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Judith J. Wurtman, PhD

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The Cause of Weight Gain People Don't Talk About

Posted: 12/03/10 07:43 AM ET

Why do we feel obliged to comment on each other's appearance when we meet after an absence of several months? But since we do, especially when we see family members at holiday gatherings, how do we handle weight gain, either ours or that of someone else? If your family is typical, there will be someone named Tiny whose weight has occasionally topped 350 pounds, or a distant cousin coming off or just going on the latest diet fad. Often there is also at least one relative who feels obliged to make everyone aware that she (and it is usually a she) has noticed that you have gained weight.

Well, what does one do when the weight gain was not caused by a 14-day cruise, a new job as a pastry chef or the inability to exercise due to a bad back? What does one say when the weight gain was caused by medication taken for an emotional disorder such as depression, panic attacks, anxiety, or cyclical mood swings? Do you really want to explain to cousin Shirley or aunt Josephine that you are taking Zoloft or Lexapro or Depakote and the drug caused you to put on 20, 30 or maybe even 70 pounds since last Christmas? Do you want to spend time explaining that the emotional problem causing you to take the medication has been helped, but now you are left with many unwanted pounds?

Unfortunately, relatively few people are aware of the weight-gaining potential of antidepressants and similar medications. Most of us know that if we have to go on prednisone (cortisone) for a medical problem such as severe asthma or Crohn's disease, one of the side effects is weight gain. And when the weight gain occurs, few people would blame it on lack of will power, understanding instead that sometimes the weight gain is unavoidable. But the weight gain caused by treatment with antidepressants, mood stabilizers and atypical antipsychotic medication is rarely recognized by physicians, let alone your distant relatives. Indeed, if people were asked about the usual side effects of these medications, they might list dry mouth, impotence and tiredness, but not weight gain.

The reason aunt Josephine and cousin Shirley don't know about this cause of weight gain is that very little attention is paid to it in discussions about the "obesity epidemic" or in television shows devoted to helping fat people become thin. Has any reality show had volunteers who were thin until they started on Zyprexa or Respiradel? Have any television medical show hosts gone to a meetings of the National Alliance on Mental Illness and met members who are carrying 75 or 100 extra pounds because of their medication? Have well-meaning public figures mentioned the severe weight gain seen among school children because they are taking medication for pediatric bipolar disorder? Do national weight-loss organizations such as Weight Watchers address this problem in their meetings?

I am a co-author of a book offering a weight-loss program for people who have gained weight on antidepressants and thus receive e-mails from people frustrated and angered because neither their psychiatrists nor nutritionists understand the impact of antidepressants on their eating.

"Eat less, exercise more" or "Stop eating carbohydrates and just eat lean protein" are typical comments told by their physicians to the people who write to me. Many of the people who have gained weight were thin before going on their medication and always ate and exercised appropriately. But the medications seem to remove their control over eating and leave them too tired to engage in much physical activity. Moreover, advice to stop eating carbohydrates is counterproductive in the extreme.

Eating carbohydrates (except those from fruit) allows the brain to make new serotonin. Eliminating carbohydrates prevents this from occurring. What is the point of prescribing antidepressant medication that works on serotonin and then telling the patient to follow a diet preventing serotonin from being made? Moreover, increasing serotonin increases satiety and helps turn off the excessive appetite turned on by the medications.

Perhaps the solution to the media silence about weight gain and antidepressants is telling the audience, i.e. the aunt Josephines and cousin Shirleys, about the problem. Our relatives don't have difficulty understanding the connection between prednisone and weight gain, and they shouldn't have a problem with accepting the connection between medications that affect brain chemistry and weight gain. Perhaps when all our relatives recognize the connection between antidepressants and obesity, those people committed to solving the problem of obesity will too.

 

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Why do we feel obliged to comment on each other's appearance when we meet after an absence of several months? But since we do, especially when we see family members at holiday gatherings, how do we ha...
Why do we feel obliged to comment on each other's appearance when we meet after an absence of several months? But since we do, especially when we see family members at holiday gatherings, how do we ha...
 
