Psych Drugs and Obesity...

The pills that make us fat
08 March 2008 by Paula J. Caplan
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WALK down any street in America and you'll see the effects of the "obesity epidemic". Two-thirds of adults, more than 130 million people, are now considered overweight, and nearly half of these are classified as obese. Those who are overweight by 45 kilograms or more are the fastest-growing group of the overweight in the US. Accompanying these skyrocketing figures are increases in diabetes, heart problems and deaths.

In print and on the airwaves there are numerous stories about how fast food, large portions, sedentary lifestyles and poverty are playing big parts in weight gain, while government bodies desperately throw together public health programmes to educate people about the dangers their lifestyles bring.

Yet one culprit is rarely mentioned: the broad range of psychiatric drugs that can cause substantial weight gain. They include drugs marketed as antidepressants (such as amitriptyline, doxepin and imipramine), mood stabilisers (including lithium and valproate) and antipsychotics (including clozapine, olanzapine and chlorpromazine). After 10 years on lithium, for example, two-thirds of patients put on around 10 kilograms. And in December 2006, The New York Times published an article based on internal documents from the drug company Eli Lilly which indicated that it had intentionally downplayed the side effects of olanzapine, which it sells as Zyprexa. The company's data showed that one-third of patients who have taken the drug for a year gain at least 10 kilograms, and half of these gain at least 30 kilograms.

The mechanisms behind this weight gain appear complex and are certainly poorly understood. Some psychiatric drugs may impair the central nervous system's control of energy intake, leading to food cravings, whereas others, such as selective serotonin reuptake inhibitors (SSRIs), may alter a patient's metabolic rate. Worryingly, doctors are increasingly prescribing multiple psychiatric drugs for the same patient at the same time, even though many effects of doing so, including the effect on weight, have not been investigated.

Doctors often fail to warn patients that the drugs they prescribe may increase their appetites
We don't know how much these drugs are adding to Americans' waistlines, but the number of people affected is likely to be high. Prescriptions in the US for Zyprexa alone run into millions. In 2004, 32.6 million Americans purchased outpatient prescriptions for antidepressants, stimulants, antipsychotics and tranquillisers, up from 21 million in 1997. Overall, around 50 million Americans - that's 1 in 6 of the population - currently take at least one psychotropic drug. From a crude look at the numbers, it seems that they could potentially be causing a significant - and growing - portion of America's obesity problem.

It seems surprising then that commentators rarely make the link between psychiatric drugs and the obesity epidemic. For example, a report broadcast last year by the PBS TV network called Fat: What no one is telling you included a vast array of lifestyle and physiological factors that could be contributing to weight gain. Psychiatric drugs were not mentioned.

Another factor that the media and governments have failed to publicise is that rising obesity in teenagers and even young children over the past 10 to 15 years coincides with a fivefold increase in prescriptions of antipsychotic drugs in those age groups, and that children taking these drugs are even more likely to gain weight than adults are. We don't know how much of this increase in obesity is due to the drugs, but shouldn't somebody be finding out?

Though drug-induced weight gain is potentially a worldwide problem, it is a particular concern in the US because American culture is so eager to label negative feelings and problems as evidence that a person is mentally ill - and to push drugs as a supposedly quick fix. Furthermore, doctors often fail to warn patients that the drugs they prescribe may increase their appetites, and people labelled as mentally ill often learn to attribute all their problems - including eating more - to their psychological disorder. In a curious article last May in the American Journal of Psychiatry (vol 164, p 708), two doctors even proposed that obesity be classified as a mental illness. One likely consequence of that would be another massive increase in the prescribing of psychotropic drugs, resulting, no doubt, in another upsurge in obesity statistics.

Recent revelations that some antidepressants may work little better than placebo in most cases (see "Mindfields: Talking down antidepressants") make the potential scale of the side effects more worrying than ever. Anyone taking psychiatric drugs who is concerned about weight gain and its associated ill effects should be reminded that to stop taking them suddenly - and what is gradual enough for one person may be far too sudden for another - can precipitate serious withdrawal symptoms. But at the very least, every person considering taking these drugs needs to be able to make a fully informed decision about whether to get their prescription filled. The government and the media must take the lead in ensuring that drug companies disclose the extent of the weight gain that their drugs cause and in educating the public about the risks.

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Paula J. Caplan is a clinical and research psychologist at Harvard University and author of They Say You're Crazy

TJ

We don't know how much of this increase in obesity is due to the drugs, but shouldn't somebody be finding out?

Yeah, so why doesn't this person do that before writing scaremongering articles for vulnerable people. No proof is cited here, a bunch of things just might be true. Some medications cause weight gain, some don't. Some medications work, some don't. She lumps all manner of drugs together as if they are all equally (in)effective and equally (un)necessary. A rise in obesity "coincides" with lots of things besides an increase in the number of antipsychotic prescriptions.

This author has a book about feminism and psychiatry, which needs to be discussed and I appreciate it. But it seems to undermine her credibility to also say "and what's more it makes you fat!!!!"

