Nutrient Deficiencies And Depression
Theres other evidence that nutrient deficiencies can lead to chronic depression. Lower levels of omega-3 fatty acids, B vitamins, zinc, magnesium, and vitamin D are all linked to lower levels of brain function and can contribute to depression.
You can test your nutrient levels with a functional medicine or naturopathic doctor. If you want to avoid prescription drugs, youll have to get to the root cause of the issue.
How To Avoid Weight Gain When Taking Antidepressant Medication
With Sean Wharton, MD, PharmD, Michael McGee, MD, and J. Michael Gonzalez-Campoy, MD, PhD
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Are you among the nearly one in eight adults in the United States) who should be or is already taking an antidepressant to address a mood disorder,1 or an antipsychotic medication for other mental health conditions such as obsessive compulsive disorder or bipolar disorderbut your hesitate out of worry about gaining weight?
Taking an antidepressant or antipsychotic medication often produces the added worry of possible weight gain but starting a formal weight loss program can prevent it. Photo: 123rf
While these medications are very effective, they often come with a major downside for many patientsundesirable and often significant weight gain.2 For anyone who may benefit from a psychiatric drug but fears the prospect of obesity and its related complications, there is now a good answer.
As simple as it may sound, the best chance of avoiding, or lessening further, undesirable weight gain when taking a prescribed antidepressant or antipsychotic medication, is to simultaneously participate in a formal weight management program. This is true regardless of the psych medication you are taking,2 according to the experience of patients who were treated at the Wharton Medical Clinics in Toronto, Canada.
How Can I Lose Weight While On Antidepressants
Losing weight is often a struggle, especially when a person is also living with a mood disorder. The causes are multiple. Increased appetite and carbohydrate craving, along with reduced activity level, are common symptoms of depression. And yes, certain antidepressants and other medications may increase appetite. However, most medications do not alter metabolism, per se. Thus, weight loss can still occur when attention is given to other factors, including the composition and timing of dietary intake.
Eating more frequently and smaller amounts, increasing the relative amount of protein eaten , reducing breads and starches, eating a healthful breakfast, and avoiding large meals or snacks late in the evening can provide a more balanced diet throughout the entire day.
If one believes their current efforts to lose weight should be more productive, a consultation with a nutritionist may be helpful. If that isnt possible, keeping a written log of ones consumption may provide clues to problem areas and reinforce better dietary habits. In particular, check out the nutritional content of commonly eaten foods and foods believed to be healthy.
Chronic, low-grade sleep deprivation is another contributor to obesity. Skipping sleep leads to persistently elevated levels of the bodys stress hormone, which can cause elevated blood sugar levels and increased fat stores. Staying up late may also make one more prone to late night snacking.
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Seek The Help You Need
If you are feeling anxious or depressed, its important to seek out the help you need. Speak with your healthcare provider or a mental health professional to figure out whether antidepressants, therapy, or a combination thereof are right for you. If you are concerned about weight gain or weight loss on antidepressants, be sure to discuss that with your healthcare provider as well. Together, you can determine a treatment approach thats best for you.
How To Avoid Weight Gain On Psych Meds
Asking for a referral to a qualified weight loss program in your area is a good idea, says Dr. McGee. What else?
- Focus on what and how you eat
- Don’t eat for gratification, boredom, or self-soothing or overeat to punish yourself
- Discuss whether weight loss medicines, in addition to the structured weight loss program, may be appropriate, at least to start.
According to Dr. Gonzalez-Campoy, ”along with a prescription for antipsychotic medications and most antidepressants, a concomitant prescription for weight management should be provided .”
And for those on antipsychotics, you should be made aware of the health risks that come with significant weight gain such as the development or worsening of high blood sugar, high blood pressure, and high cholesterol, he says. These are medical issues that should be monitored as well, he says.
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Types Of Antidepressants That Could Cause Weight Gain
Dr. Singh explained that some antidepressant medications are more likely to lead to weight gain than others, including:
Selective Serotonin Reuptake Inhibitors
Brand names include: Celexa, Lexapro, Prozac, Zoloft, and Paxil
Risk of weight gain: With this type of medication, usually there is a drop in weight early, but long-term, those on SSRIs have experienced mild weight gain. Amongst these medications, Dr. Singh said those that contain paroxetine usually cause the most amount of weight gain.
Selective-norepinephrine Reuptake Inhibitors
Brand names include: Cymbalta and Effexor
Risk for weight gain: Among the SNRIs used to treat depression, people usually experience transient weight loss and dont see much weight gain.
Tricyclic Antidepressants
Brand names include: Pamelor, Elavil, and Vivactil
Risk of weight gain: TCAs are some of the earliest forms of antidepressants and arent as commonly prescribed today because they can cause more side effects, including weight gain.
