Cam.....Please Clarify a Previous Post of Yours

In a recent thread about SSRI induced weight gain you stated that in your clinical experience the weight gain brought on by SSRI's such as Lexapro is usually irreversible. Did you mean that as long as a person STAYS on that drug they find it very difficult, if not impossible to lose the weight, or did you mean that even after they discontinue that particular med they are unable to lose that weight? As in, the mechanism of action that caused the weight gain has become permanent? I really don't see how this could be, but am completely freaking out about this as I stopped taking Lexapro 2 months ago (took it for 3 1/2 months) and did experience the increase in appetite that you talked about. While on it, I had no desire to exercise, ate junk food like crazy and as a result gained quite a bit of weight.

I'm trying to lose now, doing all the 'right' things, all the things that worked for me in the past (as recently as less than one year ago) but I'm having a hell of a time these past few weeks. I've lost maybe 1 pound since I've been weighing in (almost 2 weeks.)

I took Effexor XR a few years ago and couldn't lose while on it, but once I stopped and started eating right the weight came off. So, by irreversible, did you mean that as long as you are taking the drug, but not after d/c-ing it? With my current situation I'm beginning to wonder. Thanks in advance for responding!

Pebblypoo - I have no proof of my statement that SSRI-induced weight gain is irrevesible. It is just that in my experience, those who gain weight after taking an SSRI (esp. Paxil - paroxetine) cannot seem to shed that weight, even if they stop taking the antidepressant. Now, this is a blanket statement. I do know people who have lost the weight that they gained from an SSRI, but these people are in the minority.

I am not sure if the drug has reset a person's "normal" (natural?) body weight, but even when people eat a sensible diet, they seem to stay at this new level. Again, I have no proof of this, it is only an observation.

That being said; I have also noticed that if a person is able to diligently maintain their weight when taking the SSRI, they can avoid gaining weight. I have beeen told that it is very difficult to eat sensibly, due the the intense carbohydrate craving that is common with SSRIs. I believe that everyone that I have talked to who has avoided SSRI-induced weight gain has mentioned that they were ALWAYS hungry. Many of these people have used a food journal, writing down everything that they eat, and following a rigid diet plan. The diet is not a starvation diet, just eating sensibly, usually with the help of a nutritionist. The journal keeping needs to begin when the SSRI is started, long before that incidious weight gain is able to creep up on one.

It seems (to me) that the carbohydrate craving and weight gain do tend to fade (in most people) after 9 months to a year of being on the SSRI. I have noticed that (again, in most people) weight does level off, but it seems that most people have a new "natural weight".

I really don't mean to freak anyone out; and I definitely don't want anyone to give up trying to lose weight. I am just stating what I have seen clinically. My clinical experience is limited; I haven't done any studies on this; I have no proof of what I am saying. I am just stating what I have observed over the years (be it right or wrong).

Everyone should eat a sensible diet; but I do not take my own advice. I do think about eating properly, but I don't follow through. I am probably about 10 pounds over what I should be; I no longer working on my karate, nor do I exercise as much as I should.

When I had to start taking antidpressants, I found that SSRIs made me worse. At first Wellbutrin (bupropion) did allow me to achieve remission, but that success was short-lived. My doctor and I pushed the dose of Wellbutrin to 450mg/day and even up to 600mg for a couple of weeks. I had to add Effexor XR (venlafaxine) and was up to 450mg/day before cutting back to 300mg and reintroducing the Wellbutrin at 300mg/day. Finally success! I never did gain much permanent weight with the Effexor XR, probably because I still depressed until I reintroduced the Wellbutrin, which took my appetite away for the first 3 months. This probably saved me from weight gain, but it wasn't a conscious thing (probably just dumb luck). I hadn't made the SSRI/weight gain connection at this point.

I don't think that Effexor XR causes weight gain to the same extent as the true SSRIs. Paxil, Zoloft, and Luvox (fluvoxamine) seem (to me) to be the SSRIs that are the SSRIs most likely to cause irreversible weight gain. It is very hard to lose the weight even after stopping these antidepressants. Again, this is a generalization on my part.

I hope that this clears up your questions. Just remember, I am just relating my limited experience; this phenomena is just from my limited experience. I don't mean for anyone to take this as a scientific "truth", only "my" observation. - CM

i'm going to add my two-cents worth here. i lost 38 lbs on EffexorXR..i am five feet tall..i looked anorexic. when i started tapering, in about 30 hours, i had an appetite. i was eating every two or three days while taking the full dose of it. now i'm on depakote and lamictal and small dose of elavil. i am hungry all the time and i really watch what i eat...i am gaining..i've put on about 15 lbs in a very short time. i eat veggies, grains, tofu smoothies, whole wheat bread and am vigilant against "fatty" foods...but i still gain........i'm going to go back to walking as soon as my knee allows it. 4 miles a day and we'll see what happens. i also think that women gain easier than men.

