Is ‘weight gain’ or ‘weight loss-plateau’ seriously considered as a side effect by our doctors when prescribing antidepressant? Especially if we are food addicts that experience severe disturbances in our behavior around eating.

The goal of this blog is simply to address the limitation issue we are encountering when counselingSana-Barada-Eating-Healthy.png food addiction patients with depression. We are specifically referring here to patients with addictive behavior towards food that makes them overweight or obese.

All our patients are highly compliant after increasing awareness about their case. At a certain point they are able to fully assume the responsibility of managing their lives independently, identifying the triggers and using protection factors when needed.

They are aware of their emotions, sensations, thoughts and know how to deal with them without concentrating everything towards food. The endpoint has always been an improvement in their quality-of-life parameters, including their weight...until depression sets in. In this case, patients are referred to a psychiatrist, ensuing in a huge limitation to the improvement process when antidepressant medications are prescribed, causing weight gain or a weight-loss plateau.

Weight gain clearly contributes to medical comorbidities [1, 2]. So what if we are talking about individuals who "chronically consume more food than they need to maintain health and show compulsive intake behaviors associated with loss of control of eating? "[3, 4] In addition to which, they are also asked to deal with the physical and psychological complications arising from their behavior. Threatening them further with weight increase or weight loss plateau with the administration of medication meant to help them feel better does not seem to provide them with the support they need.

For this purpose, a review of literature was conducted and gave the following results: currently prescribed psychotropics (antipsychotics, antidepressants, and mood stabilizers) may cause a 2–17   kg weight gain over the course of clinical treatment [5–6]. While the prevalence of weight gain from antidepressants such as imipramine (causing a 3-4   kg weight gain) is chronic and very common, it is underestimated because depression and anxiety are more prevalent diagnostically and epidemiologically than psychotic disorders [7]. Tricyclic antidepressants (TCAs) and perhaps also monoamine oxidase inhibitors (MAOIs) are more likely to cause weight gain than the selective serotonin reuptake inhibitors (SSRIs), while mirtazapine can be placed between the SSRIs and the TCAs in terms of relative risk of weight gain [8, 9]. Bupropion could be the only modern agent that lowers weight [10]. There is a 1–3  kg average weight gain with antidepressants in 10–20% of the population treated. This is further complicated by the fact that the administration of antipsychotic medication is escalating following FDA approval for bipolar and major depressive disorders, which probably increases the incidence of metabolic effects. The use of MAOIs results in moderate weight gain [6]. Trazodone studies show a 0.5 to 1.1  kg weight gain over time [11,12], while a 5% baseline weight loss or 3–4.4   kg weight loss has been reported with bupropion [13–14]. Although initial studies showed weight loss with fluoxetine, long-term follow-up reveals that its weight reducing effect is associated with a gain in body weight over time [15]. While an acute loss of 0.35  kg may be observed, there is an average weight gain of 2–2.5  kg [16]. Citalopram can cause a weight gain of from 1 to 1.5  kg a year [17, 18]. Two studies on Fluvoxamine [10, 19] show neither weight gain nor weight loss. In the SSRI group, paroxetine is the most likely to cause weight gain. Tohen et al. showed that paroxetine caused greater weight gain than fluoxetine and sertraline [20]. These findings suggest a minor iatrogenic weight-gain side-effect profile compared to the SGAs mentioned above. Seventy-one percent of patients treated with divalproex may gain more than 4  kg [6]. A divalproex-induced weight gain of from nine tenths of a kilogram to fourteen kilograms has been reported in other studies [16, 17] with an incidence of 8–59%. Lamotrigine has a more neutral weight profile and may cause weight loss (of 2  kg) or gain (up to 0.6  kg) [18]. Based on limited studies, carbamazapine may cause a weight gain of up to 15  kg [19, 20]. Reviews suggest that weight gain is also a common side effect of lithium. In one study twenty percent of patients on lithium gained 10  kg or more, and in another study there was a 6.3-kg weight gain [21].

 

In Conclusion:

In conclusion, all antidepressant medications may cause weight gain, very few do not. Yet this increase in body weight can differ from between 0.2 and 7 kg a month, and the percentage of the population with an increase in body weight differs from 7% to 71% if we are talking about mood stabilizers. Increased body weight and obesity, which are risk factors for the public health in general, give rise to greater complications in particular when dealing with subjects with inappropriate behavior towards food and struggling with weight issues. Finding new solutions to treat psychological problems and hence decrease the weight-gain side effect is an excellent option, especially in the aforementioned population. The TMS findings suggest the opening up of exciting new possibilities for treating food addiction patients suffering from depression without risking the numerous side effects often associated with psychotropics, especially weight gain.

 

About SanaFirenze:

A multi-disciplinary team of professionals dealing with addiction that derives not only from drugs, but also from certain lifestyles. An initiative stemming from a long personal struggle with food addiction. In a few words, I have given life to what I would like to have found when I myself was a food addict. That’s why, in addition to the clinical and prevention work, I have also created online counseling, a direct line that breaks down all barriers and allows me to reach everyone who needs help. Being in Florence has given added value, as it is the place that best translates the essence of healthy Italian living. Located in the heart of the city, we get to know great people from all over the world on a personal level that sometimes leads to important professional collaborations, as in the case of Christopher, a partner in TMS solutions. Chris and I are both very happy to be able to help people from half way around the world!

