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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 5 to 29 of 54. Go back in thread:
Posted by Kathy99 on April 16, 2001, at 11:43:27
In reply to Citalopram » Kathy99, posted by SalArmy4me on April 16, 2001, at 0:00:00
> Perhaps you could choose the SSRI that has the least weight gain. Citalopram is supposed to have the least weight gain, according to the PDR monograph.
I just tried it, and had the worst side-effects I'd ever had, for 3 weeks non-stop. Almost missed tax deadline today!
Paxil seems to have almost no side effects for me, so I'm just going back to it.You seem to know a lot about meds, so here's a Q. for you:
my doc seems to think that 10 mg Paxil is not a "therapeutic dose" and I'll admit I did a lot better rising above depression on 20 mg. But now that I'm doing well, and I'm also taking 150mg Wellbutrin (for sexual reasons), I'm wondering if the combo is good enough for maintenance. From what you know, is 10 mg Paxil therapeutic?I'm really not worried about weight gain TOO much, but a lot of the folks here seem to think it's "due" to the SSRIs, and as a nutritionist, I study these things. I'm giving lectures on obesity and dieting this week, so the association between SSRIs and weight gain has triggered my interest. Also since if people have uncontrollable feelings of hunger or carb. cravings, it would be good to keep myself on guard while on this stuff...
Posted by Lorraine on April 16, 2001, at 12:05:41
In reply to Re: Citalopram, posted by Kathy99 on April 16, 2001, at 11:43:27
My experience on weight gain on Effexor was that it was related to carb cravings which meant that I ate more. The way that I licked this was to go low carb, which cuts the cravings. By the way, I know that the traditional view is calorie based, but if you really read up on low carb, I think that you will find that there is a fair amount of evidence that weight gain is attributable to sugar and refined carb consumption which causes insulin release which causes weight gain. For years I was low fat, but that did not work for me and then after I did extensive research I switched to low carb. You might want to look into it.
Posted by SalArmy4me on April 16, 2001, at 13:15:58
In reply to Re: Citalopram, posted by Kathy99 on April 16, 2001, at 11:43:27
10 mg would be okay for a maintenance dose of Paxil, but not for the first 6 weeks of treatment.
Posted by Kathy99 on April 16, 2001, at 15:49:17
In reply to Re: Low carb, posted by Lorraine on April 16, 2001, at 12:05:41
>I think that you
> will find that there is a fair amount of evidence that weight gain is attributable to sugar and refined carb consumption which causes insulin release which
> causes weight gain. For years I was low fat, but that did not work for me and then after I did extensive research I switched to low carb.Believe me, I have looked into that. The only evidence that insulin causes weight gain is when insulin is INJECTED, as with diabetics. A lot of popular books suggest the point of view that you mention, but there is no solid research behind it. BTW, protein increases insulin levels as well.
Protein is the main dietary factor associated with satiety, perhaps that is why some people find that it works better for them. People who eat meals high in carbs but low in protein may not maintain their blood sugar as well from meal to meal... may lead them to eat sooner.
Posted by Sunnely on April 16, 2001, at 18:38:58
In reply to Weight gain and SSRIs, posted by Kathy99 on April 15, 2001, at 11:49:03
Hi Kathy,
SSRIs have similarity to the anorectic (appetite-suppressant) drug dexfenfluramine (Redux, now off the market) with regard to their serotonergic effect. Therefore, it would be expected that all SSRIs should exert a similar anorectic action and subsequent weight loss. However, case reports indicate evidence to the contrary. In addition, although the anorectic action of fluoxetine (Prozac) is well recognized, long-term follow-up studies in depressed patients and in obese nondepressed patients reveal that its weight-reducing effects are transient, even leading to a gain in body weight. Similarly, paroxetine (Paxil) and citalopram (Celexa) have also been associated with weight gain. These latter observations are unexpected because Paxil and Celexa are highly potent and selective SSRIs, respectively.
Although SSRIs are termed "selective serotonin reuptake inhibitor" drugs, they actually do not act purely and only on serotonin alone. It appears that the paradoxical weight gain observed with the SSRIs rest on the interaction of serotonin with multiple mechanisms. Aside from the serotonin receptors being involved, it appears other receptors play a role in SSRI-induced weight gain. These include histamine receptor (H1), dopamine (DA) receptors, and norepinephrine (NE) receptors. In addition, the role of glutamate, nitric oxide (NO), and leptins in SSRI action requires further clarification.
