![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by bulldog2 on May 18, 2008, at 15:03:43
Many people end up having to discontinue a good med because of weight gain even though they are dieting. Since many of these meds raise prolactin that will lower dopamine and human growth hormone levels which will lower thyroid output.
It would seem that it would be routine that docs do a full thyroid panel before embarking on these meds and do periodic checks while on them.I feel if thyoid levels were kept at a healthy level (at least normal mid point not low normal) that weight gain would not be an issue for stopping meds. Also igf-1 should be measured (marker for growth hormone levels) and supplemented with hgh shots (done subq very painless) for those with low igf-1 levels.
Posted by Phillipa on May 18, 2008, at 16:56:16
In reply to How Docs Should Handle Med Weight Gain, posted by bulldog2 on May 18, 2008, at 15:03:43
Tell my endo that a level in the middle is good as the new standard is between l-2. I seem to do better weight wise on a higher thyroid level. Top of normal range around 5. The others I know nothing about. Excercise maybe helps too. Love Phillipa
Posted by bulldog2 on May 18, 2008, at 17:07:02
In reply to Re: How Docs Should Handle Med Weight Gain » bulldog2, posted by Phillipa on May 18, 2008, at 16:56:16
> Tell my endo that a level in the middle is good as the new standard is between l-2. I seem to do better weight wise on a higher thyroid level. Top of normal range around 5. The others I know nothing about. Excercise maybe helps too. Love Phillipa
yes but most p-docs are not even measuring thyroid period. They give out meds and tell you weight gain is a possible side and never even bother to meaure the thyroid when the patient is pouring on the pounds.
Posted by Racer on May 18, 2008, at 19:19:54
In reply to How Docs Should Handle Med Weight Gain, posted by bulldog2 on May 18, 2008, at 15:03:43
That's one theory, and one possible mechanism for the weight gain from medications.
It should be standard of care to check thyroid regularly for those with depression. In fact, I swear I read somewhere that it is part of the professional guidelines, but who knows if I'm remembering that right?
Many medications cause weight gain in some people, but the mechanism of action may not be clearly understood. Depakote, for instance, is theorized to cause weight gain through the gastrointestinal irritation is can cause -- simple mechanism: it upsets the tummy, eating soothes it, so people eat more. That is about the only medication I've ever heard of which seems to cause weight gain through increased eating, and it can apparently be controlled with OTC acid-reducers. Others, like Zyprexa, cause weight gain through very different mechanisms, and will require different strategies for mitigation.
It's true that optimal thyroid function will help with weight control. But I'd hesitate to say that this is the way doctors should handle weight gain. I think thyroid function should be tested as part of normal treatment for depression, but I don't think that should be done as a target for medication related weight gain.
Posted by bulldog2 on May 18, 2008, at 19:35:40
In reply to Re: How Docs Should Handle Med Weight Gain » bulldog2, posted by Racer on May 18, 2008, at 19:19:54
> That's one theory, and one possible mechanism for the weight gain from medications.
>
> It should be standard of care to check thyroid regularly for those with depression. In fact, I swear I read somewhere that it is part of the professional guidelines, but who knows if I'm remembering that right?
>
> Many medications cause weight gain in some people, but the mechanism of action may not be clearly understood. Depakote, for instance, is theorized to cause weight gain through the gastrointestinal irritation is can cause -- simple mechanism: it upsets the tummy, eating soothes it, so people eat more. That is about the only medication I've ever heard of which seems to cause weight gain through increased eating, and it can apparently be controlled with OTC acid-reducers. Others, like Zyprexa, cause weight gain through very different mechanisms, and will require different strategies for mitigation.
>
> It's true that optimal thyroid function will help with weight control. But I'd hesitate to say that this is the way doctors should handle weight gain. I think thyroid function should be tested as part of normal treatment for depression, but I don't think that should be done as a target for medication related weight gain.Didn't imply that's the way doctors should routinely handle weight gain. Dietary habits should be the first thing that doctors look at. But thyroid testing should be done routinely. Actually a hormone panel wouldn't be a bad idea. Many of these meds (especially ones that elevate serotonin) will increase prolactin and if prolactin is not brought under control there will probably be weight gain. Another strategy might be to use prolactin lowering meds when prolactin is abnormally high.
I have a feeling to many docs are dispensing these meds without enough follow up blood work. At least that is the case with my doc.I have to request these tests.
Posted by 4WD on May 18, 2008, at 20:59:31
In reply to Re: How Docs Should Handle Med Weight Gain, posted by bulldog2 on May 18, 2008, at 19:35:40
I am lucky to have an internist who does all these tests. Being on Nardil, I was expecting weight gain but I haven't gained any weight.
I think Zyprexa has two weight gain mechanisms. First of all, it makes you eat like a horse. Second it has the effect of making you gain even if you keep your diet under control. However, I was on Zyprexa for a couple of months and did not gain weight. When I overate, I threw up on purpose (I am a recovering bulimic and Zyprexa brought me back into full blown bulimia). So I didn't gain weight from overeating.
But I also didn't gain weight just from being on Zyprexa either. I guess it is different for different people.
Marsha
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.