Thanks Thanks:  6
Likes Likes:  0
Page 1 of 2 12 LastLast
Results 1 to 10 of 15
  1. #1
    Join Date
    Mar 2004
    Location
    Ottawa, Canada
    Posts
    35,301
    Mentioned
    20 Post(s)
    Tagged
    0 Thread(s)

    Preventing and Reversing Weight Gain Associated with Psychiatric Medications

    Preventing and Reversing Weight Gain Associated with Psychiatric Medications
    by Candida Fink MD
    October 24, 2008

    Many people who carry the bipolar diagnosis also carry something else ? extra pounds ? primarily due to the medications used to treat mania or depression. Atypical antipsychotics, including Zyprexa and Seroquel; anti-manics, including lithium and Depakote; and even some antidepressants have been known to pack on the pounds, despite a person?s best efforts to stay fit and trim.

    Doctors and therapists don?t always treat medication-induced weight gain with the sensitivity or importance it deserves. As long as you?re not manic or depressed, they seem to think you should be thankful and accept the weight gain as a necessary trade-off for the privilege of mood stability. Others casually shift the responsibility to their patients, suggesting that normal exercise and dieting can shed the unwanted pounds, rarely acknowledging the fact that when you?re depressed, you may not feel much like jogging or swimming laps.

    When you?re not the one carrying the extra 10 to 50 pounds, it?s easy to shrug it off as though it?s of little concern, but weight gain can and often does lead to other problems:

    • Poor self esteem ? from tight-fitting clothes and looking or feeling not as fit as they would like.
    • Medication noncompliance ? stopping the medications they suspect of causing the weight gain.
    • Physical health risks ? including high-cholesterol, diabetes, and heart disease.
    Weight gain is one of the most common and difficult side effects of many of the medications used to treat bipolar disorder and other psychiatric illness. It is something I address daily with patients and families ? when picking an initial medication or adjusting or changing prescriptions. This topic comes up constantly.

    In this post, I highlight the most common culprits (the medications most likely to cause the most weight gain) and offer a pro-active approach that has helped many of my patients keep the pounds off or shed them later.

    Atypical Antipsychotics
    Almost all of the atypical antipsychotics are notorious for causing fairly significant weight gain in most (but not all) people who take them. Here?s the list of culprits ranked from most to least risk for causing weight gain:

    • High risk: Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), and clozapin (Clozaril)
    • Little to no risk: Ziprasidone (Geodon) and older first-generation antipsychotics such as perphenazine (Trilafon)

    The weight gain from antipsychotics appears to come from increased appetite (?hyperphagia?) and some changes in metabolism. This family of medicines also has varying degrees of risk of certain health risks such as diabetes and elevated cholesterol, which may be related to the medication?s effect on metabolism.

    Antidepressants and Antianxiety Medications
    Antidepressants and antianxiety medications all have some risk of weight gain, although not typically in the same severe range as the antipsychotics. The risk seems to be more individualized ? some people notice a lot of change in appetite and weight and some notice little. Occasionally, some people actually lose weight on these meds. In addition, these medications do not carry specifically the risks of diabetes and high cholesterol.

    The most common antidepressants and antianxiety medications are the SSRI?s and SNRI?s (the weight gain risk really depends on the individual):

    • SSRI?s: Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa) are some examples.
    • SNRI?s: Venlafaxine (Effexor) and Duloxetine (Cymbalta) are the most common.

    Bupropion (Wellbutrin), which is in a class of its own, is the only antidepressant without any risk of weight gain ? but it is not particularly effective for anxiety.