Finally, the neurobiology of depressive illness itself, and recovery from it, plays a major contributing factor to individual response to these drugs.
Bottom line is, the exact mechanism as to the SSRI-induced weight gain remains unclear.
Try to get hold of the reference cited below. I believe it will help you immensely with your lecture.
Reference: Harvey BH, Bouwer CD: Neuropharmacology of paradoxic weight gain with selective serotonin reuptake inhibitors. Clinical Neuropharmacology 2000;23(2):90-97.
+++++++++++++++++++++++++++++++++++
> I'm a bit confused by all the discussion of weight gain on SSRIs. It seems that many people attribute their weight gain to effects of the medication.
>
> Since it is well known that the only way to gain weight is to eat more calories than you burn, I wonder what is happening while SSRI users are GAINING weight.
>
> Is your appetite notably increased? Can you tell you are eating more than you used to?
> Do you choose fattier foods, nibble more?
>
> Is your exercise level notably reduced?
>
> Since there HAS to be a change in one of these, and pounds just don't accumulate without reason, I wonder if any of you remember the situation clearly or are going through it now.
>
> I'm interested because I'm taking SSRIs myself, and am also a nutritionist.
Posted by aetherial on July 8, 2001, at 11:47:37
In reply to Weight gain and SSRIs, posted by Kathy99 on April 15, 2001, at 11:49:03
> I'm a bit confused by all the discussion of weight gain on SSRIs. It seems that many people attribute their weight gain to effects of the medication.
> snip
HI
This perfectly civil question produced the biggest surge of fustration!I'll tell you why.I have been on a calorie resticted lo fat eating regime: Strict then semi- veg etarian hi fibre, etc etc. (I was a healthy hippy type in the 70's and kept the habits). I exercise regularly and work at a job that caused me to lose weight when i started as I'm on my feet walking twenty hours a week. I am not a fitness fanatic but my BP is 126/80 and I'm 44.
For the last four or five I've been even more careful as I approached and hit the magic forty.Despite this, in the last two years I have put on 2-3 dress sizes and 4 stone (56 pounds or 20 kilos approx). The only thing I am doing differently is taking aropax (paroxetene/paxil)
Clearly eating more and doing less is NOT the only cause of weight gain. The resting rate of our unique metabolism is affected by all sorts of things, so why not by complex drugs like SSRI s.?If it were a simple equation then each person eating the same food and doing the same things would all add or lose weight at the same rate and that is clearly not the case.
The frustration I have experienced in trying to persuade well meaning people like yourself that I am NOT a closet eater. That I do NOT eat sweets or cakes, except at parties (ie once every 6-8 and I dont binge then!.)I don't drink alcohol. I don't pig out on cheese etc etc. Even my doctor could only mutter that the cause of my ballooning size seemed to be genetic.
I asked about the meds and each doctor i spoke to quoted the old drug company literature line that ssri's cause weight loss. Well they do. In the first weeks when you feel sick. 1-2 pounds in the first week.That seems to be it.
The problem is long term use of Paroxetene also causes severe weight gain. Check the amazing refs supplied in this thread. check the info on the packet (it used to say weight loss now mine at least says weight gain.) They don't know why it does this, but I am now noticing that the competing drug companies are promoting new anti depressants on the basis that they don't cause weight gain.
So I guess we're all just fat (and happy?) little guinea pigs.
But PLEASE, don't try to tell us that we need to eat less and do more, cause it just doesn't work!
regards
aether
Posted by Elizabeth on July 8, 2001, at 15:26:41
In reply to Re: Weight gain and SSRIs, posted by aetherial on July 8, 2001, at 11:47:37
> I have been on a calorie resticted lo fat eating regime: Strict then semi- veg etarian hi fibre, etc etc. (I was a healthy hippy type in the 70's and kept the habits).
Have you tried a carbohydrate-restricted diet? (Atkins, etc.) A lot of people I know who have weight troubles from psych meds say that kind of diet really helps them.
> I am not a fitness fanatic but my BP is 126/80 and I'm 44.
That'd be quite good for a man, but it's pretty good for a woman too.
