Advice needed: weight loss with meds

I too have a problem with some of my medication. The side affects of some is weight gain. I am doing not too bad with my weight loss so far!

Liftng4Lis wrote: »

Medications can increase appetite. Eating too much causes weight gain. Be conscientious and you stay in a deficit and you'll lose weight.

Very true!

Warning: long post ahead

I don't want to be mean, but it's not necessarily helpful to give simple advice on weight gain/loss from meds (especially psych meds), when you've never been on them and have never heard accurate data and advice from a qualified physician -- specifically a psychiatrist who knows exactly the "ins and outs" of these drugs.

I've been on psych meds since 2001, and I've probably tried nearly any/all you can name, or at least one of them in the same class/category (which tend to share the same side effect profiles). Anything you read below is because I researched it after my psychiatrist told me the exact same information first, and I wanted to see the data for the claims/info.

Psych meds affect weight in one of three ways: 1) weight-gain promoting; 2) weight-loss prohibiting; and 3) weight-loss promoting. There are various biological and biochemical ways that this happens, and it is NOT all due to changes in appetite (increase vs. decrease).

Examples:
#1 -- weight-gain promoting: almost all anti-psychotics (see below)
#2 -- weight-loss prohibiting: mood stabilizers (basically, anti-epilepsy drugs often used for bipolar and sometimes schizophrenia -- they mess with your metabolism without affecting your appetite -- but it is still possible to lose weight)
#3 -- weight-loss promoting: Topamax (This is actually the only one I can think of that has this side effect for almost everyone -- the extent that this med (actually another anti-epilepsy med) is prescribed totally off-label at an often unsafe high dosage level specifically for weight loss by unscrupulous non-pysch doctors who don't know about any of the other side effects and risks. It was used in the past as an anti-depressant, but now is almost never used for that purpose -- mostly for epilepsy and migraines.)


For the anti-psychotics (the med which the OP asked about, Abilify, is in this class; Sertaline is the generic name for Zoloft), which is a sucky name for the class of drugs that are prescribed for so many other useful purposes but has such a stigma-loaded name, there are at least two mechanisms that affect/cause the very common side effect of weight gain. Yes, the first is increased appetite. But the second, and the biggest reason, is Metabolic Syndrome. I'm just going to insert a long quote here, because it explains it with science better than I can sum it up:

Stahl thinks the mechanism by which APs mess with insulin is antagonism of histamine H1, muscarinic M3, and serotonin 5HT2C receptors (which are all responsible for increased appetite), and, possibly, the as-yet-unidentified “factor X” he uses as a placeholder for antipsychotics’ mechanisms of action that haven’t been fully explained. Even without factor X those all explain why Zyprexa, Seroquel, and Clozaril (clozapine) pack on the pounds and screw up your glucose tolerance, but not why Risperdal (risperidone) and Invega (paliperidone) can do the same thing, or why Abilify will mess with your blood sugar without affecting your weight. While the worst offenders are atypical antipsychotics, my money is on dopamine antagonism itself being the key factor. Why? Because your pancreas has dopamine D2 receptors that affect how much insulin you make, that’s why. Just as hay fever meds make you sleepy because they affect the histamine receptors in your brain, crazy meds affect neurotransmitter receptors you have in other parts of your body. There doesn’t seem to be much difference in the diabetes rate (of people taking APs) between smokers and non-smokers, and if M3 antagonism is a factor, smoking should help prevent AP-induced diabetes. There’s no doubt smoking will make the cardiovascular and triglyceride problems worse, but if M3 were involved, there should be plenty of evidence of smoking preventing diabetes in the same way it helps to prevent Parkinson’s. It’s documented all over the place that antihistamines and 5HT2C antagonists can cause obesity (see the bibliography page), which is why Remeron (mirtazapine) will make you fat, yet may even make it somewhat less likely you’ll get diabetes than someone with untreated MDD.
Oh, and bromocriptine, a D2 agonist, is approved by the FDA to treat type 2 diabetes because it improves glycemic control.
The rates of diabetes, obesity, and metabolism syndrome in general are low with Geodon (ziprasidone), and Geodon doesn’t do squat with the muscarinic receptors, is comparable with Seroquel as an antihistamine, is more potent than Zyprexa when it comes to 5HT2C receptors, and doesn’t have that mysterious X factor. These two Pfizer-sponsored studies show that Geodon sucks less than Zyprexa when it comes to glucose intolerance, and switching from Risperdal, Zyprexa, or miscellaneous first-generation antipsychotics to Geodon leads to weight loss, lower cholesterol, increased attractiveness, and immortality. OK, I made up the last two. Sometimes the brown-nosing in drug company-sponsored studies is as obvious as the product placement in Bones.
Then again, Geodon is also a serotonin and norepinephrine reuptake inhibitor, a potent 5HT2A antagonist, and a partial 5HT1A agonist. If someone could develop a drug with only those four actions they’d have an antidepressant that causes weight loss and boosts sexual function. http://www.crazymeds.us/pmwiki/pmwiki.php/MedClass/APEPS

