MEDS THAT (OFTEN) LEAD TO WEIGHT GAIN- PART 2

5. PSYCHIATRIC MEDICATION

Psychiatric and mood-related medications can generally be divided into 3 categories: Antidepressants, Antipsychotics and Mood Stabilizers…



ANTIDEPRESSANTS OVERVIEW

Antidepressants can further be broken down into sub-categories, the number of which depends on who’s doing the organizing. I’ve listed 5 sub-categories of antidepressant medications, including…

1. TCAs: Tricyclic Antidepressants. See below for specific drugs from this class of medications.

2. MAOIs: Monoamine Oxidase Inhibitors. Drugs here include phenelzine (active ingredient in Nardil), selegiline (active ingredient in Emsam) and tranylcypromine (brand name Parnate). MAOIs, along with TCAs, were released in the 1950s and were the first pharmaceutical medications designed for treating mood disorders. MAOIs are still available but have largely fallen out of favor, in part due to some potentially lethal dietary and drug interactions associated with their use.

3. SSRIs: Selective Serotonin Reuptake Inhibitors. See below for specific drugs from this class of meds. Used clinically since the 1970s, these drugs came to dominate the antidepressant medication market by the late 1980s. SSRIs are the most commonly prescribed class of antidepressant medication in the U.S.

4. SNRIs: Serotonin & Norepinephrine Reuptake Inhibitors. Drugs here include duloxetine (Cymbalta) and venlafaxine (Effexor). SNRIs first became commercially available in the mid 1990s.

5. Atypical or Miscellaneous Antidepressants: This group includes…


* NDRIs: Norepinephrine and Dopamine Reuptake Inhibitors. Only one drug in this class- bupropion (Welbutrin; more information below).


* NRIs: Norepinephrine Reuptake Inhibitor. Drugs here include teniloxazine (Lucelan) and viloxazine (Vivalan).

* SARIs: Serotonin Antagonist and Reuptake Inhibitors. Drugs here include trazedone (brand name Desyrel).

* SMSs: Serotonin Modulator and Stimulator. Drugs here include vilazodone (Viibryd) and vortioxetine (Trintellix).

* TeCAs: Tetracyclic Antidepressants. Drugs here include mirtazapine (Remeron, which I discuss more below) as well as a handful of others.


As far as drug-induced weight gain in concerned, the primary culprits here tend to be from the TCA and SSRI classes, along with a few atypical antidepressants.


TCA ANTIDEPRESSANTS & WEIGHT GAIN

Of all the antidepressants on the U.S. market, TCAs tend to cause the most weight gain (from 4-8lbs per month, on average). This is likely due, at least in part, to their antihistamine effects, which can boost appetite leading to weight gain. Some of the primary culprits include amitriptyline (brand name Elavil, Endep, Vanatrip). A 2006 study found that 30% of people taking amitriptyline gained more than 5% of their body weight in 6 months (ex. a 200lb person would gain >10lbs in 6 months). Another potentially serious side effect- one overdose of amitriptyline can cause significant heart damage. Other TCAs that are likely to cause weight gain include doxepin (Adapin, Dilenor, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor), trimipramine (Surmontil), clomipramine and desipramine.



SSRI ANTIDEPRESSANTS & WEIGHT GAIN

While generally not as likely to cause weight gain as TCAs (and not nearly to the degree), certain SSRIs have been known to cause moderate weight gain, in part through increased cravings for carbohydrates as reported by users. Most research implicates paroxetine (Paxil) as being the primary culprit. Those SSRIs which carry somewhat lower risk of medication-induced weight gain include sertraline (Zoloft), fluvoxamine (Luvox) and citalopram. Many of those prescribed fluoxetine (Prozac) report weight loss during the first 6 months of use, and then the weight gradually coming back with continued use.


ATYPICAL ANTIDEPRESSANTS & WEIGHT GAIN

The tetracyclic antidepressant mirtazapine (Remeron) is also known to contribute to weight gain, in part due to its antihistamine effects (which generally boost appetite). Remeron is actually sometimes given to underweight elderly individuals in order to increase their weight. And lastly, the NDRI bupropion (Wellbutrin) may cause the least amount of weight gain of all the medications mentioned thus far.