Atypical Antidepressant Mirtazapine
Risk of weight gain: This drug has been linked to both increased appetite and weight gain. Most often we use this side effect to our advantage with patients who have stopped eating, Dr. Singh said.
What Does Antidepressant Medications Do
Antidepressant medications increase the activity of chemicals called neurotransmitters in the brain. Increasing the activity of the neurotransmitters serotonin, norepinephrine and dopamine seems to help lessen the symptoms of depression and anxiety. However, the brain is a very complex organ and the reasons why these drugs work are not yet fully understood.
We do know that these drugs help to relieve symptoms of depression and anxiety in up to 70 per cent of people who try them. This rate is even higher when people who dont get relief with one type of antidepressant try a second type.
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Weight Management Tips For People With Depression
Are you up or down? It’s not just your mood, but also your weight that can be affected by depression. These tips can help you regain balance.
Which comes first, obesity or depression? Just like the chicken or the egg scenario, the underlying problem with depression and weight gain can be hard to tell. Symptoms of depression and weight management issues are linked, and the relationship is a two-way street. In fact, a study done in the Netherlands found that obesity increases the risk for depression in initially non-depressed people by 55 percent, and depression increases the risk for obesity in initially normal-weight people by 58 percent.
Why are depression and weight issues so intertwined? The part of the brain responsible for emotion the limbic system also controls appetite, explains Joseph Hullett, MD, senior medical director of clinical strategy for OptumHealth Behavioral Solutions in Golden Valley, Minn. When this emotional part of the brain gets disturbed in someone who is depressed, appetite gets disturbed as well.
In addition, some of the medications used to treat depression can have weight-related side effects, either causing weight loss or weight gain.
Depression and Weight Gain Versus Weight Loss
When depression sets in, the appetite control center of the brain can get thrown off in either direction. Some people have a problem with depression and weight gain, and other people have a problem with depression and weight loss, Dr. Hullett says.
Weight Gain Can Cause Added Worry With Psych Meds
You are not alone in gaining benefit from psychiatric medicationand you arent the only one who stresses about the weight gain linked with many of the drugs. As such, this challenge inspired Ms. Christensen to test for a solution that would address this vexing problem. She tells EndocrineWeb that concern about weight gain is both a real and almost universal experience among the patients in her clinic that are prescribed psychiatric medications.2
“The fear of weight gain is sometimes so powerful that people will stop taking their medication,” says Dr. Wharton who is the senior investigator of the study that shows that participating in an organized, medical weight loss programs work.
As if to confirm how common this conundrum is, Michael McGee, MD, chief medical officer at The Haven at Pismo, an addiction treatment center near San Luis Obispo in California, says that he frequently hears about the anxiety linked with medication-related weight gain.
“My patients fear and complain about weight gain, particularly the women, who often do gain weight, but it is not a given,” he tells EndocrineWeb. With years of practice, Dr. McGee has seen many patients who have experienced weight gain, increasing about five to 10% of their starting weight. That means, for example, a 150-pound woman would be facing up to a 15-pound gain in body weight.
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Managing Your Weight While Taking Ssris
If you’ve gained weight while taking antidepressants and it really bothers you, you may be tempted to stop taking your medication. But before you do, talk to a doctor. In all likelihood, you can get to a weight you’re comfortable with without sacrificing your mental health.
It can also be dangerous to just stop taking an antidepressant. With many of them, stopping all of a sudden, or quitting “cold turkey,” can lead to an array of unpleasant withdrawal side effects known collectively as discontinuation syndrome.
Here are other things you can do to manage your weight, improve your health, and help you have a healthy relationship with food and eating.
When To See A Doctor
If you are concerned about or are experiencing significant weight changes while taking an antidepressant, you may want to talk with your healthcare provider. A doctor may be able to change your medication, alter your dose, refer you to a nutritionist, recommend lifestyle changes, or help address any questions or concerns you have about your medications.
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Important Safety Information For Bupropion Sustained
Warning: Suicidal Thoughts and Behaviors
Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. In short-term studies, antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults under age 24. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24 there was a reduction in risk in patients 65 and older.
Patients of all ages being treated with antidepressants should be observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially early during antidepressant treatment and when the dose is adjusted up or down. Families and caregivers of patients should look for the emergence of symptoms on a day-to-day basis, since changes may be abrupt.
How Should I Take Bupropion Sr
You can take bupropion SR with or without food. The tablet should be swallowed whole and not crushed, split, or chewed.
You should take bupropion SR exactly as prescribed, and continue to take bupropion SR as prescribed even after your symptoms improve. You should not change your dosing regimen or stop taking bupropion SR without discussing with your provider first. A gradual reduction in dosage rather than abruptly stopping is recommended whenever possible.
If your symptoms are not improving or you have any questions about changing or stopping medication, reach out to your Ro-affiliated provider for guidance.
