Can you help solve an argument?
Pickle107
Posts: 153 Member
Both my sister and I are on anti-depressants. I've been on mine for many years and am 30 lbs from my ideal weight. My sister has been on hers for about 6 months and has put on about the same amount in that shorter time.
I thought that my metabolism from the meds was making it hard to lose weight. But once I started tracking my cals on mfp and setting a low enough calorie goal since I'm bed-ridden a few days a week, I've lost 5 lbs in 4 weeks. So my experience and the main opinion on here is that you need to run at a calorie deficit to lose weight. I was overeating for how inactive I am.
My sister is adamant that the meds are making her gain weight, she's no less active as she's been in an office job for years and that if anything, she's eating less than usual.
I think that that is physically impossible. She strongly disagrees. Neither of us have thyroid issues. Is there a right/wrong or is it more nuanced?
I thought that my metabolism from the meds was making it hard to lose weight. But once I started tracking my cals on mfp and setting a low enough calorie goal since I'm bed-ridden a few days a week, I've lost 5 lbs in 4 weeks. So my experience and the main opinion on here is that you need to run at a calorie deficit to lose weight. I was overeating for how inactive I am.
My sister is adamant that the meds are making her gain weight, she's no less active as she's been in an office job for years and that if anything, she's eating less than usual.
I think that that is physically impossible. She strongly disagrees. Neither of us have thyroid issues. Is there a right/wrong or is it more nuanced?
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Replies
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Well, you've done detailed measurements (logging) of what you're doing and what happens. Has she?
In some ways, it could be a tiny bit nuanced, because there is variation in different people's side effects from different medications. In most cases I'm aware of**, the weight gain associated with certain medications come from (1) water retention increases, (2) increased appetite (possibly subtle), or (3) fatigue (possibly subtle) that increases rest/sleep and/or decreases daily life activity and exercise frequency or intensity, thus reducing calorie expenditure.
Someone who is not estimating intake or activity to the best of their ability really has no truly reliable handle on whether they're eating and moving the same amount. We tend not to notice subtle or gradual changes in our own behavior. A 30-pound fat gain over 6 months is around 500-600 calories per day via some combination of increased appetite or decreased activity, or a combination of the two. That's a fair amount, but very much within the realm of possibility to go unnoticed in someone who isn't tracking, IMO.
** I'm not a doctor or anything like it, but have taken some drugs that are commonly believed to affect body weight tendencies. I know the story for those, and have read about a few others, but I certainly admit there could be drugs with different mechanisms of action and different side effects.11 -
If you and your sister are both willing to log all your food carefully (using a food scale), then the two of you will have the data to see for yourselves.9
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I would say it's more nuanced. Some antidepressants are strongly correlated with weight gain. However, it seems like they don't cause weight gain by breaking down physics, or even (for the most part) by altering metabolism - a calorie is still a calorie - but by impacting appetite and non-exercise activity level. Your sister may believe she's no less active, but actually be using fewer calories because she doesn't fidget as much, make that extra trip upstairs to pick up something, and so on. Most people are not very aware of their non-exercise activity level. Likewise, people who don't track calories and weigh food may feel that they are eating the same amount, but a handful of almonds has turned into a big handful, that one slice of roast may be the thick slice of roast now, and the doughnut at office break which before was a random doughnut is now the biggest one in the box. These changes can be subtle, but add up.
If your sister has gained 30 lbs in six months after being put on new meds, and was at a stable weight previously, it seems very likely that her meds are having an effect on her weight, whatever the mechanism is. She may be able to fight back through deliberate exercise and calorie counting, or possibly by asking for a change in meds. It's definitely something she should bring to the attention of her doctor, since excess weight isn't healthy.11 -
I have both gained weight and lost weight on Paxil. I lost weight when I tracked on MFP at a rate expected for my deficiate. When the Paxil stopped working, I stopped tracking and gained weight. I am now on a three drug combination to control my depression. I am tracking and losing. The difference is tracking! IMHO it is the uncontrolled depression that causes the weight gain and not the drugs. If she tracked she would know if she is eating more and or moving less. If her medication is working correctly she might be more willing to track.0
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Side effects of the medicine should be listed in the documentation that came from it. When a side effect is that it may cause weight gain, it doesn't mean that you can't lose weight but that it may be harder than normal to maintain or lose weight. It's all relative. There are many medicines that affect weight.
