Antidepressant medications, appetite, and weight

http://www.afterthediet.com/antidepressant_medications.htm Sustain Your Body…Sustain The PlanetSM
Products and Services
Join Our Mailing List
Be sure to vo te! No o ne kno ws what's b est fo r yo u b ut YOU.
The prescription drugs listed below are used for many problems other than, including: insomnia, obsessive-compulsive disorder,, and anxiety. It is important to understand why you have been prescribed these medications and to be assertive with yourcaregivers if you feel you are having complications that outweigh the benefits of using them. There may be another medication that offersmore benefits with fewer side effects--before completely stopping the medication, ask about other possibilities.
The comments in the third column are a work in progress. The information included is by no means all-inclusive, but it does provide an idea ofwhat kind of interactions with food and weight have been scientifically observed and recorded in the National L ibrary of M edicine P ubM eddatabase. All references are included below the chart.
We limited studies reported to double-blind designs, which means that neither the subjects nor the researchers knew during the study who wasreceiving the real drug and who was receiving the placebo. This is a research design that helps to reduce bias in reporting results. Weight gainafter starting a medication regime is typically one of two kinds: (1) regain of weight that was lost due to anxiety/depression (this may actuallybe a positive sign of restored health) and (2) weight gained over and above any weight change experienced before the onset ofanxiety/depression (this may be a sign of a negative medication side effect). S imply reporting that weight gain occurs with the use of amedication is not enough. A double-blind design is needed to more accurately evaluate which kind of weight gain a particular medication isprone to cause, and whether or not this is cause for concern.
1. O ur N utritional I mplications of P sychotropic M edications C D summarizes the neurophysiological, hormonal (with emphasis on
diabetic/P CO S potential), and nutritional (weight/appetite) aspects of 58 psychotropic medications in the antidepressant, anxiolytic, mood
stabilizing, antiepileptic, antipsychotic, anti-Parkinson's, Alzheimer's, and psychostimulant categories.
--Which psychiatric medications interfere with fertility --Which psychiatric medications are associated with diabetes and metabolic syndrome --Which medications affect vitamin and mineral metabolism --Off label uses for these medications We surfed thousands of P ub M ed abstracts so you don't have to! 2. N ew! T his I s Your B rain O n P sych D rugs is our brand-new consumer publication that provides an introduction to psychotropic
medications and their nutritional perspective. It provides a summary of the most popularly linked information on our sister blog, presented in
user-friendly language.
3. B ecause this page received so much traffic and because the format in the above resource did not allow for me to write about many important
aspects of psychiatric medications, I started a new blog. Please visit!
4. Krause's F ood & Nutrition T herapy by M ahan and E sco -S tump, 12th E dition, contains more information about nutrition and
mental health. .
This nutritional supplement is quickly gaining credibility as a complementary treatment for mental health issues. for moreinformation on omega-3 fa y acids; for more information on an omega-3 supplement After the Diet has had a part in developing.
If you feel that your weight gain and your depression are related, it is possible that you have metabolic syndrome. In women, this can
manifest as polycystic ovary syndrome. After the Diet is very actively working to educate both medical professionals and women with this
disorder about nutritional options for managing both weight and depression. Please check out our--and if you happen to
live in the P hoenix or L os Angeles areas, please consider a ending our brand-new to learn more.
T HI S C HART L AS T UP DAT E D M AY 26, 2007.
Reduces appetite for sweets (1).
Significantly reduced binge eating episodes (2).
Celexa®
citalopram
Effective in the treatment of binge eating disorder (3, 4).
Meta-analysis suggests weight loss effect (5).
In rats, observed to decrease food intake in the 2 to 8 hour period following
administration (6).
In 1159 subjects, reduced weight by an average of 0.2 kg (7).
Cymbalta®
duloxetine
In a study of 128 individuals, weight modestly increased over a 2 year period (8).
In a study of 1279 patients, average weight gain after a year was 2.4 kg (9).
Useful in the treatment of binge eating disorder (10).
Reduces food intake (11).
Effexor®
venlafaxine
Weight loss has been reported (12).
In rats, observed to decrease food intake in the 2 to 8 hour period following
administration (6).
In a sample of 144 patients treated over a course of 8 weeks, significant weight gain was
observed (13).
Elavil®
amitryptiline
In a systematic review of antidepressants, had the highest incidence of weight gain (14).
Weight gain has been reported (15).
