Allowed to change meds if experiencing weight gain?

I want to know what the mental health professionals generally think of this issue. I mean, what are your experiences of doctors, nurses etc opinions about this? Have you changed meds if it has caused weight gain? Especially if you're at the healthy weight range or have/have had an eating disorder?

There are a lot of antipsychotics that can make a patient gain weight. I'm on Risperdal, 2mg and feeling like my appetite has increased significantly. In fact, I think I weighed five or eight pounds less when I came back from the hospital two weeks ago, and have gained weight ever since. (Five pounds in two weeks is a lot in my opinion!)

I talked to someone on a Finnish forum and everybody who replied to my thread agreed that one must demand for a med that does cause weight gain, since being overweight also causes a lot of problems. and the weight you gain on these meds is not just 20 lbs, it's much more.

And I'm only 5'2, I can't afford gaining 20 lbs since I'm now in the perfectly healthy weight range, not underweight and not overweight. And I'd really like to keep it that way. I've had issues with eating since day one but my therapist does not seem to understand that. She told me that I have to take Risperdal even if it makes me gain weight because being overweight is better than being delusional.

Does that mean that if Risperdal works for you but makes you gain a lot of weight, you're not allowed to try other meds?

I sometimes think I would rather hallucinate and be miserable but be at a healthy weight, rather than be overweight. My therapist does not understand, and says that going through psychosis is not an option. And lets me understand that psychosis will never end.

No wonder schizophrenics have such a gloomy future prospect..

> Does that mean that if Risperdal works for you but makes you gain a lot of weight, you're not allowed to try other meds?

Who is "allowing" or not allowing you? Are you under the control of someone? I think in the US, at least, the idea of the client having a lot of input to his or her own treatment has become quite common. It is, after all, YOUR treatment. See if your doctor will discuss it with you.

> My therapist... lets me understand that psychosis will never end.

If you have looked into some of the messages from spiritual_emergency, you will see that there are now mental health practitioners that do not agree with that kind of prediction, and that a number of people so diagnosed have recovered, in their own judgements -- see the "Schizophrenia & Recovery..." thread.

Katie_Kaboom: I talked to someone on a Finnish forum and everybody who replied to my thread agreed that one must demand for a med that does cause weight gain, since being overweight also causes a lot of problems. and the weight you gain on these meds is not just 20 lbs, it's much more.

I don't know if the fact that you talked with others on a Finnish forum means you're actually from Finland, but if you are, and if you happen to see this man roaming the Finnish streets, would you be so good as to give him a hug for me and tell him, "spiritual_emergency says, 'Thank you'."

Aside from that...

My opinion on medication is, if it's helping you and you aren't experiencing any troublesome side effects, there is absolutely no reason to change anything. However, if you're on medication and it's not helping you or if you're experiencing troublesome side effects, at that point you have a problem and problems exist to be resolved.

Your best starting point might be in the Resources topic (at the top of the board) where gardnergirl shared a link to the epocrates software. That will allow you to begin researching the medication you are on.

Your next best bet might be the internet itself, where you can continue to research the pros and cons of not only the medication you're on, but also, alternate medication. Don't overlook the blog of Furious Seasons who may have already done a great deal of your homework for you. Check out the search feature on his blog.

Once you've done your research, take it to your doctor and discuss it with him or her. Bear in mind that he or she is not the only doctor on the face of the planet. If you should discover that the fit between you no longer sits comfortably, it might be time to look for a new doc as well as a new medication.

Best of luck to you, Katie.

My input is pretty much always put down by my psychiatrist, and the last time I demanded change of meds, I still ending up taking a med that makes me feel terrible because my psychiatrist told me it is better to stand the side effects than be delusional/hallucinate/whatever.

Even if it means you sleep through the day and get only 8 hours of awake time.

I'm not sure if this is common but I surely hope not. Just because you're a mental health patient does not mean that you can't know when a med isn't good for you.

I have read quite a few posts from spiritual emergency, and they have definitely been very encouraging for me and pretty much "the light in the darkest of hours". Especially the whole story of spiritual emergency experincing psychosis without medication.

I tried to discuss this with my therapist, trying to sound polite and sensible, but with no success. That was when my therapist first let me understand that psychosis will not stop without medication.

It is weird when you are told to trust the professionals but you feel that they are mistreating / not understanding you.

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spiritual_emergency said:

Once you've done your research, take it to your doctor and discuss it with him or her. Bear in mind that he or she is not the only doctor on the face of the planet. If you should discover that the fit between you no longer sits comfortably, it might be time to look for a new doc as well as a new medication.

Best of luck to you, Katie


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Thanks again for all the great advice. I've done quite a lot of research and tried to confront my doctor, presenting the information I have, but it seems that they ignore it.

True, they aren't the only doctor on the planet, but I'm going to stand this crap for a while since I'm going to move to an another city anyway and going to have to change therapists. So maybe the new one will be more open-minded.

