The catch-22 of antidepressant therapy is the depression that comes from gaining weight on a drug used to stop the depression.
Weight gain is, alas, a common side effect of the drugs used to treat depression, fibromyalgia, severe PMS (known as Premenstrual Dysphoric Disorder) and hot flashes. As much as physicians tend to minimize the effects, or protest that patients are gaining weight because they are finally happy and going to restaurants, their patients are protesting. Many are halting their use of these drugs because they cannot stand to live in a body blown up by the overeating generated by the medications.
Anna typifies this problem. She had major depression that was intensified by PMS and was prescribed Lexapro. This drug has been used effectively to treat major depression and to relieve severe premenstrual mood changes. It worked -- and left Anna almost 50 pounds heavier after a year. Her psychiatrist claimed that this weight gain was unusual because most patients gain "only" 10 to 15 pounds". Anna claims that she may have gained more weight because not only did her appetite increase; the medication made her lethargic and diminished the time and intensity of her daily workouts. Weight Watchers was tried; she gained a pound over four weeks. Desperate to find her formerly thin body, Anna (with the knowledge of her therapist) stopped the therapy. "I am fearful that my terrible PMS will come back and that I might become really depressed again but I can't stand myself, " she told me. "As soon as I stopped the medication, the weight started to come off."
Weight gain from antidepressants is not a trivial side effect, even though therapists may trivialize the effect of gaining 15 pounds on the patient's self image (and wardrobe). Given the vast numbers of women who have been medicated with antidepressants, the number of women who may have experienced this side effect is not trivial either. Data collected by the government on the use of antidepressants between 2005 and 2008 show that 12.7 percent of women were on one or more of these medications during this time period.
The drugs work on relieving symptoms that affect physical and emotional life. But when these treatments deposit extra pounds on bodies that had been a normal size before treatment, patients like Anna may choose to live with the depression or muscle pain rather than accept being fat.
Perhaps her choice could have been avoided if her physician had discussed with her the possibility that weight gain might occur and had suggested interventions to prevent or minimize this occurrence. Physicians do discuss the side effects of the drugs they prescribe. They recommend dosing schedules, the use of food to minimize gastric distress, periodic blood tests to check on organ function affected by the drug, and information about avoiding the sun if the drug may cause photosensitivity. They may even prescribe other drugs to deal with unavoidable side effects like nausea. So why not make a discussion of weight gain part of the side effect conversation?
Anna should have been told to be aware of changes in her appetite and to pay attention to food cravings and an urge to snack even though she wasn't hungry. If she had been someone who exercised regularly, the possibility of reduced energy and thus decreased ability to exercise should have been mentioned as well. She did not have to be warned to call if her jeans suddenly stopped fitting but weighing herself at least weekly would have been a prudent recommendation. And had Anna been supported in her concern not to gain weight by the offer of dietary and exercise guidelines, then she might not have come to the point of dumping her medications to get back into her jeans. Ideally (although not realistically), she could have been sent to a weight-loss support group run by a department of psychiatry for patients like herself who were struggling with medication-associated obesity.
Unfortunately, there are very few physicians trained, or weight-loss programs designed, to treat antidepressant-associated weight gain even when it is recognized. Conventional weight-loss programs are not designed to treat this side effect and may even recommend diets that could affect the positive mood changes brought about by the drugs. For example, high-protein diets will decrease the synthesis of serotonin, the neurotransmitter on which most antidepressants work. This is because in order for serotonin to be made, an amino acid, tryptophan, has to enter the brain. High-protein diets supply too many other amino acid that compete with tryptophan to enter the brain and very little of this essential amino acid gets in.
As we discovered when we ran a weight management center at a Harvard psychiatric hospital, patients found their food cravings, uncontrolled appetite and weight gain stopped when they followed a food plan that increased serotonin. Even though their medications were increasing the activity of the serotonin involved in mood regulation, for reasons that are still not clear the serotonin involved in controlling their appetite was impaired. The only intervention available then and now was to increase the amount of serotonin in the brain. When this occurred, our patients stopped their snacking and bingeing and began to lose weight.
Fortunately, the dietary intervention to promote serotonin's control over eating required only a small adjustment to their diets. Since it had been known for decades that serotonin was made when any non-fruit carbohydrate was consumed, we told our patients to consume a small amount of carbohydrate an hour before lunch, late in the afternoon or an hour before dinner and, if needed, about an hour before bedtime. By controlling the amount of carbohydrate in these snacks and limiting fat content, it was easy to insert the snacks into a 1,200 to1,400-calorie daily diet plan.
We also did not minimize or ignore the tiredness and lethargy that was reported by our patients. Many of them had exercised regularly before they become depressed, but while on their medications they reported feeling too exhausted to continue doing so. It is not easy to force one's body onto a treadmill or into a pool when lying down seems a much better option. Our clinic had a staff of personal trainers who worked with the patients to develop exercises compatible with their reduced energy levels. As this particular side effect wore off, the amount and intensity of physical activity was increased.