Ludiomil®
maprotiline
In a systematic review of antidepressants, had "intermediate potential" for weight gain
(14).
Weight gain has been reported (16).
Nardil®
phenelzine sulfate
Reduces symptoms of bulimia (17).
No weight gain reported in a 4 week study in individuals with depression (18).
Norpramin®
desipramine
May have therapeutic benefit in reducing symptoms of bulimia (19).
Decreases appetite (20).
Parnate®
tranylcypromine sulfate
Reduces symptoms of bulimia (21).
In a study of 32 elderly patients treated for 8 weeks, those who gained the most weight
were the ones who had lost the most weight prior to using medication. Degree of
weight loss associated with depression was correlated with the severity of depression
(22).
A total of 96 patients with major depressive disorder were given paroxetine and
compared to similar groups on sertraline and fluoxetine. The patients were treated for
26-32 weeks. A significantly greater number of patients receiving paroxetine than those
on the other two drugs gained 7% of their original weight or more during the course of
treatment (23).
In a sample of 144 patients treated over a course of 8 weeks, no significant weight gain
paroxetine hydrochloride
was observed (13).
3% of a sample of approximately 100 subjects lost weight over 8 weeks of treatment
with an average dose averaging 25.5 mg per day (14a).
Less weight gain when compared to mirtazapine in a 6 week study of 123 patients
averaging a dose of 22.9 mg/day (24).
A review of over 1800 research subjects with generalized anxiety disorder did not show
any significant increase in weight (25).
A marked association between general and abdominal obesity has been reported (26).
Reduces food intake and is associated with weight loss in depressed and otherwise
healthy individuals (23, 27-30).
Weight changes are dependent on weight at onset of use; weight loss is observed in
persons whose weight is classified as "overweight," "ideal" weight persons gained some
weight, and "underweight" persons showed now significant weight trend (31).
F luoxetine plus behavior modification therapy resulted in greater weight loss than
fluoxetine alone. Protocol did not appear to help with binge eating (32).
Significant reduction in body weight in women with bulimia who used the drug in
combination with intensive psychotherapy (33).
Prozac®
fluoxetine hydrochloride
Improved symptoms of bulimia, including: depression, carbohydrate craving, and
dysfunctional eating a itudes and behaviors (34, 35, 36, 37).
A modest but insignificant number of 44 patients receiving treatment for 26 to 32 weeks
gained more than 7% of baseline weight (23).
11.88% of a sample of approximately 100 subjects lost weight over 8 weeks of treatment
with an average dose averaging 27.5 mg per day (14a).
Helps to lose weight in obsessive-compulsive disorder (38).
Weight gain reported on doses of 15-60 mg over 8 weeks of treatment (39).
Weight gain reported on average dose of 32.7 mg over 6 weeks of treatment (40).
Weight gain in 50% of individuals receiving an average of 18.3 mg over 8 weeks (41).
Weight gain averaged 1.4 kg over 40 weeks of treatment on a dose of 15-45 mg (42).
Remeron®
mirtazapine
No weight gain reported with an initial dose of 15 mg (increased to 30 mg when
needed) over 4 weeks of treatment (43).
More weight gain when compared to paroxetine in a 6 week study of 127 patients
averaging a dose of 32.7 mg/day (24).
In 147 patients treated with mirtazapine, the average weight gain was 0.8 lbs. (38).
Trend toward increased appetite and weight (44).
Sinequan®
Increased a preference for sweets in 15% of a test sample (45).
Weight gain has been reported (46, 47).
Perception of weight change altered with treatment; a 5 lb. weight change was more
problematic during recovery than during depression (48).
Tofranil®
imipramine
Reduces binge duration in obese bingers (13, 14a); adding this drug to nutrition and
psychological counseling helps with weight loss even for at least 6 months off of
medication (14a).
Reduces symptoms of bulimia (24).
Is currently under investigation as a potential component of obesity treatment (49, 50).
Meta-analysis suggests weight loss effect (5).
Wellbutrin®
bupropion
Associated with weight reduction (50).
Reported to decrease food intake and weight (54).
A modest but insignificant number of 48 patients receiving treatment for 26 to 32 weeks
gained more than 7% of baseline weight (23).
Inhibits food intake and decreases weight without affecting locomotion (51-53).
Zoloft®
sertraline hydrochloride
In individuals with obsessive-compulsive disorder, an average weight gain of 4.5% was
experienced during a 2 year period of using this medication (54).