> For the last four or five I've been even more careful as I approached and hit the magic forty.Despite this, in the last two years I have put on 2-3 dress sizes and 4 stone (56 pounds or 20 kilos approx). The only thing I am doing differently is taking aropax (paroxetene/paxil)
I have heard a lot of weight gain stories related to paroxetine -- more than the other SSRIs. Have you considered switching to a different SSRI, or perhaps to nefazodone? (What disorder are you taking the paroxetine for? Another SSRI is about equally likely to help, but different classes of drugs may not work depending on what's being treated.)
> Clearly eating more and doing less is NOT the only cause of weight gain. The resting rate of our unique metabolism is affected by all sorts of things, so why not by complex drugs like SSRI s.?
The only thing I can say here is that the effect is centrally mediated, and there's a lot more variation in human brains than in other characteristics. And that's why SSRIs have such widely differing effects on different people.
> But PLEASE, don't try to tell us that we need to eat less and do more, cause it just doesn't work!
Yeah, I hate when people say that too. :-)
-elizabeth
Posted by MB on July 9, 2001, at 12:20:00
In reply to Re: Weight gain and SSRIs » aetherial, posted by Elizabeth on July 8, 2001, at 15:26:41
> Have you tried a carbohydrate-restricted diet? (Atkins, etc.) A lot of people I know who have weight troubles from psych meds say that kind of diet really helps them.Hey Elizabeth,
Interesting that you mentioned low carb diets. I spoke with a "biological" psychiatrist once who asked me how the SSRIs worked for me. I told him that they worked well for a few weeks then stopped, at which point extreme carbohydrate cravings kicked in. He suggested taking inositol with the SSRI; it was his contention that the inositol would somehow prevent such a poop-out (and the carbo-craving anecdote prompted this conclusion of his). Anyway, he turned out to be a jerk, but a smart jerk. I wonder...if he is right, if inositol can curb SSRI induced carbohydrate cravings, could it curb SSRI weight gain?
Posted by Elizabeth on July 9, 2001, at 19:04:01
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 9, 2001, at 12:20:00
> Interesting that you mentioned low carb diets.
I used to be skeptical about them (I thought that Atkins was just another fad diet), but I met a bunch of people who've had great success with them -- including one who is very well-versed in biology and was able to explain the mechanism to my satisfaction. (I'm not sure I could replicate his explanation, however.)
> I spoke with a "biological" psychiatrist once who asked me how the SSRIs worked for me. I told him that they worked well for a few weeks then stopped, at which point extreme carbohydrate cravings kicked in. He suggested taking inositol with the SSRI; it was his contention that the inositol would somehow prevent such a poop-out (and the carbo-craving anecdote prompted this conclusion of his).
It could be worth a try. Inositol is one of the more reputable "food supplements" (i.e., natural drugs).
> Anyway, he turned out to be a jerk, but a smart jerk.
Those are the worst. :-)
> I wonder...if he is right, if inositol can curb SSRI induced carbohydrate cravings, could it curb SSRI weight gain?
Some people say they didn't have carb cravings or eat more on SSRIs (or Effexor), but gained weight anyway, presumably due to some sort of metabolic change. I wonder about their activity level, though. (Paxil seems to be the worst of the SSRIs in the weight gain department, although this is just my impression -- I haven't looked at statistics or anything. < g >)
-elizabeth
Posted by Lorraine on July 9, 2001, at 19:23:08
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 9, 2001, at 19:04:01
I switched to low carb after I gained 45 lbs and was able to lose it all within about 4 or 5 months. I have kept it off for a year and lost an additional 10 lbs. Low carb actually works. I still do not eat sugar, breads, pasta, potatoes and only have rice in small quantities. I don't think the elimination of these items is bad nutritionally--there is little nutritional value in these items typically.
Posted by MB on July 9, 2001, at 19:47:07
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 9, 2001, at 19:04:01
> > I used to be skeptical about them (I thought that Atkins was just another fad diet), but I met a bunch of people who've had great success with them -- including one who is very well-versed in biology and was able to explain the mechanism to my satisfaction. (I'm not sure I could replicate his explanation, however.)I feel like my "motor" is running "hotter" on low carb diets. That's the only way I can describe it. I fill up on fewer calories, and I just feel, well, "hotter." But, I'm never satisfied, even when full. I could eat zucchini and chicken breasts until my stomach popped, and i'd still be standing in front of the fridge with the door open, scratching my head, "what is it that I'm craving?"