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Tips To Avoid The Extra Pounds
What Should I Tell My Ro
- Bupropion SR contains the active ingredient bupropion. It is the same active ingredient that is found in medications called Wellbutrin, Wellbutrin SR, Wellbutrin XL, Aplenzin, Zyban, or Forfivo XL. Tell your provider if you are taking one of these medications.
- Bupropion SR has many drug interactions. Its important to tell your Ro-affiliated provider all of the medications you are currently taking, including prescription, over-the-counter medications, vitamins, and herbal and dietary supplements. Some medications to watch out for include:
- Monoamine oxidase inhibitors , including the antibiotic linezolid and intravenous methylene blue
- Antipsychotics, such as risperidone and haloperidol
- Other antidepressants, including SSRIs and SNRIs
- Theophylline
- Drugs used to treat Parkinsons Disease called levodopa and amantadine
- Digoxin
- Tamoxifen
- Its important to share your entire medical history with your provider. In particular, tell your provider if you have a past history of:
- Suicidal thoughts or attempted suicide
- Bipolar Disorder
- Family history of Bipolar Disorder or family history of suicide
- Seizures
- If you are a smoker and/or youre trying to quit smoking
- Alcohol or opiate abuse
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How To Prevent Weight Loss Due To Antidepressants
When taken as directed, antidepressants can be effective in treating both depression and anxiety.
If you lose an excessive amount of weight after starting an antidepressant, talk to your doctor about the medications benefits and side effects.
If the benefits dont outweigh the weight loss side effects, you can also ask if adjusting the doseor switching medicationsmight be helpful. Discuss the pros and cons with your doctor before making such a decision.
Side Effects Of Antidepressants
The jury is still out on whether or not prescription antidepressants even work. Its not my job whether or not to tell you to take them or not. Prescription drugs, in general, are overprescribed and the number of prescriptions written rise year after year with no sign of stopping.In 2016, doctors doled out 4.4 billion prescription drugs in the U.S., up 1.9% from 2015.
For all the claims of happiness, antidepressants sure come with a lot of risks. Here are just a few of the most common side effects of antidepressants:
- Stomach upset
I think we can do better.
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Matching The Antidepressant To The Clinical Presentation
Antidepressants differ in the specific symptoms that they target, so it is possible to choose an antidepressant according to the patients clinical presentation. It is also possible to use the adverse effects to target specific symptoms. For example, mirtazapine is sedating, so it is an option for patients with significant insomnia. Mirtazapine is also associated with weight gain so it may be useful for major depression accompanied by significant weight loss.6 In short-term trials, the serotonin modulator vortioxetine benefited patients who had major depression with marked cognitive deficits.7
Antidepressants And Weight Gain: What Happens And Why
Although there are a number of theories as to why antidepressants lead to weight gain, Sussman believes that both appetite and metabolism may be affected.
“I have had patients who swear that they are not eating any more, but still gaining weight, so that tells us there is some kind of metabolic influence going on I have also had patients tell me that they are not only more hungry and eating more, but that the medicines are encouraging a carbohydrate craving that is hard to control, so we know appetite also plays a role,” he says.
Fincham says antidepressants may also simply help us to rediscover pleasure in our life — including food.
“It might be a situation where someone feels so much better when taking an antidepressant that lots of things suddenly start feeling more pleasurable to them, and food is just one of them. So in this instance they may actually be overeating and not even realize they are doing so, says Fincham.
Findings from a group of Italian researchers published in the journal Psychotherapy and Psychosomatics suggest that the simple act of recovery from depression may play a role in the weight gain.
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A Drug Combination That Reduces Weight Gain Associated With Antidepressant Therapy
Newer generation antidepressants seem less likely to be associated with cardiovascular side effects and toxicity associated with older generation antidepressants, such as tricyclic antidepressants or monoamine oxidase inhibitors . Currently, newer generation antidepressants include selective serotonin reuptake inhibitors , venlafaxine, duloxetine, nefazodone, mianserin setiptiline, viqualine trazodone, cianopramine, and mirtazapine. Weight gain has been a major concern with certain of the newer antidepressants, particularly, with paroxetine ) and mirtazapine :37-41 Carpenter et al, J. Clin. Psych. 60:45-49 Aronne et al, J. Clin. Psych. 64 :22-29 , both of which are incorporated by reference herein in their entirety). A large proportion of patients treated with paroxetine, mirtazapine, and other antidepressants, such as venlafaxine , gain a significant amount of weight. Most of these patients find it difficult to lose the weight gained as a result of treatment, even after discontinuing use of the particular antidepressant. Weight gain is unacceptable in patients and a major reason for noncompliance with antidepressant therapy Deshmukh et al, Cleveland Clinic J. Med. 70:614-618 . It is believed that potential mechanisms for the observed weight gain include histamine HI receptor antagonism for mirtazapine, and anticholinergic effects in the case of paroxetine.