There are several classes of antidepressants, the most widely used drugs belong to the class of selective serotonin reuptake inhibitors, for safer, tolerated with fewer side effects, but often those who are in therapy undergoes weight increases even substantial happen to increase by almost 10 pounds in just eight months. In this article My Canadian Pharmacy Rx will still speak of antidepressants and how they are able to change the human attitude towards food and thus lead very often to weight gain.
Antidepressants side-effecting in weight gain
The use of antidepressants has exploded in the past decades. In the USA, today one-tenth of the country’s population with some type of antidepressant medication. According to an OECD report from 2013 used 79 doses of antidepressants per 1000 inhabitants per year in an average European country. The major use in combination with differences in treatment effect between the various preparations are quite small means that the side effects become particularly important in the treatment choices. The Lancet Psychiatry, a group of researchers looked at differences in weight gain between different antidepressants. The study includes nearly 20,000 adult Americans during the period 1990 to 2011 were treated with some form of antidepressant medication. The authors have had access to data on body weight, and looked at how that developed in the year that followed after treatment was inserted. The average age of the treated was around 45 years old and the majority, around 65%, were women. Most were given drugs for depression, but some were treated for anxiety or pain problems. It is worth noting that a majority were overweight before treatment – the average BMI for the entire cohort was 28.3 before treatment.
The authors have subsequently assumed effect on body weight of citalopram, one of the most common SSRIs and other drugs compared with this. On average, citalopram-treated up 3 pounds kilograms of weight, but the spread was great (around 8 pounds).
The preparation tricyclic amitriptyline (e.g. Saroten) and monoamine reuptake inhibitor bupropion (Wellbutrin XR) were associated with reduced risk of weight gain compared to citapolpram. On average, amitriptyline-treated up 0.8 kg while those who received bupropion instead went down 0.2 kg. The differences between the preparations and citalopram are statistically significant but, apparently, relatively small in absolute terms. Regarding other SSRIs such as sertraline and paroxetine noted modest differences between the products were not significant (P <0.05) compared with citalopram. For SNRIs, including venlafaxine, noted also no statistically significant differences compared with citalopram. The differences in weight gain between the different preparations were, unsurprisingly, even more modest in those individuals who completed treatment prior twelve months.
The results can be summarized with the differences in weight gain between different antidepressants are small but that amitriptyline and bupropion appear to cause fewer problems with this, compared with SSRIs and SNRIs. The authors have not looked at the treatment effect against depression and anxiety, but only weight development. Many depression leads as familiar to decreased appetite and subsequent weight loss, but an atypical picture with increased appetite is not uncommon, making it very difficult to forecast the effect of treatment on the basis of weight development.
The relationship that exists between drugs and food is often very narrow, just think that taking grapefruit juice during a drug treatment is always recommended, this seemingly innocuous product could interfere on the effectiveness of the drug often enhancing the effect (grapefruit juice usually it reduces slows the metabolism of the drug which then remains in longer circle procuring an enhanced effect to the subject) and the alcohol? Usually, but it not always alcohol acts in the opposite way speeding up the metabolism and thus reducing the effectiveness of drugs.
Some examples of association of grapefruit juice-drug:
- Certain calcium channel blockers (such as Nifedipine Nifediac and Afeditab);
- Certain statins (Simvastatine Atorvastatine, Pravastatine as Zocor, Lipitor, Pravachol);
- Certain antiarrhythmics (amiodarone as Cordanone and Nexterone);
- Certain immunosuppressants (such as Cyclosporine Neoral or Sandimmune);
- Certain medicines for anxiety (such as Buspirone BuSpar);
- Certain antihistamines (such as Allegra Fexofenadine) in this case the effectiveness of the medication reduction.
How antidepressants make people pack on pounds
The scientific studies are very few, what is certain is that during treatment with these drugs and the resulting increase in serotonin, improving mood itself leading to an increase in food intake for two main effects on ‘ daily attitude:
- Improving the quality of life that prepares to take on larger amounts of food;
- Reduction of physical activity and adopting a more sedentary lifestyle.
More recent studies are showing the hypoglycaemic effect of some antidepressant drugs, but the jury is still out on this one.
The following scientific study, however, provides interesting information on the effect of treatment with certain drugs related to the treatment of schizophrenia.
It was conducted on 800 subjects from four prospective studies who were given a questionnaire for the analysis of the behavior towards food, the largest share is occupied by those who had undergone weight gain in each group; declared explain the reasons for the weight gain were the following:
- Stronger sense of hunger;
- Increased appetite;
- Excessive intake of food;
- Worries and negative thoughts;
- Inability to refrain from eating between meals, and other reasons.
Weight gain may be due to increased body fat, muscle mass or fluid retention. The drugs cause weight gain in several ways, for example by increased appetite, intake of sugar or thirst, reducing the basal metabolism by altering the carbohydrate metabolism or lipid modifying the distribution of body fat and inducing reduction physical activity. It can be difficult to determine the role of certain basic conditions, such as psychological disorders, and the drugs used for the treatment of these (antidepressants and neuroleptics, for example).
The odds of weight gain by drug class
Tricyclic antidepressants, such as amitriptyline and doxepin, frequently cause weight gain, especially during the first months of treatment. The magnitude of weight gain appears to depend on dose and treatment duration.