> > Some people say they didn't have carb cravings or eat more on SSRIs (or Effexor), but gained weight anyway, presumably due to some sort of metabolic change. I wonder about their activity level, though. (Paxil seems to be the worst of the SSRIs in the weight gain department, although this is just my impression -- I haven't looked at statistics or anything. < g >)
>
> -elizabeth
When I was taking Paxil, I could have sworn I was getting *a lot* of exercise and eating very little. Looking back, though, I was eating quite a bit. I wonder how these drugs affect our *perception* of how much we're eating. I was eating at least two, huge ~700Cal meals/day and at least two 16 Oz. mochas with whole milk. That's not counting my two bowls of morning cereal and all of the carbo snacking throughout the day. At the time, I considered myself a very "light" eater. I would think to myself, "I wonder why I've put on 20 lbs. I'm not eating really that much." Looking back on it in an unmedicated state, I feel like I was a pig. I do obsess over my weight and food consumption when unmedicated. Maybe it was just correcting an obsession. Maybe I'm meant to be fat, and my diet obsession keeps me thin? It's all so complicated.
Posted by MB on July 9, 2001, at 19:48:16
In reply to Re: Weight gain and SSRIs, posted by Lorraine on July 9, 2001, at 19:23:08
> I switched to low carb after I gained 45 lbs and was able to lose it all within about 4 or 5 months. I have kept it off for a year and lost an additional 10 lbs. Low carb actually works. I still do not eat sugar, breads, pasta, potatoes and only have rice in small quantities. I don't think the elimination of these items is bad nutritionally--there is little nutritional value in these items typically.
Question: do you restrict fat intake on your low carb diet?
Posted by Lorraine on July 10, 2001, at 14:02:02
In reply to Re: Weight gain and SSRIs » Lorraine, posted by MB on July 9, 2001, at 19:48:16
> Question: do you restrict fat intake on your low carb diet?
No, I don't restrict fat. Actually, fat is very filling--it signals the brain that you are full. I don't restrict calories either. Buy the Atkin's book if you are seriously trying to lose weight. Otherwise, just cut out the sugar, bread, pasta and potatoes and limit the fruit to say one piece a day eaten alone. Cut out beer and wine as well. Although occassionally, it's ok. If you really want bread, there are low carb breads out there (Irene's breads are the best).
Posted by MB on July 11, 2001, at 1:58:16
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 9, 2001, at 19:04:01
> Some people say they didn't have carb cravings or eat more on SSRIs (or Effexor), but gained weight anyway, presumably due to some sort of metabolic change. I wonder about their activity level, though. (Paxil seems to be the worst of the SSRIs in the weight gain department, although this is just my impression -- I haven't looked at statistics or anything. < g >)
>
> -elizabeth
I remember when Prozac first came out there was a theory that depressed people craved carbohydrates (in an attempt to raise serotonin levels through diet) and that SSRIs would actually *lower* these carbo cravings by increasing serotonin levels. I don't remember my experience with Prozac all that well, but my experience with Paxil was, "bring on the pasta, baby, and pass the box of donuts!"
Posted by super on July 11, 2001, at 13:12:28
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 11, 2001, at 1:58:16
Don't you get constipated if you don't eat any high fiber foods?
>
> > Some people say they didn't have carb cravings or eat more on SSRIs (or Effexor), but gained weight anyway, presumably due to some sort of metabolic change. I wonder about their activity level, though. (Paxil seems to be the worst of the SSRIs in the weight gain department, although this is just my impression -- I haven't looked at statistics or anything. < g >)
> >
> > -elizabeth
>
>
> I remember when Prozac first came out there was a theory that depressed people craved carbohydrates (in an attempt to raise serotonin levels through diet) and that SSRIs would actually *lower* these carbo cravings by increasing serotonin levels. I don't remember my experience with Prozac all that well, but my experience with Paxil was, "bring on the pasta, baby, and pass the box of donuts!"