So your sister is likely right that she has gained weight while eating and exercising as she normally would with the only difference being the medication. But you are also right that she could lose weight if she starts to eat less or exercise more.
To give you an example of medication effect on weight that I am familiar with: I've recently started taking metformin for insulin resistance, and a frequent side effect is to lose weight compared to if someone with this illness wasn't on the medication. If you look into the science of how our body metabolises energy, and the interactions it has with different hormones and processes, then it is clear that in an ill body it does not just come down to basic understandings of "CICO".
In the case of my illness - insulin resistance - the insulin has a harder time opening fat cells to release the stored energy for the body to use, so it is harder (but not impossible) to lose weight than in a normal healthy body. When the body doesn't think it has enough energy to run at full capacity (even though there may be plenty in storage) it sends signals that it is hungry (tempting people to eat more), and it starts prioritising processes, reserving the energy for crucial life functions, so the body might get cold hands and feet due to restricted blood flow, might get a fuzzy brain as higher order thinking is not considered a necessity, drop in sex drive, drop in motivation, change in mood, the body will feel tired and like resting more to conserve energy, etc. This means the basal metabolic rate can drop even if the person is diligent in eating & exercising the same as normal, which leads to weight gain. The medication tries to correct this dysfunction in the insulin/energy processes, so weight loss becomes easier than without it.
It is impossible for anyone to accurately calculate the "calories out" part of the CICO equation, we are only approximating and assuming based on what is considered "normal" for someone of our gender/age/height/weight/activity level. Illness and medicines can change the processes involved with the basal metabolic rate, satiety, mood, energy levels, etc, which has an effect on weight compared to a person not on the medication or without an illness.
So in your sister's case, the medication might cause her body to burn less energy than normal even if she is eating and exercising the same, or it might encourage the body to store more energy unnecessarily.8 -
In a nutshell, some antidepressants can affect hunger signals. None can cause a person to gain weight by themselves. If the brain chemistry is affected to where someone feels hunger more often, they are likely to overeat.9
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Grand. Thanks every one. I'll try and get her to join up and see for herself. Should be interesting (I mean that in a non-sarcastic manner).
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The usual way a med caused weight gain is through increased appetite, and it's incredibly easy to eat more than you think you are if you're not carefully logging everything you eat.6
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Both my sister and I are on anti-depressants. I've been on mine for many years and am 30 lbs from my ideal weight. My sister has been on hers for about 6 months and has put on about the same amount in that shorter time.
I thought that my metabolism from the meds was making it hard to lose weight. But once I started tracking my cals on mfp and setting a low enough calorie goal since I'm bed-ridden a few days a week, I've lost 5 lbs in 4 weeks. So my experience and the main opinion on here is that you need to run at a calorie deficit to lose weight. I was overeating for how inactive I am.
My sister is adamant that the meds are making her gain weight, she's no less active as she's been in an office job for years and that if anything, she's eating less than usual.
I think that that is physically impossible. She strongly disagrees. Neither of us have thyroid issues. Is there a right/wrong or is it more nuanced?
Study after study demonstrates that people are notoriously bad at estimating how much they are eating.
If your sister gets a food scale and logs every morsel, I am convinced she we discover that she is eating more than she thinks.
Some anti-depressants can indeed increase hunger, and that is how people gain weight while taking ADs - from eating more than they burn.
Wellbutrin is an AD that is NOT associated with weight gain. It's about the 6th AD I tried, and the only one I've stuck with. It is also a tiny bit speedy, which I find useful to encourage me to move more.5 -
I'm on meds that cause weight gain. But, when I track my calories and eat less, I lose weight anyway.3
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You don't say whether your sister and you are on the *same* "antidepressant." They're not all the same and some have different effects on appetite and on things like how much you move.
You finding it easy to track and lose on YOUR med really says very little about your sisters experience on HER med.0 -
If you could explain to your sister that if she were to weigh her food and track her calories as you do she may discover that it is the medication she is taking which might not suit her and could be reasoned information which might help her achieve a better product for herself.