1. W irz-Justice A, van der Velde P, Bucher A, Nil R. Comparison of light treatment with citalopram in winter depression: a longitudinal single case study. IntClin Psychopharmacol 1992 Nov; 7(2): 109-16.
2. Pallanti S, Querciolo L, Ramaccio i A. Citalopram in anorexia nervosa. Eat Weight Disord 1997 Dec; 2(4): 216-21.
3. Carter W P, Hudson JI, Lalonde JK, Pindyck L, McElroy SL, Pope HG Jr. Pharmacologic treatment of binge eating disorder. J Clin Psychiatry 2003 Aug; 64(8): 927-35.
4. McElroy SL, Hudson JI, Malhotra S, Welge JA, Nelson EB, Keck PE Jr. Citalopram in the treatment of binge-eating disorder; a placebo-controlled trial. J ClinPsychiatry 2003 Jul; 64(7): 807-13.
5. Li Z, Maglione M, Tu W , Mojica W , Arterburn D, Shugarman LR, Hilton L, Su orp M, Solomon V , Shekelle PG, Morton SC. Meta-analysis: pharmacologictreatment of obesity. Ann Intern Med. 2005 Apr 5;142(7):532-46.
6. Jackson HC, Needham AM, Hutchins LJ, Mazurkiewicz SE, Heal, DJ. Comparison of the effects of sibutramine and other monoamine reuptake inhibitors onfood intake in the rat. Br J Pharmacol 1997 Aug; 121(8): 1758-62.
7. Hudson JI, W ohlreich MM, Kajdasz DK, Mallinckrodt CH, Watkin JG, Martynov OV . Safety and tolerability of duloxetine in the treatment of majordepressive disorder: analysis of pooled data from eight placebo-controlled clinical trials. Hum Psychopharmacol 2005 Jul; 20(5): 327-41. 8. W ohlreich MM, Mallindkrodt CH, Prakash A, Watkin JG, Carter W P. Duloxetine for the treatment of major depressive disorder: safety and tolerabilityassociate with dose escalation. Depress Anxiety 2007; 24(1): 41-52.
9. Raskin J, Goldstein DJ, Mallinckrodt CH, Ferguson MB. Duloxetine in the long-term treatment of major depressive disorder. J Clin Psychiatry 2003 Octo;64(1): 1237-44.
10. Carter W P, Hudson JI, Lalonde JK, Pindyck L, McElroy SL, Pope HG Jr. Pharmacologic treatment of binge eating disorder. Int J Eat Disord 2003; 34 Suppl:S74-88.
11. Jackson HC, Needham AM, Hutchins LJ, Mazurkiewicz SE, Heal DJ. Comparison of the effects of sibutramine and other monoamine reuptake inhibitors onfood intake in the rat. Br J Pharmacol. 1997 Aug;121(8):1758-62.
12. ,,,,,,. The effect of venlafaxine on behaviour, body weight andstriatal monoamine levels on sleep-deprived female rats. Pharmacol Biochem Behav. 2004 Nov;79(3):499-506.
13. Christiansen PE, Behnke K, Black CH, Ohrstrom JK, Bork-Rasmussen H, Nilsson J. Paroxetine and amitriptyline in the treatment of depression in generalpractice. Acta Psychiatr Scand 1996 Mar;93(3):158-63.
14. Drieling T, Biedermann NC, Scharer LO, Strobl N, Langosch JM. Psychotropic drug-induced change of weight: a review. Fortschr Neurol Psychiatr 2007 Feb;75(2): 65-80. 14a. Chouinard G, Saxena B, Belanger MC, Ravindran A, Bakish D, Beauclair L, Morris P, Vasavan Nair NP, Manchanda R, Reesal R, Remick R, O'Neill MC. ACanadian multicenter, double-blind study of paroxetine and fluoxetine in major depressive disorder. J Affect Disord 1999 Jul;54(1-2):39-48. 15. de Jonghe F, Ravelli DP, Tuynman-Qua H. A randomized, double-blind study of fluoxetine and maprotiline in the treatment of major depression.Pharmacopsychiatry 1991 Mar;24(2):62-7.
16. Remick RA, Froese C, Keller FD. Common side effects associated with monoamine oxidase inhibitors. Prog Neuropyschopharmacol Biol Psychiatry 1989; 13(3-4);497-504.