Threadjack in progress!

Pat, you're a shorty too? I'm another 5 footer. Whoo hooo!!

You may now return to the previously posted topic.

It is probably the Depakote, it made me hungry, tired and gain weight. I was so happy when my pdoc switched me to Lamictal, never caused me to gain weight, and plus I lost the Depakote weight
Elavil, that may or may not do this, I recall my brother was on Elavil years ago, he didn't seem to gain weight from it, but everyone is different.
I do know about the Depakote, my nephew had to be put on high doses, he got fat and just slept constantly, it was sad to see this kid so shot down, he was and now is thin again, not thin but perfect build, and tall.
His pdoc had switched his meds too after awhile.

Just my 2 cents.
Wish Cam would drop by here again.

Darkeyes & Fayerody - The Depakote (Epival - divalproex) is probably the main culpert in the weight gain department, but antidepressant doses of Elavil (amitriptyline - 200mg - 250mg/day) also caused weight gain. I used to see a lot of people gain in the pre-SSRI days (pre-1990s), but the mechanism was probably different and the gains were not as drastic as we are seeing today with the SSRIs.

The weight gain with the TCAs (tricyclic antidepressants) like Elavil was due to the drugs' binding to a number of secondary receptors, other than those thought to be responsible for the antidepressant action. Similar to Effexor (venlafaxine), Elavil increases concentrations of both serotonin and norepinephrine (via reuptake blockade). Unlike Effexor, Elavil also binds to and blocks histamine-H1 receptors, which is notorious for causing weight gain. Elavil also blocks muscarinic-cholinergic (M1) receptors resulting in water retension (ie. bloating), and since it also blocks alpha-1-adrenergic receptors leading to profound drowsiness. Both of these side effects can indirectly lead to weight gain.

Acs an aside, many psychiatrists think that the TCAs are much better antidepressants than the SSRIs, but the profound drowsiness, dizziness, and cardiotoxic effects (which cause fatalities in overdose) seriously limit their use. The trade-off with the SSRIs is their relative safety in overdose, and relatively benign side effects profile (moderate weight gain is not ordinarily lethal).

The weight gain associated with Depakote is mainly due to an increase in appetite. I am not certain of the mechanism of appetite increase, but the drug has also been shown to increase testosterone in some teenage girls with epilepsy. The testosterone increases can lead to polycystic ovarian syndrome resulting in menstrual problems, unwanted hair growth, and obesity (ie. hyperandrogenism)

A 2001 University of Toronto study of women aged 18-50 years with bipolar disorder compared lithium and divalproex. Half of those taking divalproex (Depakote) had menstrual irregularities compared to 15% of those taking lithium. Weight gain was also prevalent among those taking divalproex. Blood tests also showed that those taking divalproex had higher bloods levels of androgens (eg. testosterone) and leptins (which is associated with weight gain), than those taking lithium.

When I read the report of this study, I thought, "Wow! No female should be taking Depakote for bipolar disorder!", but then I looked up the actual study, I found that it was presented at the annual meeting of the Canadian Psychiatric Association in 2001. The study consisted of only 38 women (18 taking divalproex and 20 taking lithium). When they concluded that 50% reported menstrual abnormalities, this meant only 9 women. So, when they said that half of the women taking divalproex who were overweight AND had menstrual irregularities, also had increased blood levels of androgens (ie. hyperandrogenism), they were referring to only 2 or 3 women. I don't know how you can make any generalizations from sample sizes this small (but when you use percentages, it does look impressive and convincing).

BTW - I read somewhere that the hyperandrogenism can be averted by simply taking birth control pills when taking Depakote. I don't know if this would prevent the increase in appetite or weight gain associated with the drug ..... I doubt it.

I hope that this is of some help, or interest. - Cam

Cam, I always find your answers interesting and enlightening. I want to know how the medicines work that I take. You have a way of explaining things that makes the meds easier to understand. The psych doc put me on the depakote and lamictal at the same time, kept the elavil and prozac in small doses. I asked her if I could quit the prozac but she wants me to stay on it. It's only 10mg, but I think it affects my hunger also. Thanks, again. Pat

Cam, just wondering about what you said about TCAs not being as bad for weight gain as SSRIs. Is that just your clinical experience? Or have you seen anything in the literature?

I'm nuts on this topic, having gained HUGE amounts of weight on the only TCA I was ever able to tolerate, on SSRIs, and one Effexor XR/Prozac combo. It's a big part of the reason I'm hard to treat -- the second a doctor starts to minimize the whole weight gain thing, I leap to the conclusion that this doctor Is Not Listening To Me, you know? (Yeah, well, we all have our little quirks, right?)