Posted by Elizabeth on July 11, 2001, at 15:38:17
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 11, 2001, at 1:58:16
> I remember when Prozac first came out there was a theory that depressed people craved carbohydrates (in an attempt to raise serotonin levels through diet) and that SSRIs would actually *lower* these carbo cravings by increasing serotonin levels.
There's a guy at MIT (well, I'm not sure if he's still there) who was really trying to push the serotonin-carb connection hypothesis (he had a major interest in Redux, of course).
Thing is, this idea doesn't explain why so many depressives stop eating and lose interest in food (carbohydrate or otherwise)!
> I don't remember my experience with Prozac all that well, but my experience with Paxil was, "bring on the pasta, baby, and pass the box of donuts!"
I didn't lose weight on Prozac, but I didn't gain back the weight I'd lost while depressed. Paxil seems to be worse than the other SSRIs as far as causing weight gain.
-elizabeth
Posted by Elizabeth on July 11, 2001, at 15:39:34
In reply to Re: Weight gain and SSRIs, posted by super on July 11, 2001, at 13:12:28
> Don't you get constipated if you don't eat any high fiber foods?
If you don't get any fiber, yes, you're liable to get extremely constipated. This is a big problem with the Atkins diet, although I think there's a way around it.
-elizabeth
Posted by MB on July 11, 2001, at 18:30:34
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 11, 2001, at 15:38:17
> There's a guy at MIT (well, I'm not sure if he's still there) who was really trying to push the serotonin-carb connection hypothesis (he had a major interest in Redux, of course).
Doesn't Meridia work on Serotonin? I just watched an online video called "Metabolic effects of Atypical Antipsychotics"(check it out if you haven't already: http://www.mentalhealth.ucla.edu/opce/gr.html ). It mentioned antagonism of 5HT-2c as a possible mechanism for neuroleptic weight gain. It also mentioned that stimulation of this site might lead to appetite reduction...in fact, I think the guy stated that this was the puted mechanism of Meridia. Anyway, it's interesting that Meridia was originally tested as an antidepressant. I assume that the action of SSRIs indirectly leads to stimulation of the 5H-2c sites in the brain. I wonder why they make people fat...> Thing is, this idea doesn't explain why so many depressives stop eating and lose interest in food (carbohydrate or otherwise)!
I gorge myself when I'm dysthymic or anxious, but I barely eat when i'm *really* depressed. I think I might be atypical (eat and go to bed when my mood is low). However, I am *worse* in the morning and sometimes peaceful and euphoric at night (calm, not manic...although I *did* think I was Buddha one time). That would go against an atypical dx, wouldn't it?
> I didn't lose weight on Prozac, but I didn't gain back the weight I'd lost while depressed. Paxil seems to be worse than the other SSRIs as far as causing weight gain.
>
> -elizabethYeah, I gained about 30lbs while taking Paxil. I've gotten my body fat back down to about where it was before I started, but my body is just stockier and heavier...shaped differntly...it's like the Paxil just permanently changed my body type, or something. Or, maybe it's just hitting 30 yrs old that did it.
Posted by TomV on July 11, 2001, at 22:04:29
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 11, 2001, at 18:30:34
> I'm certain my eating habits haven't changed; I do work out at the gym frequently; that being said I've gained about 10 pounds in 6 weeks on Celexa. I've tried alot of other meds (all the other SSRI's and many others i.e. wellbutrin, effexor)but none have worked like Celexa so it looks like its here to stay for a little while. I'm currently up to 20 mg a day.
Now that I'm certain my weight gain is strictly associated to a metabolic change from Celexa my question is: Is it safe to combine Metabolife, or another similar "supplement" to Celexa? I really have no signs of nervousness, anxiety, insomnia on Celexa so I don't think it could aggravate me in that sense. I also wonder if it's just not safe to combine the two.
Any advice would be greatly appreciated.
Posted by Elizabeth on July 12, 2001, at 19:02:14
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 11, 2001, at 18:30:34
> Doesn't Meridia work on Serotonin?
It's a serotonin-norepinephrine reuptake inhibitor, just like Effexor. It even resembles venlafaxine structurally There's no reason it wouldn't be just as good an AD as Effexor -- it wasn't marketed for this indication because the market for ADs was already saturated. But in early literature on sibutramine, it's referred to as an "antidepressant," not as a weight loss aid. (I would bet that it's a crappy diet pill, BTW. < g >) =
> It mentioned antagonism of 5HT-2c as a possible mechanism for neuroleptic weight gain.