17. Fichter MM. Drug treatment of anorexia nervosa and bulimia nervosa. A review. Nervenarzt. 1993 Jan;64(1):21-35. 18.Aberg-W istedt A. A double-blind study of zimelidine, a serotonin uptake inhibitor, and desipramine, a noradrenaline uptake inhibitor, in endogenousdepression. I. Clinical findings. Acta Psychiatr Scand 1982 Jul;66(1):50-65. 19. McCann UD, Agras W S. Successful treatment of nonpurging bulimia nervosa with desipramine: a double-blind, placebo-controlled study. Am J Psychiatry 1990 Nov;147(11):1509-13.
20. Leibowi SF, Brown LL. Histochemical and pharmacological analysis of noradrenergic projections to the paraventribular hypothalamus in relation tofeeding stimulation. Brain Res 1980 Nov 17; 202(2):289-314.
21. McElroy SL, Keck PE Jr., Pope HG Jr., Hudson JI. Pharmacological treatment of kleptomania and bulimia nervosa. J Clin Psychopharmacol 1989 Oct; 9(5): 358-60.
22. Weber E, Stack J, Pollock BG, Mulsant B, Begley A, Mazumdar S, Reynolds CF3rd. Weight change in older depressed patients during acutepharmacotherapy with paroxetine and nortriptyline: a double-blind randomized trial. Am J Geriatr Psychiatry 2000 Summer;8(3):245-50.
23. Fava M, Judge R, Hoog SL, Nilsson ME, Koke SC. Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry 2000 Nov;61(11):863-7.
24. Benkert O, Szegedi A, Kohnen R. Mirtazapine compared with paroxetine in major depression. J Clin Psychiatry 2000 Sep;61(9):656-63.
25. Rickels K, Rynn M, Iyengar M, Duff D. Remission of generalized disorder: a review of the paroxetine clinical trials database. J Clin Psychiatry 2006 Jan; 67(1):41-7. 26. Raeder MB, Bjelland I, Emil V ollset S, Steen V M. Obesity, dyslipidemia, and diabetes with selective serotonin reuptake inhibitors: the Hordaland HealthStudy. J Clin Psychiatry 2006 Dec; 67(12): 1974-82. 27. Levine LR, Enas GG, Thompson W L, Byyny RL, Dauer AD, Kirby RW , Kreindler TG, Levy B, Lucas CP, McIlwain HH, et al. Use of fluoxetine, a selective serotonin-uptake inhibitor, in the treatment of obesity: a dose-response study (with a commentary by Michael Weintraub). Int J Obes 1989;13(5):635-45. 28. Pijl H, Koppeschaar HP, W illekens FL, Op de Kamp I, Veldhuis HD, Meinders AE. Effect of serotonin re-uptake inhibition by fluoxetine on body weight and spontaneous food choice in obesity. Int J Obes 1991 Mar;15(3):237-42. 29. Goldstein DJ, Rampey AH Jr, Enas GG, Potvin JH, Fludzinski LA, Levine LR. Fluoxetine: a randomized clinical trial in the treatment of obesity. Int J Obes Relat Metab Disord 1994 Mar;18(3):129-35. 30. Lawton CL, Wales JK, Hill AJ, Blundell JE. Serotoninergic manipulation, meal-induced satiety and eating pa ern: effect of fluoxetine in obese female subjects. Obes Res 1995 Jul;3(4):345-56.
31. Orzack MH, Friedman LM, Marby DW . Weight changes on fluoxetine as a function of baseline weight in depressed outpatients. Psychopharmacol Bull 1990;26(3):327-30.
32. Marcus MD, W ing RR, Ewing L, Kern E, McDermo M, Gooding W . A double-blind, placebo-controlled trial of fluoxetine plus behavior modification in the treatment of obese binge-eaters and non-binge-eaters. Am J Psychiatry 1990 Jul;147(7):876-81.
33. Fichter MM, Leibl K, Rief W , Brunner E, Schmidt-Auberger S, Engel RR. Fluoxetine versus placebo: a double-blind study with bulimic inpatients undergoing intensive psychotherapy. Pharmacopsychiatry 1991 Jan;24(1):1-7.
34. Fluoxetine in the treatment of bulimia nervosa. A multicenter, placebo-controlled, double-blind trial. Fluoxetine Bulimia Nervosa Collaborative Study Group. Arch Gen Psychiatry 1992 Feb;49(2):139-47.