(I have a total distrust of so called thyroid numbers, being told you are in the normal range is common for many in the general population but it does not mean that if you are at the lower end of the range that it is high enough for yourself specifically. According to STTM, stop the thyroid madness, website, these numbers were calculated by using left over bloods at a hospital one week or weekend, the samples were not accompanied by information such as, was the donation from someone taking thyroid medication, does the donwner have family members with thyroid conditions, or even the complaint for which the sample was originally taken, so all we have are number relating to that hospital population at that specific time. This testing was never repeated, anywhere in the world)
I found it useful to calculate the amount of iodine and other minerals I had in my diet. The medical advice is to have 150 micron of iodine a day or put another way 1/2 a teaspoon a year. 100 grams of Peas has 4 micron, Milk I think is 15 micron in 100 grams yoghurt is doubled. Dark green veg are similar to peas, information is available on line these are ones I remember. It is easy to go short if one is dieting. Selenium is essential for good thyroid function as are many other minerals and vitamins. Under qualified advice I have an intake of way above that level to achieve better health and well being. Iodine etc is used by the immune system and in mucus membranes to keep the body healthy.
Being low in T3 can be a contributory factor in depression and other mental health issues. Regrettably when having a thyroid blood test taken many doctors even private ones do not test the t3 levels or the reverse t3 which indicates poor conversion and a greater need for various minerals etc. Many doctors look only for the tsh, the stimulating hormone and the t4, the presence of iodine in the blood. There is so very much more to thyroid function than is often given credit
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Side effects of the medicine should be listed in the documentation that came from it. When a side effect is that it may cause weight gain, it doesn't mean that you can't lose weight but that it may be harder than normal to maintain or lose weight. It's all relative. There are many medicines that affect weight.
So your sister is likely right that she has gained weight while eating and exercising as she normally would with the only difference being the medication. But you are also right that she could lose weight if she starts to eat less or exercise more.
To give you an example of medication effect on weight that I am familiar with: I've recently started taking metformin for insulin resistance, and a frequent side effect is to lose weight compared to if someone with this illness wasn't on the medication. If you look into the science of how our body metabolises energy, and the interactions it has with different hormones and processes, then it is clear that in an ill body it does not just come down to basic understandings of "CICO".
In the case of my illness - insulin resistance - the insulin has a harder time opening fat cells to release the stored energy for the body to use, so it is harder (but not impossible) to lose weight than in a normal healthy body. When the body doesn't think it has enough energy to run at full capacity (even though there may be plenty in storage) it sends signals that it is hungry (tempting people to eat more), and it starts prioritising processes, reserving the energy for crucial life functions, so the body might get cold hands and feet due to restricted blood flow, might get a fuzzy brain as higher order thinking is not considered a necessity, drop in sex drive, drop in motivation, change in mood, the body will feel tired and like resting more to conserve energy, etc. This means the basal metabolic rate can drop even if the person is diligent in eating & exercising the same as normal, which leads to weight gain. The medication tries to correct this dysfunction in the insulin/energy processes, so weight loss becomes easier than without it.
It is impossible for anyone to accurately calculate the "calories out" part of the CICO equation, we are only approximating and assuming based on what is considered "normal" for someone of our gender/age/height/weight/activity level. Illness and medicines can change the processes involved with the basal metabolic rate, satiety, mood, energy levels, etc, which has an effect on weight compared to a person not on the medication or without an illness.
So in your sister's case, the medication might cause her body to burn less energy than normal even if she is eating and exercising the same, or it might encourage the body to store more energy unnecessarily.
Respectfully disagree- In most cases the medication increases your appetite and/or changes your activity level. This is commonly the culprit for weight gain. Once back to logging diligently, with a food scale, and following your weight trend, you can continue to maintain and even lose weight.5 -
msalicia07 wrote: »Respectfully disagree- In most cases the medication increases your appetite and/or changes your activity level. This is commonly the culprit for weight gain. Once back to logging diligently, with a food scale, and following your weight trend, you can continue to maintain and even lose weight.
While there is definitely a difficulty with appetite and activity level changes with some antidepressants, from what I understand, the research on this is still ongoing, as there are still some unanswered questions. Some research seems to indicate that with some antidepressants, there are other factors at work as well. Some of these block certain receptors, for example, which seems as though it may actually do things like alter the basal energy expenditure, potentially.