Well, they're strong antihistamines too (hence the sedation). Do "typical" antipsychotics block the 5HT-2c receptor? Or is weight gain from these drugs attributed solely to the H1 blocking?
I'll take a look at that site.
> in fact, I think the guy stated that this was the puted mechanism of Meridia.
(You mean "putative," right?" I'm skeptical of that, since no other mechanisms have been IDed for Meridia besides monoamine reuptake inhibition, AFAIK.)
BTW, SSRIs and Effexor don't "make people fat" across the board, and it's not clear that it's even a majority side effect. The people who gain weight are the ones who complain. As I mentioned, I took Prozac for between two and three years, and I didn't gain weight beyond my baseline weight *or* regain the weight that I'd lost while depressed.
> I gorge myself when I'm dysthymic or anxious, but I barely eat when i'm *really* depressed.
Perhaps you have two different problems going on at the same time. I think this might be what's happening with me (although I have fewer and subtler "atypical" symptoms).
> That would go against an atypical dx, wouldn't it?
Yes, but the subtypes haven't been defined perfectly yet. Constructing subtypes based on medication response is simply the most pragmatic way to go about doing clinical research until we have a better understanding of how the brain works (and how it malfunctions).
> Yeah, I gained about 30lbs while taking Paxil. I've gotten my body fat back down to about where it was before I started, but my body is just stockier and heavier...shaped differntly...it's like the Paxil just permanently changed my body type, or something. Or, maybe it's just hitting 30 yrs old that did it.
People do tend to get heavier as they age. I easily lost all the weight I gained on Nardil -- I call it "the depression diet" -- but because I switched directly to Parnate, the weight from Marplan hasn't gone away completely. Losing weight is *hard*.
-elizabeth
Posted by Elizabeth on July 12, 2001, at 19:06:36
In reply to Re: Weight gain and SSRIs - Metabolife?, posted by TomV on July 11, 2001, at 22:04:29
> Is it safe to combine Metabolife, or another similar "supplement" to Celexa?
I *think* that the main active ingredient in Metabolife is ephedrine (similar to Sudafed, but less reliable). Ephedrine is a weak stimulant related to amphetamine, and it won't work long-term. Personally, if I were going to use stimulants as appetite suppressants, I'd go with phentermine, phendimetrazine, or some such.
But yeah, it's safe with SSRIs, so far as I'm aware (don't use it with MAOIs and use caution with TCAs). Ask your doctor to be sure. I think that Celexa has fewer drug-drug interactions than other SSRIs (Prozac and Paxil in particular) due to more metabolic pathways.
-elizabeth
Posted by MB on July 13, 2001, at 13:37:14
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 12, 2001, at 19:02:14
> > Doesn't Meridia work on Serotonin?
>
> It's a serotonin-norepinephrine reuptake inhibitor, just like Effexor. It even resembles venlafaxine structurally There's no reason it wouldn't be just as good an AD as EffexorThe excuse I've heard for it's not being marketed as an AD is the half-life issue and consequently frequent dosing schedule (or something like that). But, if they can solve that problem with Wellbutrin by making SR, they could have solved it with sibutramine also (couldn't they have?)
> it wasn't marketed for this indication because the market for ADs was already saturated.
That sounds more plausible.
> But in early literature on sibutramine, it's referred to as an "antidepressant," not as a weight loss aid. (I would bet that it's a crappy diet pill, BTW. < g >) =Well, there must be something more to it; it's scheduled as a class IV, isn't it?
> > It mentioned antagonism of 5HT-2c as a possible mechanism for neuroleptic weight gain.
>
> Well, they're strong antihistamines too (hence the sedation). Do "typical" antipsychotics block the 5HT-2c receptor? Or is weight gain from these drugs attributed solely to the H1 blocking?The typicals are potent H-1 blockers, yet they don't seem to carry the 30% risk of 20% weight gain that the typicals carry (especially clozapine). I think the blockade of 5HT-2c receptors in the striatum is one of the things that makes the atypicals different. Blockade at these sites increases dopaminergic activity in the striatum, hence the fewer incidences of tardive dyskinesia...or so it has been hypothesized.