 No pleasure is a bad thing in itself, but the things which produce certain pleasures entail disturbances many times greater than the pleasures themselves. (Epicurus)

 

References:

  1. Allison DB, Mentore JL, Heo M, et al (1999). Antipsychotic-induced weight gain: a comprehensive research synthesis. American Journal of Psychiatry. 156(11):1686–1696. [PubMed]
  2.  Masand PS (2000). Weight gain associated with psychotropic drugs. Expert Opinion on Pharmacotherapy.1(3):377–389. [PubMed]
  3.  Ziauddeen H, Farooqi IS, Fletcher PC (2012) Obesity and the brain: how convincing is the addiction model? Nature Reviews Neuroscience 13: 279–286 [PubMed]
  4. Barry D, Clarke M, Petry NM (2010) Obesity and its relationship to addictions: is overeating a form of addictive behavior? The American Journal on Addictions 18: 439–451 [PMC free article] [PubMed]
  5. Pijl H, Meinders AE (1996). Bodyweight change as an adverse effect of drug treatment: mechanisms and management. Drug Safety. 14(5):329–342. [PubMed]
  6. Carman CL, Leung NM, Gnberman AH (1997). Weight gain in epileptic patients during treatment with valproic acid: a retrospective study. Canadian Journal of Neurological Sciences. 24(3):240–244. [PubMed]
  7. Kaplan HI, Sadock BJ (1998). Synopsis of Psychiatry. 8th edition. Baltimore, Md, USA: Williams & Wilkins.
  8. Frank E, Kupfer DJ, Bulik CM, Levenson JA (1990). Imipramine and weight gain during the treatment of recurrent depression. Journal of Affective Disorders. 20(3):165–172. [PubMed]
  9. Prince JB, Wilens TE, Biederman J, et al (2000). A controlled study of nortriptyline in children and adolescents with attention deficit hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology. 10(3):193–204. [PubMed]
  10. Fava M (2000). Weight gain and antidepressants. Journal of Clinical Psychiatry. 61(11):37– 41. [PubMed]
  11. Weisler RH, Johnston JA, Lineberry CG, Samara B, Branconnier RJ, Billow AA (1994). Comparison of bupropion and trazodone for the treatment of major depression. Journal of Clinical Psychopharmacology. 14(3):170–179. [PubMed]
  12. Paradis CF, Stack JA, George CJ, et al (1992). Nortriptyline and weight change in depressed patients over 60.Journal of Clinical Psychopharmacology. 12(4):246–250. [PubMed]
  13. Trivedi M, Rush A (1992). A review of randomized controlled medication trials in major depression. Biological Psychiatry. 31:188–189.
  14. Anderson JW, Greenway FL, Fujioka K, Gadde KM, McKenney J, O’Neil PM (2002). Bupropion SR enhances weight loss: a 48-week double-blind, placebo-controlled trial. Obesity Research. 10(7):633–641.[PubMed]
  15. Leinonen E, Skarstein J, Behnke K, Ågren H, Helsdingen JTh (1999). Efficacy and tolerability of mirtazapine versus citalopram: a double-blind, randomized study in patients with major depressive disorder. International Clinical Psychopharmacology. 14(6):329–337. [PubMed]
  16. Michelson D, Amsterdam JD, Quitkin FM, et al (1999). Changes in weight during a 1-year trial of fluoxetine.American Journal of Psychiatry. 156(8):1170–1176. [PubMed]
  17. Biton V, Mirza W, Montouris G, Vuong A, Hammer AE, Barrett PS (2001). Weight change associated with valproate and lamotrigine monotherapy in patients with epilepsy. Neurology. 56(2): 172–177. [PubMed]
  18. Ginsberg (2003). In: Proceedings of the 156th Annual Meeting of the American Psychiatric Association; San Francisco, Calif, USA.
  19. Lampl Y, Eshel Y, Rapaport A, Sarova-Pinhas I (1991). Weight gain, increased appetite, and excessive food intake induced by carbamazepine. Clinical Neuropharmacology. 14(3):251– 255. [PubMed]
  20. Luef G, Abraham I, Haslinger M, et al (2002). Polycystic ovaries, obesity and insulin resistance in women with epilepsy: a comparative study of carbamazepine and valproic acid in 105 women. Journal of Neurology. 249(7):835–841. [PubMed]
  21. Baptista T, Teneud L, Contreras Q, et al (1995). Lithium and body weight gain. Pharmacopsychiatry. 28(2):35–44. [PubMed]

 

 

About TMS Solutions:

Depression is a serious and debilitating mental illness, affecting upwards of 16 million adults in the US. Getting out of bed is hard, relationships are hard, and everyday life has a "grayness" and heaviness to it. The people around you may not notice much, but you feel it constantly. As many with depression have found out, addressing the illness honestly, getting help from a doctor and utilizing technology like TMS Therapy, can provide hope and remission from depression. Learn more about the help TMS Therapy and TMS Solutions can provide depression sufferers.

To learn more about TMS Therapy click here.

 

Topics: Food and Depression

Sana Barada, PharmD, MS in IPAS -Specialized in Applied Pharmacology and Pharmacovigilance

Written by Sana Barada, PharmD, MS in IPAS -Specialized in Applied Pharmacology and Pharmacovigilance

Sana had her PharmD in 1999 from the Lebanese American University. After moving to Italy, from 2004 to 2008 she attended another four-year specialisation program on applied pharmacology & pharmacovigilance at the University of Florence, and from 2012 to 2014 she followed her Master degree in International Program in Addiction Studies, IPAS, provided by the Virginia Commonwealth University, King’s College London, and the University of Adelaide, recommended by the NIDA.