Johns Hopkins Health Alert
Weight Gain: An Unwelcomed Side Effect of Psychiatric Medications
In recent decades, psychiatric medications have revolutionized the treatment of mood and anxiety disorders, helping millions of people lead more fulfilling lives. Unfortunately, many of these medications are often associated with the unwelcome side effect of weight gain.
Sometimes the weight gain is minimal -- only a few pounds over six months to a year. But all too often, the weight gain is medically significant, with many patients reporting at least a 7 percent increase in body weight. Such increases in body weight can raise the risk of many health conditions, such as high blood pressure, lipid disorders, diabetes, heart disease, arthritis and some types of cancer.
What causes the weight gain? Psychiatric medications do their job by altering levels of brain chemicals that regulate mood. Unfortunately, they also alter levels of brain chemicals that affect appetite, satiety, metabolism and fat storage. After starting treatment, many patients say they feel hungrier than usual or develop intense cravings for high-calorie sweets and other carbohydrates. They also complain that they don't feel full, no matter how much they eat, and that the added weight goes straight to their bellies, buttocks and hips.
Researchers don't fully understand the mechanism by which psychiatric medications cause weight gain. In some cases, it may simply be a consequence of successful treatment; i.e., as patients recover from their illness, they may also recover their appetite. In other cases, however, researchers suspect that the medications -- especially the SSRI (selective serotonin reuptake inhibitor) antidepressants and tricyclics -- may stimulate abnormal appetite by blocking histamine H1 and serotonin 2C receptors in the brain.
Among newly diagnosed patients with a mood disorder or anxiety complaint, weight gain is often a serious concern. Many fear that they'll become fat -- or get fatter -- if they start medical treatment. Consequently, they may decide to forgo treatment that could significantly improve their quality of life and reduce their risk of suicide.
Weight gain is also one of the major reasons why patients prematurely discontinue an otherwise effective treatment, fall back into depression and experience a poor outcome.
If weight gain is a major concern for you, here are some drug options to discuss with your physician: Among antidepressants, bupropion (Wellbutrin) is less likely to cause weight gain than either the SSRIs or tricyclics, and may even be associated with weight loss. Among antipsychotics, ziprasidone (Geodon) and aripiprazole (Abilify) are considered least likely to cause weight gain.
Posted in Depression and Anxiety on November 15, 2011
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