> I'll take a look at that site.
>
> > in fact, I think the guy stated that this was the puted mechanism of Meridia.
>
> (You mean "putative," right?" I'm skeptical of that, since no other mechanisms have been IDed for Meridia besides monoamine reuptake inhibition, AFAIK.)Uh...yeah...putative. Sometimes I accidently make up new words (LOL!) When the guy mentioned 5HT-2c interaction as a possible mechanism for Meridia's anorexigenic effects, I think he was referring to the indirect *stimulation* of these sites by monoamine (in this case serotonin) reuptake inhibition. I was a little ambiguous about that. I'm sure the indirect NE-a1 activation (from NE reuptake inhibition) might also contributes to the anorexigenic effects.
> BTW, SSRIs and Effexor don't "make people fat" across the board, and it's not clear that it's even a majority side effect. The people who gain weight are the ones who complain. As I mentioned, I took Prozac for between two and three years, and I didn't gain weight beyond my baseline weight *or* regain the weight that I'd lost while depressed.
Right, and there's also the theory that it's the alleviation of depression (and it's comorbid anorexia) that is behind the SSRI-weight correlation (and that the correlation is not directly causative). Anecdotally, I eat more when depressed, and still gained weight on SSRIs. Maybe, at some point, we just have to admit that nobody really knows?
> > I gorge myself when I'm dysthymic or anxious, but I barely eat when i'm *really* depressed.
>
> Perhaps you have two different problems going on at the same time. I think this might be what's happening with me (although I have fewer and subtler "atypical" symptoms).
>
> > That would go against an atypical dx, wouldn't it?
>
> Yes, but the subtypes haven't been defined perfectly yet. Constructing subtypes based on medication response is simply the most pragmatic way to go about doing clinical research until we have a better understanding of how the brain works (and how it malfunctions).I'm starting to think that for a classification system to truely be accurate, there would need to be a subtype for every ill individual! < g > Like you said, it seems that the best that doctors can do is to classify based on medication response. So the question that begs asking is whether these subtypes are really discrete disorders, or whether there is really a multiaxial spectrum upon which every individual falls (I assume that the axial nexus would be "normalcy," whatever *that* is).
> > Yeah, I gained about 30lbs while taking Paxil. I've gotten my body fat back down to about where it was before I started, but my body is just stockier and heavier...shaped differntly...it's like the Paxil just permanently changed my body type, or something. Or, maybe it's just hitting 30 yrs old that did it.
>
> People do tend to get heavier as they age. I easily lost all the weight I gained on Nardil -- I call it "the depression diet" -- but because I switched directly to Parnate, the weight from Marplan hasn't gone away completely. Losing weight is *hard*.
>
> -elizabeth(losing weight is hard)
Amen to that!Peace,
MB
Posted by DebbieLynn on July 13, 2001, at 22:49:08
In reply to Re: Weight gain and SSRIs - Metabolife? » TomV, posted by Elizabeth on July 12, 2001, at 19:06:36
> > Is it safe to combine Metabolife, or another similar "supplement" to Celexa?
>
> I *think* that the main active ingredient in Metabolife is ephedrine (similar to Sudafed, but less reliable). Ephedrine is a weak stimulant related to amphetamine, and it won't work long-term. Personally, if I were going to use stimulants as appetite suppressants, I'd go with phentermine, phendimetrazine, or some such.
>
> But yeah, it's safe with SSRIs, so far as I'm aware (don't use it with MAOIs and use caution with TCAs). Ask your doctor to be sure. I think that Celexa has fewer drug-drug interactions than other SSRIs (Prozac and Paxil in particular) due to more metabolic pathways.
>
> -elizabeth
I hate to butt in here, I was specifically told by my doctor to stay away from metabolife. I asked to be put on a diet med (like phentermine) and he said NO because it is a CNS stimulant. It may have unwanted side effects.
I am currently in nursing school, going into psychiatric nursing. I take Effexor XR 225 mg, and I have gained weight,(@10 lbs) but I have to admit that I do crave carbs! Thanks for the info. I am going to restrict them to see what happens!Good Luck!
Debbie
Posted by Elizabeth on July 15, 2001, at 17:50:09
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 13, 2001, at 13:37:14
> The excuse I've heard for it's not being marketed as an AD is the half-life issue and consequently frequent dosing schedule (or something like that).
