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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by janey on November 12, 1998, at 16:18:04
Toby or Dr. Bob, could you offer any information on
this for me?The manufacturer of Meridia (sibutramine) has been
advertising on television recently about their weight-
loss medication. I have only 35 lbs. to lose and have
stalled or plateaued here for a couple of months. I
work out and try to keep the carbs down to a minimun,
and I eat very little animal fat. (Carbs are my down-
fall though!)This Meridia sounds somewhat hopeful? However, in the
ads they warn not to take it with anti-depressants.
Do you know why? I would appreciate any information
you might have. I'm also curious about taking any OTC
"diet" meds with antidepressants -- is this contraindicated,
and if so, why? I just want to kick-start things and
begin losing more. I'll continue to exercise and keep
an eye on my diet intake. BTW, I take Effexor XR 150 mg
bid and 300 mg of trazodone at hs.Thanks for any light you can shed on this!
janey
Posted by Toby on November 13, 1998, at 12:49:55
In reply to Meridia (sibutramine) and anti-depressant ? Toby? , posted by janey on November 12, 1998, at 16:18:04
Meridia works by increasing serotonin in the brain in the same fashion that the SSRI antidepressants do. Meridia and antidepressants can't be taken together because they may interact, causing way too much serotonin to accumulate which can result in a toxic reaction called the serotonin syndrome (has been known to be deadly). Having said that, it is important to note that sometimes different antidepressants are used together in severe depression and people do OK. Therefore, if one has a very knowledgeable doctor who can monitor a patient closely to head off any reactions, it may possibly, maybe, potentially, etc, be OK to take an antidepressant with Meridia.
Having said that, to qualify for Meridia, a person needs to have a Body Mass Index of 30 or more (27 if there are complications of high blood pressure or diabetes associated with obesity). To calculate your BMI, multiply you weight in pounds by 704, then divide that by your height (in inches) squared. For example, a person who is 5 foot 4 inches tall and weighs 130 pounds: 130 x 704 divided by 64 x 64 equals a BMI of 22. A woman 5 foot 6 inches would have to weigh 185 pounds to qualify for it.
Some doctors are still using fenfluramine by itself for mild weight loss. Nonetheless, if you have reached a stall in your program, you may need to reevaluate what you are doing and eating that may lend itself to jump starting the loss again rather than trying medication. Add an extra 10 minutes of exercise to your program or change to a different form of exercise for awhile (walking/running to bicycle or stairmaster or vice versa) to stimulate different muscle groups to burn energy.
Just as an aside, you may not be able to do anything about this, but trazodone is notorious for weight gain. If you need it for sleep and other things have not been helpful, don't risk relapse to depression, stay on it. But you and your doctor may be able to find something else with less tendency for weight gain to help with sleep. Or, if you have been in remission for a while, a very gradual reduction in dose may help jump start the weight loss and still help with sleep.
Posted by janey on November 13, 1998, at 13:14:14
In reply to Re: Meridia (sibutramine) and anti-depressant ? , posted by Toby on November 13, 1998, at 12:49:55
Toby,
Thank you for such a quick follow-up and understandable
reply to my question! I'm sure it's a question
a lot of doctors will hear.Alas, I figured out my BMI (26), so I wouldn't
qualify anyway. Thank you for that information, too.I do a combination of exercises. I lift low weights,
many reps on the machines at my gym, use the PACE
room (passive resistance), and I walk. For a person
at my weight and height (200 lbs, 5'8"), my fat
weight is amazingly low. However, I'm going nuts
trying to lose my "belly."Thanks, too, for mentioning the info about the
trazodone. It's interesting that I noticed my
plateau began when my trazodone dose was increased
to 300 mg from the previous 150 mg.Isn't it funny that the so-called serotonin "foods"
which supposedly help keep that serotonin "up there"
are also the same foods that hinder weight loss.
~smile~ Since trazodone has been most effec-
tive in helping my insomnia along with my depression,
I'll add more time to my workouts instead.Thanks again for you help!
janey
Posted by Dr. Bob on November 14, 1998, at 20:35:36
In reply to Re: Meridia (sibutramine) and anti-depressant ? , posted by Toby on November 13, 1998, at 12:49:55
> To calculate your BMI...
Just go to:
http://www.dr-bob.org/tips/bmi.html
:-)
Bob
Posted by Elizabeth on December 13, 1998, at 20:19:56
In reply to Meridia (sibutramine) and anti-depressant ? Toby? , posted by janey on November 12, 1998, at 16:18:04
Probably not wise to combine Meridia and Effexor, as they work by similar mechanisms (inhibition of serotonin and norepinephrine reuptake) and have similar potential side effects (notably, hypertension). You might be able to _substitute_ Meridia for the Effexor, though.
I haven't heard much about trazodone causing weight problems although I don't know of a lot of people who take high doses (most just use 50-100 for sleep).
Most OTC diet pills that I am aware of contain phenylpropanolamine, which is also a decongestant and a mild stimulant. It can have adverse cardiovascular effects (including, guess what, hypertension) and I would be cautious about using it with the Effexor (or with Meridia).
If you haven't used Wellbutrin, that might be worth a try also. For many it seems to reduce appetite (including for carbs).
This is the end of the thread.
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