The mechanisms seem to be the appetite stimulation and antimuscarinic effects of tricyclic antidepressants, which increase thirst and can lead to increased consumption of soft drinks.
Monoamine oxidase inhibitors antidepressants (MAOIs) can also weight increase, increased during the first weeks of treatment and did not appear to be dose-dependent.
Other antidepressants such as duloxetine and venlafaxine can cause both increased that weight loss. Weight gain has also been reported with some selective serotonin reuptake inhibitors (SSRIs); fluvoxamine and citalopram sometimes stimulate the appetite. Mirtazapine stimulates both appetite thirst.
A meta-analysis of 4 trials showed that the weight gain was more frequent with mirtazapine compared to amitriptyline (14.4% vs 6.7%).
Benzodiazepines do not seem to act directly on hunger. Anxiety can change your eating behavior, sometimes leading to weight loss. Therefore, the anxiolytic effects of benzodiazepines may lead to increases in weight.
The weight gain is a common adverse effect of neuroleptics, both conventional and those atypical. Atypical neuroleptics, especially clozapine and olanzapine, may be associated with greater weight gain (about 4 pounds per month). Weight gain is less marked with risperidone and quetiapine (about 2 pounds per month) and even lower with aripiprazole.
Weight gain is mainly observed during the first year of treatment. Several mechanisms explain the weight gain induced by neuroleptics, especially blood sugar disorders, endocrine disorders and a reduction in physical activity due to the sedation.
The lithium frequently causes an increase in weight: 75% of the average of 8 pounds acquired patients during the first 2 years of therapy. The increase of the weight induced by lithium can reach 20 pounds. They look different mechanisms involved, such as increased thirst, water-sodium retention and edema, a reduction of basal metabolism associated with a frequently subclinical hypothyroidism and lithium insulin-like effects.
The antiepileptic drug valproic acid and pregabalin stimulate the appetite and therefore lead to a risk of weight gain. Both drugs can also cause a potentially marked edema. In a 32-week trial, it has been reported an increase in weight of at least 8 pounds in 12% of patients taking lamotrigine and in 62% of patients treated with valproic acid.
Weight gain pregabalin can reach 40 pounds. About 6% of patients treated with pregabalin in clinical trials showed weight gain (mean 3 pounds) versus 1% of patients exposed to placebo (mean 0.6 pounds).
Although gabapentin and levetiracetam are associated with such adverse effects. Weight gain was reported in 4% of patients treated with vigabatrin in clinical trials.
Several other psychotropic drugs induce an increase of the weight, including methadone at high doses and piracetam.
Progestins affect the appetite and weight. The long-term treatment with progestins by injection as medroxyprogesterone is associated with weight gain: 1 to 4 pouds in the first year (sometimes even more) and up to 8 pounds in the second year. Weight loss has been reported occasionally. Weight gain over 6 pounds was reported after 6 months in about 16% of women treated with etonogestrel implants in clinical trials in approximately 37% of women after 24 months.
Cyproterone is also known for causing an increase of weight.
Megestrol, a progestin used in hormone therapy for breast cancer, causes weight gain, increased appetite for more, food consumption and for water retention-sodium water-sodium retention. In clinical trials, weight gain of more than 10% was observed in 17% of patients treated with megestrol versus 8% of patients exposed to exemestane, an aromatase inhibitor.
Combined oral contraceptives can cause both increased that weight loss. It was also implicated high dose of estrogen. Weight gain has been reported with diethylstilbestrol, a synthetic nonsteroidal estrogen for prostate cancer.
There have also been cases with clomiphene and tibolone.
Raloxifene, an inhibitor of estrogen used to treat osteoporosis, causes weight gain.
The testosterone and other androgenic substances such as danazol cause weight gain, in particular for their anabolic effects (increase of protein synthesis and muscle mass). In comparative trials conducted on a testosterone based plasters used to stimulate.
Counterbalancing the side effects that promote weight gain
Taking into consideration the data accrued from the above studies, it should be made a priority for practicing therapists, psychiatrists and other prescribers to take into account metabolic characteristics of the patients before appointing the therapy. Nutritional and lifestyle habits should be inquired into. When possible, body measurements should be made and BMI should be calculated.
These practices are especially essential in patients predisposed to obesity or having a tendency for overweight. The questions of possible weight fluctuations should be considered with extreme caution in individuals in whom other mental symptoms coincide with eating disorders of varied nature. In such cases, a licensed and experienced nutritionist should be made a part of the healthcare team.
As the therapy progresses, it is very important that weigh-ins and other types of body measurements should be taken regularly. Blood tests should be drawn in order to timely prevent development of such conditions associated with weight gain as hypercholesterolemia and hyperlipidemia, as well as elevated glucose levels.
In case of severe weight gain, it is imperative that the patient is made to understand the importance of measures taken in order to stabilize the weight. A restrictive diet should be established by a nutritionist, and exercising regimen should be implemented in order to promote healthy and stable weight loss. A reasonable response towards an extreme weight surplus attained within 6 months (more than 7% weight gain) is a regimen of significant calorie restriction coupled with minimally effective physical activity (at least 40 minutes of brisk walking) should be appointed under the supervision of a nutritionist. After the weight loss goal is attained, a dietary change towards sensible fat and carbohydrate consumption should be made.
It should be stressed that the earlier the problem of weight surplus caused by the implementation of antidepressants is addressed, the easier it is to reverse it.
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