Nope. Sibutramine is very long-acting -- you'd only have to take it once a day.
> Well, there must be something more to it; it's scheduled as a class IV, isn't it?
Yeah. Totally ridiculous.
> The typicals are potent H-1 blockers, yet they don't seem to carry the 30% risk of 20% weight gain that the typicals carry (especially clozapine).
FWIW, Moban is supposed to be better in this department. Some of the newer ones (Seroquel, Geodon) are supposed to cause less weight gain than Clozaril and Zyprexa, but I don't know if that's just hype or what.
> I think the blockade of 5HT-2c receptors in the striatum is one of the things that makes the atypicals different. Blockade at these sites increases dopaminergic activity in the striatum, hence the fewer incidences of tardive dyskinesia...or so it has been hypothesized.
They also help with negative symptoms, which are largely untouched by the older drugs.
> Uh...yeah...putative. Sometimes I accidently make up new words (LOL!)
Me too.
> When the guy mentioned 5HT-2c interaction as a possible mechanism for Meridia's anorexigenic effects, I think he was referring to the indirect *stimulation* of these sites by monoamine (in this case serotonin) reuptake inhibition.
Ahh, ok. That's a looser use of the term "agonist."
> I was a little ambiguous about that. I'm sure the indirect NE-a1 activation (from NE reuptake inhibition) might also contributes to the anorexigenic effects.
I think that it probably just isn't a very good diet pill. < g > Seriously: people don't really lose much weight on SSRIs or Effexor, and a lot of people gain weight on them. I don't see any reason to suppose that Meridia would be any different.
> Right, and there's also the theory that it's the alleviation of depression (and it's comorbid anorexia) that is behind the SSRI-weight correlation (and that the correlation is not directly causative).
I'm sure that accounts for some of it. But I don't think that's all.
> Anecdotally, I eat more when depressed, and still gained weight on SSRIs. Maybe, at some point, we just have to admit that nobody really knows?
(Man, that sucks!)
Yeah, we do. That doesn't mean we should stop trying to figure it out, of course.
> I'm starting to think that for a classification system to truely be accurate, there would need to be a subtype for every ill individual! < g >
No, I don't think so. Looking at which drugs work on which symptoms (or clusters of symptoms) seems to have paid off where it's been tried, but it hasn't been tried much.
> Like you said, it seems that the best that doctors can do is to classify based on medication response.
Yeah. You know, migraine has pretty much been redefined as any headache that responds to sumatriptan!
> So the question that begs asking is whether these subtypes are really discrete disorders, or whether there is really a multiaxial spectrum upon which every individual falls
I think it's a little of both.
> (I assume that the axial nexus would be "normalcy," whatever *that* is).
< g >
-elizabeth
Posted by Elizabeth on July 15, 2001, at 17:56:08
In reply to Re: Weight gain and SSRIs - Metabolife?, posted by DebbieLynn on July 13, 2001, at 22:49:08
> I hate to butt in here,
IMO, there's no such thing as butting in. It's a public forum, and exchanging ideas is what it's here for, right?
> I was specifically told by my doctor to stay away from metabolife.
Well, OTC "herbal food supplements" (i.e., drugs that are sold without being FDA-approved) are notoriously unreliable. So I can see where your doctor is coming from.
> I asked to be put on a diet med (like phentermine) and he said NO because it is a CNS stimulant. It may have unwanted side effects.
You know, any effective drug has side effects. If a drug doesn't have side effects, it often seems to turn out that it doesn't do anything at all. (I'm thinking of the non-drowsy antihistamines here. They aren't *completely* ineffective, but they're pretty lousy compared to Benadryl or Atarax or ChlorTrimeton.)
> I am currently in nursing school, going into psychiatric nursing.
Cool! Good luck with it. I think it's great when people who have personal experience with depression, anxiety, mania, psychosis, etc. go into mental health professions.
> I take Effexor XR 225 mg, and I have gained weight,(@10 lbs) but I have to admit that I do crave carbs!
Nothing to be ashamed of. < g > That happened to me on the hydrazine-type MAOIs (Nardil and Marplan) -- I was constantly obsessing about food, especially sweets. Weird stuff.
-elizabeth
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