Also, it's pretty well known that switching drugs can alter the weight gain for various patients, which may indicate certain genetic differences in how people respond to the medication (whether that is in appetite increases, activity, level, or something else is unknown).
So for the OP - yeah, your sister could potentially be correct that something else is going on with the medication (no way to know without keeping track herself, but it's not outside the realm of possibility). Your situation may not be the same one she is experiencing. It could be, but there is literally no way to know without keeping track.
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If you look around, the science on this is definitely not settled, and people's experiences vary. From my experience, the medication absolutely impacted my metabolism. I'm sick of people shouting "It's calories in vs. calories out!!!" while pretending that ABSOLUTELY NOTHING can impact the second part of that equation (even though we already know that isn't true).
Until anti-depressants, I had never been overweight in my life. I eat reasonably well and exercise regularly--did then, still do. But after the medication, my weight skyrocketed despite my frantic efforts to stop it. I've gained 20+ lbs in about a year. I have tracked calories, carefully controlled my nutritional intake, and increased my exercise to no avail.
The impact of these medications on our hormones--and therefore all of our bodily processes--is not fully understood, and people insisting they know for sure (without having experienced it themselves) are simply overconfident.13 -
aguilar_k3 wrote: »If you look around, the science on this is definitely not settled, and people's experiences vary. From my experience, the medication absolutely impacted my metabolism. I'm sick of people shouting "It's calories in vs. calories out!!!" while pretending that ABSOLUTELY NOTHING can impact the second part of that equation (even though we already know that isn't true).
Until anti-depressants, I had never been overweight in my life. I eat reasonably well and exercise regularly--did then, still do. But after the medication, my weight skyrocketed despite my frantic efforts to stop it. I've gained 20+ lbs in about a year. I have tracked calories, carefully controlled my nutritional intake, and increased my exercise to no avail.
The impact of these medications on our hormones--and therefore all of our bodily processes--is not fully understood, and people insisting they know for sure (without having experienced it themselves) are simply overconfident.
and yet you stated in another thread that once you reduced your caloric intake you lost weight, SO... it wasn't to no avail, was it?2 -
I suggest you do not argue with her. Just tell her that you love her and you hope she figures her situation out and let you know if there is anything you can do to help.
If a person is not ready for the truth shouting it louder does more harm than good.
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tinkerbellang83 wrote: »aguilar_k3 wrote: »
and yet you stated in another thread that once you reduced your caloric intake you lost weight, SO... it wasn't to no avail, was it?
I think the eyeroll I just did reading this burned a good number of calories, so thanks for that I guess.
Anyhoo, your comment far underestimates my level of Type A major geekery plus a finance degree with an indecent love for spreadsheets. Sick of being dismissed by people such as yourself, I kept a detailed diary that included measuring portions and tracking calorie burn using my Apple Watch. I should have lost about 8 lbs. I added up my numbers in a spreadsheet at the end of each week and tracked the variance from the expectation.
What happened instead was that I started out losing about 4 lbs (yay!), then inexplicably gained 2 back (without going off the diet), and then plateaued. Hopeful that perhaps I was gaining muscle, I also took measurements I found basically the same outcomes. Overall, my weight loss was about 20% of the expected.
Perhaps you have the willpower to maintain an 1100 calorie-per-day diet for life just to maintain your weight--although since you're also a member of MyFitnesssPal, I doubt it--but I cannot.
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aguilar_k3 wrote: »tinkerbellang83 wrote: »aguilar_k3 wrote: »
and yet you stated in another thread that once you reduced your caloric intake you lost weight, SO... it wasn't to no avail, was it?
I think the eyeroll I just did reading this burned a good number of calories, so thanks for that I guess.
Anyhoo, your comment far underestimates my level of Type A major geekery plus a finance degree with an indecent love for spreadsheets. Sick of being dismissed by people such as yourself, I kept a detailed diary that included measuring portions and tracking calorie burn using my Apple Watch. I should have lost about 8 lbs. I added up my numbers in a spreadsheet at the end of each week and tracked the variance from the expectation.
What happened instead was that I started out losing about 4 lbs (yay!), then inexplicably gained 2 back (without going off the diet), and then plateaued. Hopeful that perhaps I was gaining muscle, I also took measurements I found basically the same outcomes. Overall, my weight loss was about 20% of the expected.