    Anti-Manics or ?Mood Stabilizers? and Anti-Seizure Medications
    Mood stabilizers and the anti-seizure medications often used to treat or prevent mania may also carry the risk of causing weight gain, but the risk varies depending on the medication and its effect on the person taking it:

    • High risk: Valproic acid (Depakote)
    • Moderate risk: Lithium
    • Low risk: Lamotrigine (Lamictal) and carbemazapine (Tegretol)

    Curbing Weight Gain via Medication
    When medication triggers weight gain, one of the more obvious solutions is through medications ? either selecting a different medication that?s less likely to cause weight gain or adding a medication that has a track record for negating the weight-gain side effect. Here are some common options:

    • Choose a different medication. If Zyprexa causes significant weight gain, for example, switching to Geodon may deliver similar benefits with little or no risk of causing weight gain.
    • Try a different form of the same medication. Olanzapine (Zyprexa), for example, is also offered as a dissolvable tablet (Zydis) that melts in your mouth. The theory is that your mouth membranes absorb most of the medication before it gets into your stomach where it?s more likely to stimulate the appetite. (This does not have any scientific support at the moment, but it doesn?t hurt to try.)
    • Add topiramate (Topamax) to the mix. Topiramate has been shown, in some studies, to reduce appetite and limit weight gain (particularly weight gain associated with atypical antipsychotics).
    • Add metformin (Glucophage) to the mix. Metformin, a medication used to treat diabetes, ?is being studied to see if it may reduce weight gain and/or the risk of developing diabetes associated with some psychiatric medications.
    • Replace your atypical antipsychotic with an older, first-generation antipsychotic. The atypical antipsychotics (second-generation antipsychotics) generally have been thought to have fewer serious side effects than the older versions. However, several recent studies have indicated that the atypical antipsychotics may not have any better outcomes than the older ones, such as perphenizine (Trilafon) and molindone (Moban). And while the older antipsychotics have their own particular risk profile ? movement disorders in particular ? they do not have the same weight gain and metabolic risks seen in the newer drugs. So it seems that the choices for medications may be broader than we have gotten used to recently. In other words, for some people, the older, less expensive antipsychotics may be a better choice.

    In some cases, changing medications can be ?just what the doctor ordered.?

    Taking a Proactive Approach to Curbing Weight Gain
    In my practice, we remain well aware of the potential weight gain risks associated with the various medications and prescribe medications in such a way as to reduce the risks as much as possible. In addition, we take a very proactive approach in monitoring weight and take action as soon as we notice any changes:

    1. We monitor weight and appetite from the start, so that we can take action before the weight gain becomes a big problem. You needn?t jump on the scales every day. We just check weights at regular visits and sometimes recommend briefly keeping a food and/or appetite journal.
    2. We order regular lab tests to keep an eye on glucose and cholesterol levels. The testing should be done at least once a year ? probably more like every six months. It should include just a routine glucose and a lipid panel. The ?range? on the lab slip shows the cut offs, but more importantly, we?re looking for significant shifts from baseline.
    3. When starting a new medication or changing medications, work with your doctor to increase the calories you burn while maintaining your caloric intake. Any movement will do, so don?t think you have to join a gym ? walking a little more each day can do wonders. Likewise, you don?t have to go on a strict diet ? try to keep the calories going in about the same as before or with as little increase as possible. Some studies have shown that the weight gain can be more limited with a proactive approach to nutrition and exercise.We may include a consult with a nutritionist or exercise trainer (assuming that?s an option) to help plan and monitor calorie intake and develop reasonable and doable exercise or movement plans. Small, manageable changes are the goals.
    4. We often work together with the primary care doctor in all of the steps. Because of the medical risks with the atypicals, it?s a good idea to keep the primary care physician in the loop; they can keep a closer eye on health issues related to these meds, and may have other ideas or input regarding keeping weight gain down to a dull roar.

    The most important factor here is good communication with your prescriber and regular monitoring of the medications and their effects ? both good and bad. Some weight gain may be unavoidable, but try to be honest with your doctor about what you will and will not live with in this department.

    Remember: Call your doctor to discuss any problems with the medicines, rather than stopping the medication on your own. This is a team project, and the outcomes are better when the team works together.