 
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10:53 PM on 12/08/2010
The revelation that many drugs cause obesity, particularly antidepresants is news to many.Antidepressants are mood altering medications that have effects on the brain . If you were to look at the chemistry of antidepressants and where they work at(i.e, Prozac) we see they work at the same places that some appetite suppresants work at. Both being serotonin effectors. It is up to drug company Internal Review Boards(IRBs)to submit all the data from a new product in all phases of development. But, this area is facing scrutiny and we are seeing approved drugs that are often recalled.This paradox is becoming more often seen with missed or unreported side effects getting through the process.But, why are synthetic(artificial) products even sought after for either depression or weight loss automatically when organic alternatives that have been peer reviewed exist.St. John's Wort has been looked at as a viable alternative to treat certain types of depression .Organic appetite suppresants such as Hoodia(whose patent was sought after by drug companies) works in the brain without the negative effects. Garcinia(Hydroxycitrate/HCA) is another product that may be compatible with someone on an antidepressant to combat the problems with satiety threshold. If numerous antidepressants work on serotonin receptors in the brain(SRI/SSRIs), then to reduce some pharmacologic competitive inhibition or reducing the others effect, maybe more studies in seeking compatible organic, natural, herbal, and botanical will need to be done. The paradigm not only shifts but becomes wholistic or complementary.
04:50 PM on 12/07/2010
An article that's long overdue. Because there is still a stigma attached to mental health issues, many people are reluctant (and rightly so) to discuss weight gain associated with antidepressants. Whenever I see a woman who has gained a noticeable amount of weight in a short time, I automaically assume that she's either taking antidepressant or other weight-gain meds or she's menopausal (if she's of a 'certain age"). And the reasons for weight gain are none of my business unless she volunteers the info. Maybe this issue needs to be discussed on the Oprah Winfrey show - Ms. Wurtman, you should try to get on her show to promote your book and discuss this issue in a sympathetic venue.
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03:40 AM on 12/06/2010
Thank you for this article! I just recently lost almost all the weight I gained from a medication I was taking it for sleep issues, and it was not a health professional that told me about the side affect. It was pure coincidence someone I knew knew someone that was taking it to gain weight! I am not much of a big eater, and all of a sudden I could not stop being extremely hungry, no matter how much I ate. Not only did it cause me to gain weight, but it through so much of my health off, including my thyroid, which can cause depression and tiredness, which just makes the problem worse. It is going to take me a few more months to get back to 100% of what I was before just because I took the meds for a few months!
12:21 AM on 12/06/2010
This is way more than a media issue. Either the Pharmaprofiteers must invent an effective weight loss med that isn't going to cause your heart to stop (which they only "discover" after they've made a pile of profit off of it--cf phenfen and Meridia), or regulators must consider weight gain a contraindication for the efficacy of an antidepressant. The FDA should refuse to approve new antidepressants and remove from the market current ones that cause significant weight gain in more than a small number of patients. And it's time physicians consider--and disclose--this side effect when prescribing, especially to women, and work harder to tailor alternatives for relief of depression are not counterproductive. If obesity is, as so loudly touted these days, America's most threatening "disease," then regulators and health professionals need to deem it an unacceptable side effect. We patients must insist on safe depression and weight loss meds from the pharmaceutical industry--that includes ones that don't increase a patient's weight. And we must complain when efficacious meds are pulled from the market because a handful (literally a few dozen) patients with certain preexisting conditions had negative side effects. Pharma needs initially to test more rigorously and relabel and re-educate when such information becomes known, and docs need to test patients for such conditions before prescribing.
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soisay
Angry? Scared? Thank a Republican.
09:44 PM on 12/07/2010
Whoa there magee. Weight gain is monitored by the doctor or psycho-pharmacologist during regular periodic office appointments during prescription refills. What makes weight gain a "side effect" is that it does not occur in all patients. However, neither do the positive results occur for all patients.

