Posted by sweetmarie on April 5, 2001, at 16:27:06
In reply to The Skinny on SSRI- (and others) induced wt gain, posted by Sunnely on August 9, 2000, at 22:03:38
> Sorry, I can't tell you which antidepressant is best for you with regard to avoiding weight gain. Everyone reacts differently to medications. That aside, here's the skinny on SSRI (and other atypical antidepressants)-induced weight gain. This is not etched in stone!
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> 1. Comparing the SSRIs Prozac, Zoloft, and Paxil: a] Prozac was associated with a slight weight loss in the short-term treatment and weight neutral in the long-term treatment; b] Zoloft was associated with a nonsignificant weight gain, and essentially weight-neutral in the short-term and long-term treatment, respectively; c] Paxil was associated with significant weight gain. To summarize, there appears to be more early weight loss with Prozac than Zoloft and both remain relatively weight-neutral over time. There is a significantly greater risk of weight gain with Paxil.
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> 2. Results from the short-term clinical trials of Celexa indicate that it does not produce significant weight gain or loss. Long-term treatment (1 year) with Celexa was associated with a mean weight gain of 1.5 kilogram, which was accompanied by a decrease in symptoms of reduced appetite. Little information is available on Luvox.
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> 3. The possible explanation for SSRI-induced weight gain are: a] recovery from depression or clinical improvement, b] appetite increase/carbohydrate craving, and c] changes in serotonin 5HT2C receptor activity. However, there are no definitive studies to explain the exact cause of weight gain as a side effect of SSRIs.
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> 4. Patients maintained on Wellbutrin, and later on Wellbutrin SR gained minimal or no weight gain. In fact, patients who received either drugs had weight loss, although relatively small. The exact reason why patients lose weight on Wellbutrin (bupropion) is not known. It should be noted, however, that the drug is structurally related to a well-known weight-loss drug, Tenuate (diethylpropion).
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> 5. It appears from data collected from clinical trials that weight gain from Effexor may not be particularly a big issue. Effexor, at least in the short-term, is not associated with weight gain. On the other hand, very little is known about the effect of Effexor on weight in the long-term. It is interesting to note that Effexor and Meridia (sibutramine), a weight-loss drug, have somewhat similar effects on norepinephrine and serotonin. Both drugs have been reported to increase blood pressure in some patients.
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> 6. There is some convincing evidence that Serzone may be relatively weight-neutral both in the short- and long-term treatment. Compared to the SSRIs, it was suggested that Serzone may be less likely to cause weight gain in long-term treatment. Serzone's lack of ability to cause weight gain may be due to the effects of its metabolite, m-chlorphenylpiperazine (mCPP). In studies, administration of mCPP decreased appetite and cause weight loss.
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> 7. Weight gain with Remeron appears to be inversely related to the dose based on the European and US studies. Weight gain from Remeron appears to be due to increased appetite which in turn is related to its blocking effect on the histamine (H1) receptors. When exceeding Remeron's dose of 15 mg/day, the H1 receptors become saturated and other receptor effects, such as increased release of serotonin and norepinephrine predominate, and enhanced appetite and weight gain may be less of an issue. An analysis of 4 US studies showed that most of the weight gain experienced with Remeron tends to take place during the first 4 weeks of treatment.
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> 8. Unfortunately, once patients gain weight, as long as they continue on the antidepressants, they may have trouble losing it, even with dieting and vigorous exercise.
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> 9. The use of appetite suppressant drugs such as Tenuate (diethylpropion) or Fastin (phentermine) may help. The occurence of serotonin syndrome is a concern when combined with the SSRIs. Meridia is contraindicated with the use of SSRIs, and Xenical (orlistat) may cause objectionable side effects such as diarrhea.
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> 10. Other drugs purported to curb the weight gain of antidepressant treatment include the H2 blockers such as famotidine (Pepcid) and cimetidine (Tagamet); psychostimulants; T3 (Cytomel); naltrexone (Revia); and topiramate (Topamax). The main problem is that none of these strategies has been tested systematically. They are derived primarily from anecdotal observations and case series.
Re. Anti-depressants and weight gain.I have been on two Tricyclics over the years, both of which cited weight gain as a common side effect. I didn`t gain weight on either.
The only anti-depressant that I have gained weight on is Nardil (which I think is fairly notorious for this). I gained a lot of weight - 3 stone (I don`t know what that is in the States, but it`s 3 dress sizes). I totally hate this - I`m not naturally a big person, I`ve always been slim.
My psychiatrist reckons that all psychiatric medications can cause weight gain (with the exception of Prozac), and just because weight gain is a stated side-effect, this doesn`t mean that it will necessarily happen. I don`t know whether she`s right or not.
I`m shortly to go onto Remeron (Zispin in this country), which also cites weight gain as a possible side-effect. Before I do this, I have to come off Nardil and be clear for a week. What concerns me is that I won`t lose the Nardil weight, and just pile on the pounds on top of this when I embark on the Remeron. It`s to be part of a combination - Remeron and Effexor. Effexor cites weight loss as a possible side-effect, and when I was on it before I did lose weight. Could the one countereact the other?
Has anyone got any comments/ideas/experiences/info in general?
I`d be grateful to hear anyones views.
Cheers,
Anna.
poster:sweetmarie
thread:42440
URL: http://www.dr-bob.org/babble/20010403/msgs/58828.html