  2. #2
    Join Date
    Oct 2008
    Posts
    4,045
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)

    Re: Preventing and Reversing Weight Gain Associated with Psychiatric Medications

    Thank you for posting this Dr Baxter. I had simular experiences with my medication "cocktails" in the past.

    Also I remember people saying about my weight "oh you should watch your diet" and I would cringe cause I know how to eat properly. When I started an anti-psychotic I gained weight even when I was strenght training at the gym.

    Same with the high cholesterol. That I suspected, but this confirmed it. All along I would be trying to figure out what in my diet caused it to no avail.

    I am glad to see this artical is sensitive to it and offers alternatives. It offers me hope that I can find a medication with less of these side effects, which were affecting my general health.

  3. #3
    Join Date
    Feb 2009
    Posts
    6,401
    Mentioned
    30 Post(s)
    Tagged
    1 Thread(s)

    Re: Preventing and Reversing Weight Gain Associated with Psychiatric Medications

    Thank you for this article. Being educated on some of the meds that will help my daughter is great.

    I brought up perphenazine with the Dr. on call as my brother is on it, same blood line and he has no problems with it, but the Dr. on call says no too many side effects.

    Great article. Will read it over with my daughter and when we see the Dr. again will bring up some options like tomax or metformin something to help her decrease her weight gain.

    Unfortunately her regular Psychiatrist is away until May so we are having to deal with the on call Dr. for now.

  4. #4
    Join Date
    Aug 2004
    Location
    Arizona
    Posts
    13,566
    Mentioned
    55 Post(s)
    Tagged
    0 Thread(s)

    Re: Preventing and Reversing Weight Gain Associated with Psychiatric Medications

    Some studies have shown that the weight gain can be more limited with a proactive approach to nutrition and exercise.We may include a consult with a nutritionist or exercise trainer (assuming that’s an option) to help plan and monitor calorie intake and develop reasonable and doable exercise or movement plans. Small, manageable changes are the goals.
    Regarding nutrition and exercise, some similar tips for kids that apply to adults as well:


    • Enlist the help of a certified nutritionist if need be.
    • Make one change a week. Revamping a whole lifestyle in one full swoop is a recipe for failure.
    • Keep in contact with your child's doctor.
    • Don't use food to fix emotional or physical pain or as a reward.
    • Make mealtime enjoyable.
    • Know the calorie requirements for children:
    • ages 6-12 2,200 calories per day
    • teen girls 2,200 calories per day
    • teen boys 2,800 calories per day
    • Consult your child's doctor if you notice any persistent symptoms of depression or low self esteem.

    How to Stop Your Kid from Getting Fat on Psych Drugs | eHow.com

  5. #5
    Join Date
    Feb 2010
    Posts
    3
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)

    Re: Preventing and Reversing Weight Gain Associated with Psychiatric Medications

    I don't know if this applies for every medication, but I've found that switching to the generic ODT (orally disintegrating tablets) version of my meds (olanzapine/zyprexa) helped me lose the weight I gained on the branded meds. If you're in Canada and take zyprexa, I highly recommend switching to generic ODT. Last year the patent for olanzapine was ruled invalid here, so now it's available in this lovely form that's keeping me as thin as I was before I started taking the meds. I hope this helps someone out there!

  6. #6
    Join Date
    Feb 2011
    Location
    BC, Canada
    Posts
    131
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)

    Re: Preventing and Reversing Weight Gain Associated with Psychiatric Medications

    High risk: Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal)
    Oh joy. I started risperidone last week, and while my appetite hasn't changed, my waistline has. If it can happen this quickly, I don't want to think where it could end up. Unfortunately, I'm already intolerant to several of the other A/Ps, so theres not much left for me to try

    Buuuuut ... I guess the weight ... and measures to prevent tooooooo much gain are worth the symptoms relief ... but I'm very much not a happy camper.

    BTW, I have discovered that even slight exertion can set my heart racing at 100+bmp (last time i counted, it was 108), so this could get interesting. Any guess as to the chance this particular side effect will ease up over time?