ANTIPSYCHOTICS OVERVIEW

Sometimes called neuroleptics or major tranquilizers, antipsychotic medication is generally prescribed in an attempt to treat issues like bipolar disorder, schizophrenia, severe anxiety and severe depression (among other conditions). Like antidepressants, the number of drugs classes of antipsychotics generally depends on who is doing the organizing. I recognize 7 classes of antipsychotics, listed here in alphabetical order…

1. Benzamides: Includes drugs like sultopride.


2. Benzisoxazoles/benzisothiazoles: Includes drugs like risperidone (more on this drug below), along with a handful of others.

3. Butyrophenones: Includes drugs like haloperidol (more on this drug below).

4. Diphenylbutylpiperidines: Includes drugs like pimozide.

5. Phenothiazines: A dozen or so drugs from this class are available in the U.S., including chlorpromazine (more on this drug below).

6. Thioxanthenes: Includes drugs like clopenthixol and thiothixene.

7. Tricyclics: A handful of different drugs from this class available in the United States. This type of antipsychotic generally carries the greatest risk of causing drug-induced weight gain. Some of the most common culprits include clozapine and olanzapine (and to a lesser degree, quetiapine).


ANTIPSYCHOTICS & WEIGHT GAIN

Concerning antipsychotics and drug-induced weight gain, two of the chief offenders are the tricyclic medications olanzapine (brand name Zyprexa) and clozapine (Clozaril). A 2005 study found that 30% of olanzapine users gained 7% or more of their body weight within the first 18 months of treatment (that translates to 14 or more pounds for a 200lbs person). Another study found that clozapine users regularly report weight gains of 7-10% of their bodyweight with long-term use (14-20 pound weight gain for a 200lbs person). Another tricyclic, quetiapine (Seroquel) may also contribute to weight gain, but more rarely and not to the extent of olanzapine and clozapine. The weight gain caused by tricyclic antipsychotics is thought to be due, at least in part, to the potent antihistamine and serotonin-inhibiting effects, both of which are linked to increases in body weight.


Other antipsychotics that are linked to weight gain include the benzisoxazole class drug risperidone (brand name Risperdal), the butyrophenone class drug haloperidol, and the phenothiazine class drug chlorpromazine (Thorazine). Like quetiapine, these drugs generally produce more modest weight gain when compared to the tricyclic’s olanzapine and clozapine, the chief offenders in the antipsychotic category.


Many of the antipsychotics listed above have been shown to impair blood sugar control, leading to increased insulin resistance and impaired glucose tolerance, both of which are risk factors for type 2 diabetes.


MOOD STABILIZERS OVERVIEW & WEIGHT GAIN

Drug commonly prescribed for mood and mental health-related conditions that don’t fall cleanly into the antidepressant and antipsychotic categories are often grouped into a 3rd category called mood stabilizers. These drugs are generally prescribed in an attempt to treat conditions like bipolar disorder (types 1 & 2), borderline personality disorder (BPD) and schizophrenia. Some experts claim that the only drug that falls cleanly into this category is lithium (brand names Camcolit, Liskonum, Priadel, Lithonate, Litarex, Lithobid, etc.). Lithium is actually a trace mineral found in very small amounts in the human body. Despite it being “natural” and generally well tolerated, long term lithium use (especially in higher doses) has been associated with notable weight gain (up to 20lbs over the course of 5-10 years of use).


Other mood stabilizers that have been linked to weight gain include valproate (i.e. valproic acid, brand name Depakote), which is actually an anti-seizure drug (also known as anticonvulsants or antiepileptics). A 2007 study found that 44% of women and 24% of men gained 11lbs or more while taking Depakote for about a year.



OTHER SIDE EFFECTS OF PSYCHIATRIC MEDS (NOT INCLUDING WEIGHT GAIN)

The following is a quote from an article in the journal World Psychiatry, June 2015 edition, lead author Dr. Christoph U. Correll MD, on the effects of psychiatric medications (additions in parentheses are mine)...