(And don't complain about the name of the website -- it's very well researched with links to all his claims.)


As for the other med the OP is currently taking, sertaline (zoloft), this med is a straight-up anti-depressant in the SSRI category (selective serotonin reuptake inhibitor). This med has about an equal chance of weight gain vs. weight-stable vs. weight loss -- same with Prozac. Some people just have different side effects, as the drug affects their metabolism differently. So, with psych meds, it is totally case of "YMMV" -- your mileage may vary -- what works for one person will/may not work for you, and what side effects they got you may/may not get.

And also, with all psych meds, there is this possible (but rare) thing called the "paradoxical effect", where you get basically an opposite side effect of the typical side effects, so there's that weirdness that can sometimes happen too.

So here's what the real balance is, ask yourself this question:
-->Does the risk of the side effect suck more or less than the mood issues you are currently dealing with?
And that's a question only you can answer for yourself. (And with your doctor too,)

For the anti-psychotic class of drugs, which are often prescribed as a "booster" to anti-depressants, some of them will work better for some people than others. You may (or, rather, probably) will have to do a trial-and-error to find which one works for you, mood-wise, as well as side-effect-wise.

BUT -- the physical side-effects will probably manifest sooner than the positive mood effects. But not all of the physical side-effects are permanent. Some go away after your body gets used to the drug - including changes in appetite and metabolism. That's usually why psychiatrists have a patient try a new med for a month before evaluating whether it's working or not, whether the side effects are tolerable or not, whether the dose is right or not, etc.

If the weight-gain risk is more important to you than finding the perfect med first, then tell your psychiatrist that you want to try one first that has the lowest risk of that side effect in that same class of med. But, fair warning, that alternative med may not be the most effective for you. There's probably a reason that your doctor picked Abilify for you to try. Ask him/her. Tell him/her your concerns about weight gain. Make this a dialogue. It's about agreement on your treatment plan, not a dictatorship -- one way or the other.


For me, I've gained weight, maintained weight, and lost weight, all while on psych meds, multiple times -- some related to side effects, some because of my mood disorder, some because of my life situation, etc. Some of it was when I was eating healthy/well/CICO, sometimes not, but sometimes it just didn't matter how much I tried CICO -- the weight just wouldn't change (or it would go up). But sometimes I accepted that fact, because I needed the positive mood effect of that medication. Right now, I'm on a combo of meds that keep me mood-stable, but should weight-wise, be preventing me from losing weight. (They're in the weight-loss prohibiting category.) But, I'm losing weight slowly but surely. Actually, let me correct that, I'm losing inches first, then the pounds on the scale change later. Weird.

But, YMMV for any and all psych meds you try -- both for mood-effect and side-effects. Don't let anyone else tell you otherwise. Don't let anyone else scare you off trying a med just because of their horrible experience (notice that I'm not naming any of my own current meds or medication history here), or influence you to try their successful med because of their positive experience. This is a collaborative decision between you and your own doctor. That's it.

Anyways, sorry for the long post, but I wanted to give you science for your questions. Check out the CrazyMeds website for some awesome info on any and all psych meds. It's where I go first when my psychiatrist brings up a new med. It's a weird name for a site, and he has a fun way of writing, but it's all well-researched and his claims are all backed-up by links to peer-reviewed published research studies, patient data sheets, prescriber data sheets, etc.