    Thank you for posting this; I think it's going to become a lifeline before long.


  7. #7
    Join Date
    Mar 2004
    Location
    Ottawa, Canada
    Posts
    35,301
    Mentioned
    20 Post(s)
    Tagged
    0 Thread(s)

    Re: Preventing and Reversing Weight Gain Associated with Psychiatric Medications

    Quote Originally Posted by phoebe22 View Post
    I started risperidone last week... I have discovered that even slight exertion can set my heart racing at 100+bmp (last time i counted, it was 108), so this could get interesting. Any guess as to the chance this particular side effect will ease up over time?
    Have you informed your doctor about this? It is something that should be monitored carefully, IMO.

  8. #8
    Join Date
    Feb 2011
    Location
    BC, Canada
    Posts
    131
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)

    Re: Preventing and Reversing Weight Gain Associated with Psychiatric Medications

    Hm ... if I have low tolerance for the new generation A/Ps, what odds I'd be able to tolerate the older ones? (I have done battle with my weight all my life. Age is making it harder to maintain, and so, of course, have most medications.)


  9. #9
    Join Date
    Mar 2004
    Location
    Ottawa, Canada
    Posts
    35,301
    Mentioned
    20 Post(s)
    Tagged
    0 Thread(s)

    Re: Preventing and Reversing Weight Gain Associated with Psychiatric Medications

    I wasn't talking about the weight gain. I was talking about the heart rate.

  10. #10
    Join Date
    Feb 2011
    Location
    BC, Canada
    Posts
    131
    Mentioned
    0 Post(s)
    Tagged
    0 Thread(s)

    Re: Preventing and Reversing Weight Gain Associated with Psychiatric Medications

    Quote Originally Posted by David Baxter View Post
    Have you informed your doctor about this? It is something that should be monitored carefully, IMO.
    LOL! gosh, you're speedy (not that I'm complaining!)

    I'm going to be seeing him today and that's at the top of my list of Qs. I'd probably be better off talking to my pharmacist first, as my dr usually needs to refer to the Big Blue Book (which makes him cranky ) That way, I can determine how best to phrase my concerns and approach that and other questions.

    Merci

    Phb

    ---------- Post added at 08:59 AM ---------- Previous post was at 08:54 AM ----------

    Quote Originally Posted by David Baxter View Post
    I wasn't talking about the weight gain. I was talking about the heart rate.
    I know

    Weight gain is secondary; I mentioned the heart rate afterward because my mind tends to wander around a lot.



    ---------- Post added at 09:02 AM ---------- Previous post was at 08:59 AM ----------

    Oh, I see what happened. Your question re: heart rate got posted before my ponderings re: weight. I'm so good at making things more confusing than they would normally be (blush).

    ---------- Post added at 09:51 AM ---------- Previous post was at 09:02 AM ----------

    I just had an interesting (to me) conversation with my Pharmacist regarding possible alternatives and whether the side effects I'm experiencing might ease up over time, and she said Abilify seems less likely to cause my two most troubling side effects ... heart rate and fainting. The latter isn't as big a danger as my heart giving out on me (ya think?) but can be dangerous all the same, given that the last time it happened there was no one nearby who could have stopped me from falling and quite likely doing my head and neck even more damage than it's sustained to date.

    I'm very interested in thoughts, experiences, and any further information regarding this medication. As mentioned, I'm seeing my dr this afternoon and want to go in as well informed as I can be. Being prepared may be the Boy Scouts' creed, but it's also a good idea when one deals with a someone domineering, unpredictable, and impulsive physician

    Again, thanks (and my apologies for going off-topic; in these instances I have no idea how to shift a topic from one forum to another)


Page 1 of 2 12 LastLast

Bookmarks

Bookmarks

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Disclaimer: PsychLinks is not responsible for the content of posts or comments by forum members.

Additional Forum Web Design by PsychLinks
© All rights reserved.