I dislike Big Pharma and their business model as much as anyone, but medicines (especially mood stabilizers and anti-depressants) do not appear out of thin air. Withholding any of them from market, without a significant direct health impact (stroke, heart, blood, etc), is not the solution.
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midwesthousewife
12:13 AM on 12/06/2010
I was on a couple of anti-seizure/antidepressant meds for a while, one of which (depakote) made me sock on 15 pounds in a few months. After a few years, I started having regular acupuncture treatments for a physical ailment. I noticed that after my acupuncture treatments, I couldn't wipe the smile from my face. That effect lasted for a longer and longer time after each treatment. I finally up and quit my antidepressant, and have been fine for six years. Acupuncture may not work for everyone but most people feel a little "high" after a treatment. And no need to worry about drug side effects.
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John Heckers
Think of it as evolution in action!
10:37 PM on 12/05/2010
There are many causes for being a larger American, many of them out of the control of the individual experiencing the weight gain. But larger Americans face continual harassment and ridicule from the media and from the ignorant. Size bigotry is the last perfectly safe bigotry. Until it is addressed, millions of Americans who eat reasonably and even exercise strenuously (like me) will be subject to the prejudices of the medical profession and other ignorant fools.
09:28 PM on 12/05/2010
Blindly prescribe antidepres¬sants are a big problem. I once worked at a company and every woman there had been prescribed an antidepressant, including myself. I stopped taking them when I thought it would be a great idea to commit suicide. I remember walking around my apartment saying good bye to my things when the doorbell rang. It was a friend.
Besides gaining weight, the people I worked with became crazy. I had never thought of them as crazy before. I feel it was these medications exacerbates the problem.
And what is the correct amount of serotonin. No one knows.
Also these medications where supposed to be taken for a few months. But most people have been on them for years.
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Eva fate
08:28 PM on 12/05/2010
Thank you for this post. I consider depakote to have RUINED my life. I was a kid when I was put on it and was on it for 9 years. i had to take pills for my thyroid at one point, went on diets and still lost no weight. i spent high school a miserable 300 pound girl. and no one EVER told me that depakote had an effect on my metabolism or that switching to another medication might help. They let me rack up expensive visits to dieticians, let me hate myself and my body, and even start showing signs of an eating disorder instead. I had balanced seratonin, but I wasn't happy. I hated my body and I hated myself because I thought it was my fault.

I don't take psych meds anymore. instead I choose to exercise self control and other self-talk/talk-therapy methods instead. I can't believe that medical professionals believe having a bit more stable moods is worth the health risks associated with obesity and those associated with constantly taking medication of that type (liver problems, seizures if you go off it quickly, etc.) It wasn't worth it to me, but I wasn't given the information to make an informed choice.
05:57 PM on 12/05/2010
I was an average-weight teenager before I was put on the anti-depressant Remeron at 15. After being on that medication, along with trying a few others to stabilize me, I ended up gaining 65 pounds. Now at 22, I have since found the combination that works best for my bipolar disorder, but the consequences of being happy and stable are weight gain, more so now than when I was 15. I am the biggest I've ever been, but I definitely think it was worth it because being medication-free just isn't an option for me currently. I want to thank you for your article and I will definitely look into reading your book.
03:18 PM on 12/09/2010
Remeron is actually often used as an appetite stimulant (I use if often with my elderly patients when they need to eat more) and I'm baffled as to why your prescriber didn't consider/realize that. Not fun. :-(
05:49 PM on 12/05/2010
Thank you, thank you, THANK you, Judith J. Wurtman.
I've been struggling with this issue for nearly 10 years. I gained 50 pounds in the first year of taking antidepressant and anti-anxiety meds and I still haven't been able to lose the weight. I also have a physical disability which precludes most exercise (other than swimming) but it's the weight gained as a side effect of the meds that frustrates me most because many of the people in my life just don't understand the issue. It's very real, very frustrating, and rarely discussed in the media or by health care providers (at least mine).
So thank you for giving me a much needed resource to help explain the issue to the people in my life who don't understand.
05:23 PM on 12/05/2010
Maybe the author could discuss the alternatives to changing one's neurotrasmitter levels without the use of pharmacuetical antiedpressants that cause weight gain.