I just think it's better to put actual information out there than sensationalistic maybes. (Not you skeeweeaka. I mean the author )

Hello, well I respect your opinion. I agree with the premise of the article and that is that with the rise of obesity, the fact that many of these drugs do cause weight gain and is not discussed much except on boards like this and weight loss boards. As well as the fact that doctors don't really mention it or in most cases deny that the weight gain is attributed to the meds (or at least that was my case...120 pounds). As well as the fact that pharmaceutical companies downplay that issue as much as possible!

I understand that not everyone has to deal with this issue, but there are many people who are struggling with obesity who are on these meds because these drugs are seriously doing damage to your system in many ways! That said, I also understand that they work for a lot of people and so they have no choice...obesity or mental illness...well I would choose obesity if the meds worked for me but they don't.

I'm struggling with losing the weight and am a bit upset at the effect that the meds have had on my body....seizures...weight gain, etc....damaged thyroid...memory...but I keep trying.

I posted the article because I thought it was interesting...and thought that perhaps someone else would find it interesting...especially since I've lived it!

TJ

I do agree that many of the newer antiphsychotic or psychotropic drugs like zyprexa do in research directly from the manufacture warn of the weight gain issue and now FDA guidelines have placed warnings on the ones that cause weight gain and the link to diabetes, on the other hand the older drugs like Thorazine, haladol, prolixin and perphenazine cause a long string of irreversible side effects like tative dyskensia attacking the Central Nervous System and are after long periods of time irreversible, if one med causes drastic weight gain it can be replaced and such yet as I too well have experienced personally now morbidly obese, also have Parkinson's like problems and permanent CNS damage forever.

One article or warning I understand is that one major common prescribed psychotropic drug says one can gain up to 30% or more of the body weight in which they are present after starting the drug.

I would not suggest going off any medication without consulting your pdoc or MD as this can be dangerous, if one has psychotic episodes and they are under control with the medications. Until science come up with better and more medications to treat the condition, I feel we are just going to have to either be overweight, stiff, or in a state hospital due to not taking needed psychiatric meds in order to be able to function in our society.

I am glad the FDA is at least aware of the problem and are taking steps for preventative steps for those beginning treatment on these weight gaining meds. At least it is a start.kk101

Yes, I agree, it is a start! Sorry to hear about the side effects you have experienced...mine have been on newer drugs though...

TJ

This is similar to the "medication turns you into a zombie"-thing. It's different for everybody, and it shouldn't discourage someone for trying a med that might work for them. If you gain weight, talk to your p.doc and tell him you wish to stop - then try another one. It's not any worse than that.
Zyprexa is the one that's most notorious for its weight gain side effect, Lithium comes on a close second. I know two girls who both gained 50-60lbs from being on Zyprexa, but yeah - it's different for everybody. I was on lithium and gained weight, but I know many who haven't.

Yes it is different for everyone... Again, I posted it to provide information only not to prevent people from taking their meds but perhaps to ask more questions and do more research.

I took both of the drugs you mentioned, Zyprexa caused me to gain a lot of weight and have permanent seizures...Lithium...caused me to gain so much weight I couldn't walk and had extreme edema and high blood pressure...

TJ

I gained many pounds after going on Effexor. I hate myself.

I agree that these medications really help people. But I have been a victim of the psych drug weight crisis. After being prescribed zyprexa, I gained an unbelievable 10 pounds in two weeks. I gained weight so fast that my skin stretch in all sorts of unnatural ways. In the next two months, I gained another 15 pounds while being on Risperdal. The doctor had neglected to tell me about the possible side effects of the drug. Now Im told Im at great risk for getting diabetes.

So now I feel like what's gonna kill me first. The diabetes or the mental illness!

Thanks for posting this

Yes it's difficult Sherry...for me it's what is going to kill me being morbidly obese...5'3, 217...or mental illness! I gained 55 pounds last year on Neurotin in 3 MONTHS! After that I told them I was done with psych meds...they don't work for me and only cause me additional pain!

I hope you both are feeling letter...lower carb eating does help a lot with losing the weight... There are many plans out there...South Beach, Carb Addicts Diet, Protein Power, Atkins, etc...

Chromium, L-Glutamine, or Fish Oil help a lot with the cravings!

TJ

I was on zyprexa for a while before i noticed weight gain.. I notice my increase in eating habits 1st.. I would wake up just to fix cream of wheat.. I didnt miss a meal..plus snacks in between... I was happy ,family was happy that i was eating...more than 1 meal a day ...next thing you know...everybody was pointing out my weight..When i went to see my doc. i asked about the weight gain..He stated ..zyprexa will do that to you!!! I don't know what was going through his head...but i ask him why would u suggest that med..with my history..It took sometime but the weight came off..slowly.

I'm happy you were able to take it off. It can be frustrating fighting the cravings and the dry mouth... I'm happy you got it off...I'm still working on it.

TJ