35. Goldstein DJ, W ilson MG, Thompson V L, Potvin JH, Rampey AH Jr. Long-term fluoxetine treatment of bulimia nervosa. Fluoxetine Bulimia Nervosa Research Group. Br J Psychiatry 1995 May;166(5):660-6.
36. Goldstein DJ, W ilson MG, Ascroft RC, al-Banna M. Effectiveness of fluoxetine therapy in bulimia nervosa regardless of comorbid depression. Int J Eat Disord 1999 Jan;25(1):19-27.
37. Bacaltchuk J, Hay P. Antidepressants versus placebo for people with bulimia nervosa. Neuropsychobiology. 2003; 48(3): 116-23.
38. Versiani M, Moreno R, Ramakers van Moorsel CJ, Schu e AJ, Comparative Efficacy Antidepressants Study Group. Comparison of the effects ofmirtazapine and fluoxetine in severely depressed patients. CNS Drugs. 2005;19(2):137-46.
39. Leinonen E, Skarstein J, Behnke K, Agren H, Helsdingen JT. Efficacy and tolerability of mirtazapine versus citalopram: a double-blind, randomized study in patients with major depressive disorder. Nordic Antidepressant Study Group. Int Clin Psychopharmacol 1999 Nov;14(6):329-37.
40. Benkert O, Szegedi A, Kohnen R. Mirtazapine compared with paroxetine in major depression. J Clin Psychiatry 2000 Sep;61(9):656-63. 41. Ribeiro L, Busnello JV , Kauer-Sant'Anna M, Madruga M. Mirtazapine versus fluoxetine in the treatment of panic disorder. Braz J Med Biol Res 2001 42. Thase ME, Nierenberg AA, Keller MB, Panagides J. Efficacy of mirtazapine for prevention of depressive relapse: a placebo-controlled double-blind trial of recently remi ed high-risk patients.J Clin Psychiatry 2001 Oct;62(10):782-8.
43. Carpenter LL, Yasmin S, Price LH. A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine. Biol Psychiatry 2002 Jan15;51(2):183-8.
44. Feighner J, Hendrickson G, Miller L, Stern W . Double-blind comparison of doxepin versus bupropion in outpatients with a major depressive disorder. J Clin Psychopharmacol 1986 Feb;6(1):27-32.
45. Fernstrom MH, Kupfer DJ. Imipramine treatment and preference for sweets. Appetite 1988 Apr; 10(2): 149-55.
46. Berken GH, Weinstein DO, Stern W C. Weight gain. A side-effect of trycyclic antidepressants. J Affect Disord 1984 Oct; 7(2): 133-8. 47. Frank E, Kupfer DJ, Bulic CM, Levenson JA. Imipramine and weight gain during the treatment of recurrent depression. J Affect Disord 1990 Nov; 20(3): 165-72. 48. Fernstrom MH, McConaha C, Kupfer DJ. Perception of appetite and weight change during treatment for depression. Appetite 1989 Aug; 13(1): 71-7. 49 Bupropion for weight loss: an investigation of efficacy and tolerability in overweight and obese women. Obes Res. 2001 Sep;9(9):544-51.
50. Effect on body weight of bupropion sustained-release in patients with major depression treated for 52 weeks. Clin Ther. 2002 Apr;24(4):662-72. 51. Lucki I, Kreider MS, Simansky KJ. Reduction of feeding behavior by the serotonin uptake inhibitor sertraline. Psychopharmacology (Berl) 1988; 96(3):289-95. 52. McElroy SL, Casuto LS, Nelson EB, Lake KA, Soutullo CA, Keck PE Jr., Hudson JI. Placebo-controlled trial of sertraline in the treatment of binge eatingdisorder. Am J Psychiatry 2000 Jun; (157(6): 1004-6.
53. Gara ini S, Mennini T, Samanin R. Reduction of food intake by manipulation of central serotonin. Current experimental results. Br J Psychiatry Suppl 1989Dec; 41-51.
54. Billes SK, Cowley MA. Inhibition of dopamine and norepinephrine reuptake produces additive effects on energy balance in lean and obese mice. Neuropsychopharmacology 2007 Apr; 32(4): 822-34. 55. Maina G, Albert U, Salvi V , Boge o F. Weight gain during long-term treatment of obsessive-compulsive disorder: a prospective comparison between serotonin reuptake inhibitors. J Clin Psychiatry 2004 Oct; 65(10): 1365-71.

Source: http://www.fluoxetin.se/fluoxetin-vikt.pdf