"Antipsychotics, and to a more restricted degree antidepressants and mood stabilizers, are associated with an increased risk for several physical diseases, including obesity, dyslipidemia (out of balance blood lipid profile), diabetes, thyroid disorders, hyponatremia (low blood sodium), cardiovascular, respiratory tract, gastrointestinal, hematological (blood-related), musculoskeletal and renal diseases, as well as movement and seizure disorders. Higher dosages, polypharmacy (the use of multiple drugs to treat a conditions) and treatment of vulnerable (old or young) individuals are associated with greater risk." [16]


While a coverage of the multifactorial nature of many psychiatric conditions (as well as a smart holistic, personalized, evidence-based approach to treatment) is well outside the scope of this article, I hope the reader can see some of the risks associated with the use of certain psychiatric medications and consider all treatment options before embarking on a path of treatment. [1-7]


“You keep him in perfect peace whose mind is stayed on You, because he trusts in You.” ~Isaiah 26:3 ESV


“Do not be anxious about anything, but in everything, by prayer and supplication, with thanksgiving, let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and minds in Christ Jesus.”

~Phil. 4:6-7 ESV


6. SEIZURE MEDICATIONS

(ANTI-CONVULSANTS/ANTI-EPILEPTICS)

Some antiepileptic drugs (AEDs) are known to promote significant weight gain, while others are generally weight neutral, and still others may actually cause weight loss in some people. Those that are known to cause drug-induced weight gain include valproic acid (i.e. valproate, brand name Depakote), carbamazepine (Carbatrol, Epitol, Equestro, Tegretol) and gabapentin (Horizant, Neurontin). Long-term users of valproic acid have been known to gain up to 30-45lbs on the drug, and long-term users of carbamazepine and gabapentin have been known to gain up to 30lbs. Other AEDs that are linked with causing weight gain include pregabalin and vigabatrin.



As with many of the drugs discussed in this article, researchers believe it’s the inhibiting action on the histamine receptors in the brain that makes the AEDs mentioned above more likely to cause weight gain. AEDs that seem to be more weight-neutral include levetiracetam, phenytoin and lamotrigine. AEDs that may actually cause weight loss include topiramate (Topamax, Qudexy), zonisamide and felbarnate. [1-7, 17-18]


7. STEROIDS (CORTICOSTEROIDS)

Corticosteroids are natural hormones produced by the body- specifically, the adrenal cortex. The two main classes of corticosteroids are glucocorticoids (ex. cortisol) and mineralocorticoids (ex. aldosterone). These hormones are involved in a wide range of physiological processes, including immune response, inflammation regulation, carbohydrate metabolism and regulation of electrolyte levels in the blood (including potassium and sodium).

Synthetic, pharmaceutically-produced versions of corticosteroids were first produced in the late 1940s and subsequently introduced to the U.S. market in the 1950s. Since that time these drugs have been used in an attempt to treat a variety of conditions, including respiratory (asthma, COPD, Hives, some types of pneumonia), dermatological (contact dermatitis), endocrinological (Addison’s disease, adrenal insufficiency), digestive (colitis, Crohn’s), hematological (lymphoma, leukemia, multiple myeloma), rheumatological (rheumatoid arthritis, lupus), and other conditions like prostate cancer and MS.


While corticosteroids can have some powerful, seemingly positive immediate effects on a variety of aversive symptoms, they also carry a substantial risk of producing serious side effects, especially at higher doses (or if taken long-term). As has been the case with many new pharmaceuticals since, over-exuberance (and over-prescription) of corticosteroids in the 1950s and 60s led to widespread reports of serious adverse events stemming from the drugs. The reputation for corticosteroids was so bad that the next class of pharmaceuticals to hit the scene, non-steroidal anti-inflammatory drugs or NSAIDs (introduced in the 1960s), were so named, at least in part, to disassociate them from synthetic cortico-steroids.



Synthetic corticosteroids can be categorized a number of ways, one of which is by route of administration, which includes…

ORAL CORTICOSTEROIDS

Includes drugs like prednisone, cortisone and hydrocortisone.