Precursors to neurotransmitters, certain Amino Acids, cannot be patented since they are naturally occuring. From personal experience, they are one of the best ways to increase Seratonin and Dopamine without all of the nasty side effects.

Unfortunately, Big Pharma can't cash in on this method and doesn't want you to know about it..How many doctors do you know who blindly prescribe antidepressants without taking the time to actually TEST your neurotransmitter levels first? This test is easy and cheap, yet so overlooked. So, essentially doctors are playing a guessing game based on a patient's symptoms.

As for using carbohydrates to raise seratonon levels, this is so difficult to do correctly because the ingestion of fat and protein can throw off your end goal. If you want to lose weight yet are too depressed to exercise, start off eating healthly unprocessed foods with good fats and lean protein. Then get your neurotransmitter levels tested to determine what amino acids to take or avoid depending on your VERY specific brain chemistry. An added bonus, you don't have to take these forever. My Amino Acid therapy lasted two months and I recommend it to everyone who is considering the dangerous road of antidepressants. If it doesn't work for you, there is a pharmacy that will gladly take your cash to make you feel happy.
09:52 AM on 12/08/2010
You are right to say that it may be hard to raise serotonin levels by eating carbohydrates because we tend to choose the wrong foods. That is why I wrote the Serotonin Power Diet. The diet plan which will raise serotonin levels is based on about 30 years of research and if the food guidelines are followed, serotonin levels should increase.

I am puzzled by your ability to have your neurotransmitter levels measured since there is really no non-invasive ( going into the brain) way of doing this. Neurotransmitter levels in the blood don't tell you anything about what is going on in the brain. It would be wonderful if we could have a way of measuring neurotransmitters in the brain, but that is not possible now and anyway who claims to be doing so should prove it by producing research that he or she has done and published. This is why doctors don't test your neurotransmitter levels. The levels won't tell you anything.
08:53 PM on 12/08/2010
My physician uses NeuroScience tests. NeuroScience Inc. offers neurological, endocrinological, and immunological laboratory services perfomed by Pharmasan Labs, Inc. - a CLIA-certified independent reference laboratory that also holds licensure from the New York State Department of Health.

Below is some information from their website.

https://www.neurorelief.com/index.php?option=com_content&task=section&id=9&Itemid=51

The test that I took was a urine test. I was not to eat/drink anything, and collect the secord urination of the day. My results were textbook to my symptomology. They had no idea what my symptoms were other than anxiety. I wrote the code in myself. The results speak for themselves in my case. This has been the only test and treatment protocol to offer any help and I have tried just about everything. My doctor is from Europe and helps people from all over the world.
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04:08 PM on 12/05/2010
Isn't it counter-productive to take an anti-depressant which makes you gain weight?
04:22 PM on 12/05/2010
When you're intensely, despairingly depressed, weight gain is a possibility that to many people is a better choice than the "inevitable."
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Xochitl666
04:49 PM on 12/05/2010
Weight-gain just make you more depressed.
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05:17 PM on 12/05/2010
Hi Xoch, I don't disagree, but as someone on anti-depressants who has indeed been gaining weight, I am just saying that some of us aren't more depressed by that, we actually feel better. And I for one have been exercising more and eating better since I started feeling better, so I'm hoping this is temporary.

I'm not everyone, and I don't encourage the use of anti-depressants. For me it took many years of pain and denial *before* getting to this place, and seeking help, not the other way around. It is a deeply personal choice.
04:02 PM on 12/05/2010
Somehow the idea of bringing up my depression with my family this happy holiday season isn't any more encouraging that the idea of bringing up my weight gain. In fact I'd MUCH rather have Aunt Josephine talking about how fat I am than how psychotic. There's so much more to work with in the latter. NO thank you.
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