Perhaps you have the willpower to maintain an 1100 calorie-per-day diet for life just to maintain your weight--although since you're also a member of MyFitnesssPal, I doubt it--but I cannot.
Weight fluctuates constantly so what you're describing isn't really inexplicable, my own weight varies by as much as 5lb from day to day due to water retention.
How long did you keep the diary before deciding you had plateau'd?
Were you weighing food?
For years I didn't understand how I wasn't losing weight eating 1200 caloriesa day and would yo-yo, usually quitting after about 10 days seeing a rise on the scale (usually from a higher carb or sodium day) - the answer was simples, I was eating more than I thought and I wasn't patient enough. I now lose weight on 2300 calories thank to a food scale and trendweight app.
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aguilar_k3 wrote: »tinkerbellang83 wrote: »aguilar_k3 wrote: »
and yet you stated in another thread that once you reduced your caloric intake you lost weight, SO... it wasn't to no avail, was it?
I think the eyeroll I just did reading this burned a good number of calories, so thanks for that I guess.
Anyhoo, your comment far underestimates my level of Type A major geekery plus a finance degree with an indecent love for spreadsheets. Sick of being dismissed by people such as yourself, I kept a detailed diary that included measuring portions and tracking calorie burn using my Apple Watch. I should have lost about 8 lbs. I added up my numbers in a spreadsheet at the end of each week and tracked the variance from the expectation.
What happened instead was that I started out losing about 4 lbs (yay!), then inexplicably gained 2 back (without going off the diet), and then plateaued. Hopeful that perhaps I was gaining muscle, I also took measurements I found basically the same outcomes. Overall, my weight loss was about 20% of the expected.
Perhaps you have the willpower to maintain an 1100 calorie-per-day diet for life just to maintain your weight--although since you're also a member of MyFitnesssPal, I doubt it--but I cannot.
All you have proven is that you expected weight loss to linear on a bathroom scale and it is not. What your spreadsheet proves is that you are a normal human that experiences very normal weight fluctuations.
Your body requires energy to operate. If you burn more than you consume the balance of energy MUST come from somewhere and that is your energy reserves. Much like a balance sheet the assets and liabilities will always add up to zero as long as you are alive.4 -
Some medications can cause water retention which will make the scale weight increase. Some will also slow someones metabolism rate slightly so they may burn a little less doing the same activities that they did before.
CICO still works though. Once you figure out what you are actually burning if you consume less than that you will lose weight.2 -
I just skimmed a study (and actually read the discussion section) a week or two ago that found that the weight gain that was found in people who were taking SSRIs (it may specifically have been Prozac - I'd have to check) was tied to people having more energy to eat due to their decreased depression. It wasn't a metabolism issue, it was a "people have more energy to eat" issue. I can probably find the article again if you're interested (though it may be behind a paywall).
And yes, I am someone who will forget to eat or resist getting out of bed (and thus not eat because food isn't just going to come to me) when my depression is especially bad. I know that I'm not a unicorn in that respect.1 -
All you have proven is that you expected weight loss to linear on a bathroom scale and it is not. What your spreadsheet proves is that you are a normal human that experiences very normal weight fluctuations.
Your body requires energy to operate. If you burn more than you consume the balance of energy MUST come from somewhere and that is your energy reserves. Much like a balance sheet the assets and liabilities will always add up to zero as long as you are alive.
In case it wasn't clear, I spent well over a year trying to lose weight, and never experienced a sustained weight loss of any kind. The scale only went up overall. Somehow, in all the years of my adult life prior to being on antidepressants, I never struggled with understanding how to eat food or how numbers worked. Did I just forget one day?
If you look back at my first post on the subject, I am not saying that they Calories in/Calories Out Equation Doesn't work. I am saying that the medication impacts the calories out to the point that it is difficult--and maybe impossible--to maintain weight while also living life and taking in enough nutrients to actually be healthy long term.6 -
aguilar_k3 wrote: »
All you have proven is that you expected weight loss to linear on a bathroom scale and it is not. What your spreadsheet proves is that you are a normal human that experiences very normal weight fluctuations.
