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Re: New Question for Larry -- Paxil Susan J

Posted by Larry Hoover on October 8, 2003, at 9:32:56

In reply to New Question for Larry -- Paxil , posted by Susan J on October 4, 2003, at 13:25:28

> Larry,
> OK, you asked for it. I'm asking another question....

Oh, goody.... ;-)

> I was on Paxil for almost a year. In that time, I gained over 20 pounds quite rapidly. Is there any chemical/physiological reason for that weight gain?

Probably has to do with specific serotonin receptors, post-synaptically.


I'll tell you, though, that whatever you read will be an educated guess, at best. Hints, not answers.

> I've heard anecdotal evidence that people gain weight on Paxil, but as a person who's struggled with weight her entire life, I thought it was just too easy to blame it on a drug.

I gained five pounds a week on Remeron, and was eating the same portions of food. My doctor said I must have been eating more, but I didn't. My doctor would blame appetite changes (known to occur with Remeron) rather than a physiological variable directly influenced by the drug. The fact is, I buy food in bulk, and store it in portions. I wasn't eating more.

> But since I've been off of Paxil, I've lost all that weight and am losing more. I thought perhaps that since Paxil made me sooooo tired and I wanted to sleep all day, it was truly the *inactivity* that caused the weight gain.

That would be a factor, specific to your experience, but I can't see that being the only variable to consider.

> But I'd be really interested to know if there's something to messing with your seratonin level that makes you gain weight....
> Thanks!
> Susan

It's not just a consideration of the absolute serotonin concentration, it's how that serotonin is used by the body that matters. SSRIs don't so much change the amount of serotonin as they change the impact of the serotonin when it is released by a neuron.

I'll use a metaphor. You can give a poor person help by giving him money (analogous to increasing total serotonin), or you can give him targeted financial support (e.g. paying the rent, analogous to activating a particular receptor). Or, given his finite financial resources (assuming some stable level of income), you can intervene and manage the money for him. You can determine how much is spent on e.g. food vs. tobacco. The latter approach is more like what we are attempting to do with SSRIs, but we do it blindly; we don't know what the individual's true needs and budget are, but we muck with the balance anyway, hoping to make it better.

Take care,




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