Obviously, patients are not going to be given a consultation with a personal trainer by their therapist. However, this side effect should also be recognized and discussed. If, for example, they are told to be content to walk rather than run on a treadmill, or to do something less intense such as yoga rather than kickboxing until this side effect goes away, they will realize that they have more options than lying on a couch and watching their hips grow bigger.
When these dietary and exercise strategies should be implemented is up to the therapist. Obviously, the patient has to be emotionally ready to follow dietary guidelines and engage in an exercise routine. But as Anna points out, therapists should not wait until the patient is getting depressed again because of weight gain. By that time, the choice -- stop the medication and endure the depression -- may be the wrong one.
Follow Judith J. Wurtman, PhD on Twitter: www.twitter.com/stopmed_wt_gain
Weight Gain and Antidepressants (Including SSRIs)
Antidepressants and weight gain: What causes it? - MayoClinic.com
Antidepressants and Weight Gain - MSN Health - Depression
Antidepressant Weight Gain and Weight Loss: Facts and Community
10 Tips to Prevent Weight Gain on Antidepressants - Huffington Post
Antidepressants: Selecting one that's right for you - MayoClinic.com
Drug companies pay doctors to promote their drugs. Just read the article from the NY Times "Dr. Drug Rep" https://www.nytimes.com/2007/11/25/magazine/25memoir-t.html
And like our cancers are a side effect of tobacco that does not concern the conscience of big Tobacco, the marginal effectiveness of antidepressants compared to placebos, weight gain, loss of sexual desire, memory loss, brain shivers, fatigue, personality change and addiction are all side effects that does not concern the conscience of big Pharma.
Big Pharma has redifined the term "addiction" to be "discontinuation syndrome" but talk to someone who tried to kick the habit of addiction to Effexor (venlafaxine) and you will learn that these are synonymous terms. Just read the NY Times story "Self Non-Medication" https://www.nytimes.com/2007/05/06/magazine/06antidepressant-t.html?_r=1&ei=5087%0A&em=&en=cdeb03773a3deee0&ex=1178596800&pagewanted=all&oref=slogin
Big Pharma and big Tobacco are happy when you are addicted and have to pay them their tax every day.
http://sadnessaddiction.blogspot.com/
Overall, I truly believe we are still in the "dark ages" of psychiatry. The meds are awful and don't work much and they cause weight gain. Someday, people will look back on this time the way we do now at leeches and drilling holes in the skull to let the demons out.
Withdrawal Symptoms.
Not enough time has passed for researchers to see the real effects on the brain from anti-depressants. Anyone who has tried to get off anti-depressants has discovered that truly little is known about these drugs and little can be done to help patients coming of the drugs. As one who struggled to get off of them I felt the pain and agony coming from inside your brain for months and there is nothing you can do to mitigate.
Truly, they aren't worth it. Nothing you can ingest can supplant the need to take real and concrete steps to change ones life as the way to self improvement. Sorry but its the truth.
it seems the best option would be to take tryptophan or better yet, 5-HTP which is the direct precursor of seretonin. then you would have more seretonin available for the brain & body receptors. A good B complex with ample B6 or P5P and fish oil or another source of Omega 3 essential fatty acids would compliment the therapy. if that doesn't work, add more folic acid.
ONE tryptophan manufacturer in Japan tried a new filter which was insufficient and gave EMS to very few people, considering how many were ingesting tryptophan on a regular basis.
This is the facts.... scare tactics to dis a safe nutrient and allow a dangerous antidepressant to take over. Doctors recently prescribed an antidepressant for my pregnant god-daughter. She wisely took 5HTP (with B complex and magnesium) and she & the baby are doing fine. I keep seeing "lawyer ads" for a class action suit for people whos foetuses were damaged by the DRUG.
Follow the Big $$$$$$$$ on that "withdrawn from market" one.
Lexapro is not always "bad stuff."
The doctor should have supplemented lexapro with a mood stabilizer or anti-psychotic to prevent mania. That is the common treatment when anti-depressants are prescribed to individuals who have bipolar.
That is simply incorrect. They are "black boxed" for all SSRIs and SSNRIs.
If you can get by without taking the drugs, then your anxiety isn't severe enough for medication and you had no business seeking pharmaceuticals in the first place.
Thanks.
I hope you get severely depressed and treat it with vitamins. Guys like Levine and Moore are just out to make their own money.
Wake up, you're misguided and living in a dream.
Also, regardless of what you feels somebody is saying its a horrible thing to wish depression on someone, especially when they feel they are trying to help. I find it difficult to believe that someone who has suffered with any mental illness would wish it on another person.
I wouldn't say to do take anything for depression without a psychiatrist, you should always run it by them. For the most part though, you don't need a prescription to sit in the sun :)
Joseph Burgo, PhD
http://www.afterpsychotherapy.com
Of course the pharmaceutical companies are out there trying to make a buck by having their drugs overprescribed and giving doctors kickbacks.
If you're having problems, do your research and consult a psychiatrist.
I said it before and I'll say it again: Antidepressants saved my life.