Your body requires energy to operate. If you burn more than you consume the balance of energy MUST come from somewhere and that is your energy reserves. Much like a balance sheet the assets and liabilities will always add up to zero as long as you are alive.
In case it wasn't clear, I spent well over a year trying to lose weight, and never experienced a sustained weight loss of any kind. The scale only went up overall. Somehow, in all the years of my adult life prior to being on antidepressants, I never struggled with understanding how to eat food or how numbers worked. Did I just forget one day?
If you look back at my first post on the subject, I am not saying that they Calories in/Calories Out Equation Doesn't work. I am saying that the medication impacts the calories out to the point that it is difficult--and maybe impossible--to maintain weight while also living life and taking in enough nutrients to actually be healthy long term.
So a medication slowed your metabolism to the equivalent of a coma patient without any other symptoms? You realize that as far as possible answers go that is highly improbable, right? The far more likely answer is that even if you were burning slightly less than average for your stats you were also eating more than you realize.
You can choose to believe what you want about yourself but unless you have a more scientifically controlled set of results you should be cautious because you are very likely feeding a myth and possibly depriving others of hope.
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In a nutshell, some antidepressants can affect hunger signals. None can cause a person to gain weight by themselves. If the brain chemistry is affected to where someone feels hunger more often, they are likely to overeat.
And be less active/more lethargic. Not in a dramatic “I can’t get out of bed” way, but in a slowly creeping “I’m tired” way. More fatigued. Folks may not realize their workouts are less intense or that they’re moving less than usually. A fidgety person might be less fidgety or their normal walking pace might be slower.
Combine that with increased appetite and it’s a weight gain double whammy!4 -
aguilar_k3 wrote: »
All you have proven is that you expected weight loss to linear on a bathroom scale and it is not. What your spreadsheet proves is that you are a normal human that experiences very normal weight fluctuations.
Your body requires energy to operate. If you burn more than you consume the balance of energy MUST come from somewhere and that is your energy reserves. Much like a balance sheet the assets and liabilities will always add up to zero as long as you are alive.
In case it wasn't clear, I spent well over a year trying to lose weight, and never experienced a sustained weight loss of any kind. The scale only went up overall. Somehow, in all the years of my adult life prior to being on antidepressants, I never struggled with understanding how to eat food or how numbers worked. Did I just forget one day?
If you look back at my first post on the subject, I am not saying that they Calories in/Calories Out Equation Doesn't work. I am saying that the medication impacts the calories out to the point that it is difficult--and maybe impossible--to maintain weight while also living life and taking in enough nutrients to actually be healthy long term.
So a medication slowed your metabolism to the equivalent of a coma patient without any other symptoms? You realize that as far as possible answers go that is highly improbable, right? The far more likely answer is that even if you were burning slightly less than average for your stats you were also eating more than you realize.
You can choose to believe what you want about yourself but unless you have a more scientifically controlled set of results you should be cautious because you are very likely feeding a myth and possibly depriving others of hope.
It IS backed by science. As I've said elsewhere, the accepted consensus seems to be that antidepressants may cause a mix of both increased appetite AND alterations to metabolism. When I'm eating almost exclusively pre-portioned protein shakes/vegetable purees and doing meal prepping at home, it's pretty hard to make the case that I'm just eating uncontrollably and somehow don't notice.
I'm not understanding how you think it's helpful for people to be lied to about real side effects of a medication.
https://www.bmj.com/content/361/bmj.k1951
"Antidepressant treatment may also be associated with weight gain,12 through mechanisms that are only partially understood."
https://www.ingentaconnect.com/content/ben/emiddt/2015/00000015/00000004/art00002
"Metabolic changes associated with weight gain include disturbances of glucose and lipid metabolism. Clozapine and olanzapine may, in addition to mechanisms resulting from weight gain, impair glucose metabolism by blockade of the muscarinic M3 receptor (M3R). Antidepressants associated with weight gain appear to have fewer unfavourable effects on glucose and lipid metabolism than the second-generation antipsychotics clozapine and olanzapine."
https://www.medicalnewstoday.com/articles/319527.php
And here's a nice easy read: "Experts do not fully understand why antidepressants lead to weight gain in some people. One theory is that both metabolism and hunger levels may be affected."
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