INHALED CORTICOSTEROIDS

Includes corticosteroids like beclomethasone (brand name Qvar), budesonide (Pulmicort), flucticasone (Flovent), mometasone (Asmanex), ciclesonide (Alvesco) and combination drugs that also include a bronchodilator like Symbicort, Advair, and Dulera.

TOPICAL CORTICOSTEROIDS

In the U.S. these are divided into 7 classes, based on potency (7 being least potent, 1 being most potent). Some examples include…

· low concentration hydrocortisone (class 7)

· relatively low concentration fluocinolone acetonide and desonide (both class 6)

· moderately low concentration prednicarbate and flurandrenolide (both class 5)

· moderate concentration desoximetasone (class 4)

· moderately high concentration betamethasone valerate (class 3)

· relatively high concentration halcinonide and mometasone furoate (class 2)

· high concentration clobetasol propionate (class 1)

INJECTABLE CORTICOSTEROIDS

Includes methylprednisolone acetate, triamcinolone acetonide, betamethasone acetate and dexamethasone sodium phosphate.


As far as drug-induced weight gain is concerned, the primary culprits seem to be oral corticosteroids including prednisone (Deltasone), methylprednisone (Medrol Dosepak), cortisone (Sterapred), hydrocortisone and triamcinolone (Kenalog), especially with higher dose and/or longer-term use. A 2006 survey of long-term oral corticosteroid users found that 60-80% had gained weight, a finding that’s been corroborated by other researchers and medical providers. Inhaled corticosteroids like budesonide (Pulmicort), ciclesonide (Alvesco), and fluticasone (Flovent) have also been implicated by some researchers as causing weight gain in users. Additionally, user of corticosteroids tend to contribute to insomnia, increased appetite and water retention, all of which contribute to weight gain. [1-7, 19-21]


OTHER DRUGS CONTRIBUTING TO WEIGHT GAIN

Several other medications have been tied to weight gain, perhaps most notably medications used to treat migraines. Migraine medications are generally drugs from other categories, including blood pressure meds like beta blockers, psychiatric medications like tricyclic antidepressants (TCAs) and SSRIs (including Paxil, Prozac and Zoloft) and anti-seizure drugs like Depakote, all of which have been linked to weight gain in users (as I’ve covered in the material above). [1-7]


SOURCES

1 www.obesityaction.org/educational-resources/resource-articles-2/general-articles/prescription-medications-weight-gain

2 www.drugs.com/article/weight-gain.html

3 http://medicalassessmentonline.com/terms.php?R=238&L=W

4 www.health.com/health/gallery/0,,20545602,00.html/view-all

5 www.prevention.com/weight-loss/6-medications-that-cause-weight-gain-and-how-you-can-fight-back/slide/5

6 www.doctoroz.com/article/medications-may-cause-weight-gain

7 www.builtlean.com/2013/06/24/drugs-weight-gain/

8 www.womenshealthmag.com/health/allergy-side-effects

9 http://sitn.hms.harvard.edu/flash/2008/issue40/

10 www.mayoclinic.org/drugs-supplements/progestin-oral-route-parenteral-route-vaginal-route/side-effects/drg-20069443

11 www.askdrhelen.com/bioidentical/medicalarchive/natural_progesterone_better.html

12 www.drlam.com/blog/serious-progesterone-side-effects-and-brittle-adrenals-part-1/30858/

13 https://articles.mercola.com/sites/articles/archive/2008/07/10/8-drugs-doctors-would-never-take.aspx

14 www.healthline.com/health/metformin-oral-tablet#important-warnings

15 www.mdedge.com/jfponline/article/116575/obesity/drug-induced-weight-gain-rethinking-our-choices/page/0/1

16 www.ncbi.nlm.nih.gov/pmc/articles/PMC4471960/

17 www.ncbi.nlm.nih.gov/pubmed/16234878

18 www.ncbi.nlm.nih.gov/pubmed/18047602

19 www.yourhormones.info/glands/adrenal-glands/

20 www.psoriasis.org/about-psoriasis/treatments/topicals/steroids/potency-chart

21 https://pubs.rsna.org/doi/full/10.1148/radiol.2523081929