weeks 1, 4, 6, and 8 [ Time Frame: 10 weeks ]
    Change in weight from baseline to endpoint in kilograms. Reported as weight in Kilograms at Baseline, Weeks 1, 4, 6, and 8

Secondary Outcome Measures :
  1. Change From Baseline Montgomery Asberg Depression Rating Scale [ Time Frame: 10 weeks ]
    Montgomery Asberg Depression Rating Scale (MADRS) total score. Construct: Depression severity. Scores below represent mean change scores, endpoint minus baseline. Minimum total score: 0 (no depression). Maximum total score: 60 (severe depression). Lower (more negative) scores indicate a better outcome. There are no subscales.

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Ages Eligible for Study:   18 Years to 60 Years   (Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria:

  • A principal diagnosis of bipolar 1 or II disorder
  • Ages 18-60
  • Physically healthy
  • Outpatient status
  • Montgomery-Asberg Rating Scale (MADRS) Score greater than or equal to 15
  • BMI 23-30
  • Able and willing to give written informed consent

Exclusion Criteria:

  • Prior history of diabetes (types I or II)
  • BMI>30
  • Non-fasting blood glucose >124
  • Fasting blood glucose >125 or random blood glucose >200
  • Presence of dyslipidemia (baseline total cholesterol >240, HDL<50, LDL>160, triglycerides >199)
  • Current or past history of a non-affective psychotic disorder
  • Alcohol or other substance abuse or dependence in the 6 months prior to the evaluation (except for caffeine)
  • Current use of any nicotine products
  • Schizoid, schizotypal, or borderline personality disorder
  • Treatment with olanzapine in the prior 3 months or any history of non- response to or intolerance of olanzapine or the olanzapine-fluoxetine combination (SymbiaxTM)
  • Suicide potential that, in the opinion of the investigator, precludes outpatient treatment or participation in a trial
  • Participation of subjects in another drug trial within 30 days of evaluation
  • The presence of any current medical condition judged by the investigator to potentially interfere with the study procedures or measures
  • The likelihood of requiring hospitalization over the period of the study
  • The presence of any clinically-significant laboratory abnormality as judged by the investigator
  • Pregnancy or lactation
  • History of seizure disorder, excluding febrile seizures of childhood
  • Any disorder of taste or smell, including severe nasal allergies
  • Any other condition which, in the investigator's judgment might increase the risk to the subject or decrease the chance of obtaining satisfactory data to achieve the objectives of the study
  • Being unable to comprehend or follow the study procedures.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00384332

United States, Tennessee
Vanderbilt University Medical Center
Nashville, Tennessee, United States, 37212
Sponsors and Collaborators
Vanderbilt University
Eli Lilly and Company
Principal Investigator: Richard C. Shelton, M.D. Vanderbilt University Medical Center

Additional Information:

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Richard C. Shelton, Professor, Vanderbilt University Identifier: NCT00384332     History of Changes
Other Study ID Numbers: 051235
First Posted: October 6, 2006    Key Record Dates
Results First Posted: July 31, 2017
Last Update Posted: July 31, 2017
Last Verified: June 2017

Keywords provided by Richard C. Shelton, Vanderbilt University:
Bipolar Depression
Weight gain bipolar medicine
side effects olanzapine
gastrointestinal hormones bipolar medicine

Additional relevant MeSH terms:
Weight Gain
Bipolar Disorder
Behavioral Symptoms
Body Weight Changes
Body Weight
Signs and Symptoms
Bipolar and Related Disorders
Mental Disorders
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Autonomic Agents
Peripheral Nervous System Agents
Gastrointestinal Agents
Antipsychotic Agents
Tranquilizing Agents
Central Nervous System Depressants
Psychotropic Drugs
Serotonin Uptake Inhibitors
Neurotransmitter Uptake Inhibitors
Membrane Transport Modulators
Molecular Mechanisms of Pharmacological Action
Neurotransmitter Agents
Serotonin Agents