For what it's worth, about the Paxil weight gain: I was started on Paxil during an active anorexic episode in my life. For some time, my BMI had been in the 15 to 16 range, I was actively restricting, and overexercising. Without any change in those habits, and without any remission for my depression, I began gaining weight. The weight gain began early on, it continued as long as I took Paxil, and it didn't come off when I stopped. In fact, it was only when I had a relapse in the anorexia that any weight came off -- despite a very active life, a lot of exercise, and despite the fact that I had NEVER in that entire time eaten a normal amount of food.

Gee. You think there's any correlation between this sort of experience, the doctors telling me that it was my fault for eating too much and being lazy, and my lack of overwhelming trust for doctors?

Thankfully, of course, we have the Cams of the world. Thank you.

Is it Effexor XR or Paxil XR that has been pulled by the FDA.?
Poor quality pill that disintegrated too quickly and was not Extended Release.

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i am hungry all the time and i really watch what i eat...i am gaining..i've put on about 15 lbs in a very short time. i eat veggies, grains, tofu smoothies, whole wheat bread and am vigilant against "fatty" foods...but i still gain........

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I hope this isn't a thread-jacking....

There is a massive misconception, truly of mythical proportions, which has been propogated and disseminated through every possible path....

The Food Pyramid is a myth. It is an artifact of an agricultural lobby group's advertising, to try and deal with massive grain surpluses in the late 50's and early 60's. Following the Second World War, the powers that be determined that America would never be dependent on outside sources for food....the Green Revolution turned out to a miraculous success. But what to do with all that grain?

Answer: Feed it to people. Not enough critters on farms to eat it all, so they promoted feeding it to people. That's where the Food Pyramid comes from.

Question: Animals being fattened for slaughter are fed what sort of food? Answer: Grain.

We eat grain, we get fat. It's genetically encoded. Bacteria and yeast have the same genes, also activated by complex carbohydrates. If there is the slightest surplus of carb calories ingested over calories consumed, it all goes straight to fat, via an enzymatic process called de novo lipogenis (new fat creation).

One of the triggers to activate this process is fructose. If high levels of fructose are circulating in the blood (on a relative or comparative basis), while any carb of any sort is also at relatively high concentrations, the enzymes to produce fat from carb are turned on.

Fructose consumption alone virtually totally explains the explosion in Type II diabetes. It near totally explains the obesity epidemic.

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=15113714

Where's the fructose coming from? Why, it's coming from all that corn that's surplus. It's now become an industrial raw material, for the production of corn sweeteners....fructose-glucose syrups, and the like. Government policy has virtually halted the import of sugar-cane based sweeteners, and a whole industry has grown up around corn sweeteners. That's a powerful lobby group, the industrial food companies.

When we feed lab animals high-fructose diets, their blood lipids (that's tricglycerides) sky-rocket. As do VLDL cholesterol (Very Low Density Lipoproteins). Their insulin resistance goes way up. And their adipocytes (glands which store fat) go into overdrive.

Human experiments haven't given clear answers, probably because there are still too many uncontrolled variables in human diets, and dietary histories.

Geez.....I guess I'm getting way off track, from what started me spewing forth......

Appetite is tightly regulated by protein intake. If you don't get enough protein in at least one meal per day, your hunger will not abate.

Fat does not inevitably make you fat. It matters, and it matters very much, which type of fat you ingest. Omega-3 fatty acids, the long-chain ones only found in fish oil or algae-base DHA supps, work to control the dysregulated triglyceride synthesis induced by fructose. (I don't want to get distracted into fatty acid metabolism here.... A guy has to control his ranting.)

So, read those labels. If it says fructose in there, avoid it. Unless you want to develop Metabolic Syndrome (syndrome X) and Type II diabetes.

Going low-fat often leads to going low protein. Your body will crave those other macronutrients if it's only getting carbs. You can try too hard.

I like to think of things in an evolutionary perspective, from our days as hunter-gatherers, pre-agriculture.

Grains were a seasonal component of diet. Available for maybe 6 or 8 weeks. Grain harvest seems to coincidentally fall about the same time as fruits are most available. Being genetically predisposed to store those carbs (from grain) as fat, triggered by fructose (from fruits), would seem to confer a survival advantage. Fat for a good "harvest season" gets you through the winter.

We aren't subject to feast or famine environmental influences any longer, but our genes don't know that. They're still planning for that winter starvation period that never comes. We're on a never ending "harvest season" dietary pattern.

Anyway, grain-based diets are promoters of obesity, in my view. They're too restrictive in macronutrient content.

Sorry for the hijack.

Lar