I'm actually in Finland, and if I see this man I will thank him for you. And thank you for being such a great inspiration for me. If only therapists could think like you do!

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Katie_Kaboom: My input is pretty much always put down by my psychiatrist, and the last time I demanded change of meds, I still ending up taking a med that makes me feel terrible because my psychiatrist told me it is better to stand the side effects than be delusional/hallucinate/whatever.

Quite some time ago I ran across an article about a psychiatrist who questioned whether or not he should continue a patient on antipsychotic medication because it was producing such a substantial weight gain. The problem was, the patient had been (in his words) "beautiful" when she first began treatment but perhaps no longer registered on the pretty scale once she started to gain weight from the medication. In his case, he wondered if it might not be better to be psychotic than to not be beautiful. As for the patient, if I recall correctly, she felt the medication had been very helpful for her and wanted to continue. My initial digs into google have not produced the article for me but if I find it, I'll be sure to share the link.

I tried to discuss this with my therapist, trying to sound polite and sensible, but with no success. That was when my therapist first let me understand that psychosis will not stop without medication.

No, of course it won't. In fact, when people recover in countries that can't afford the costs of hospitalization and neuroleptic medication its only because they weren't really experiencing psychosis/schizophrenia, they had something else, MUST have had something else, because no one could possibly recover without drugs. See?

I suggest that you not push the point with your psychiatrist because they're letting you know very clearly that their ego stability is threatened by your perspective. If they ever had to take their blinders off, their puny little world view would come crashing down around them, their sense of self-identity would fragment and splinter and then, they'd have to ask themselves, is it better to be beautiful or psychotic?

However, since your psychiatrist is not here at the moment, I don't mind sharing this with you...

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A few years ago at a psychiatric clinic in Turku, Finland, it was decided to compare the outcome for first time psychotic patients if they got neuroleptics, with the outcome if they did not get the drugs. But first all the patients were granted three drug-free weeks.

The plan was to have about ten patients in each of the two groups. However, the study could not be carried out. After the three weeks without neuroleptics virtually all the patients had overcome the psychosis, and the drug no longer appeared justified.

The reason almost all the patients emerged from the psychosis was most likely not only that they were given three weeks without the drugs. It was certainly also important that these patients were surrounded by personnel who did not believe in neuroleptics, who regarded a psychosis as a human crisis, people with an attitude more or less like my attitude with Hebriana in her psychosis 20 years ago.

In the city of Falun in Sweden there is a psychiatric team that works according to similar principles in the care of first time psychotic patients

1. Psychosis is seen as a crisis (to be overcome).

2. Session with the whole family within 24 hours.

3. Avoid neuroleptic drugs.

4. Avoid hospitalization.

Each one of these principles is contrary to the usual routine in psychiatry. In normal psychiatry a psychotic patient is hospitalized, separated from the family, and finally, after some time, released with maintenance neuroleptic drugs. The family is "educated" to help make sure the patient takes the drugs she "needs." The psychiatry in Falun is, in short, a REVERSE PSYCHIATRY

What happens in Falun is that the people around the patient, the "family," is gathered as soon as possible for a session with the team. In this situation, everybody, not only the patient, is filled with anxiety and despair. Together with the team the family gets an increased capacity to contain and solve problems. It is often found that the patient emerges from psychosis during this first family session. The patient is almost always able to return home with the family the same day.

Source: Love, Hope & Brain Science


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I'm going to move to an another city anyway and going to have to change therapists. So maybe the new one will be more open-minded.

It seems as if the potential for finding a different kind of care is more present in Finland than just about anywhere else. Perhaps your friends on your Finnish forum could make some helpful recommendations. I also would not hesitate to try and contact professionals like Jaako Seikulla and Lars Martennson -- chances are they won't have any room on their personal roster but they may be able to recommend someone in your area who practices in a similar manner.

Thanks for your kind words Katie_Kaboom. I hope you'll continue to take very good care of yourself and to let us know what recovery looks like along the "Finnish line".

i had experience that..... that was also my complained to my doctor but my doctor keeps on telling me to exercise........ i gained almost 30 pounds because of anti psychotic medicines..... my doctor even got mad at me because i was always asking her to change my medicines......

i believe its even more depressing to see that your gaining weight even though your not eating much.......

we have always the right to complain to the doctor if don't feel comfortable with the medicines we take.....

I agree. And that was what my psychiatric nurse told me too, but it's the doctor who's always insisting on telling to take these meds.

Oh and I read that even if you exercise, you still gain weight.

Not fair huh.

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"Quite some time ago I ran across an article about a psychiatrist who questioned whether or not he should continue a patient on antipsychotic medication because it was producing such a substantial weight gain. The problem was, the patient had been (in his words) "beautiful" when she first began treatment but perhaps no longer registered on the pretty scale once she started to gain weight from the medication. In his case, he wondered if it might not be better to be psychotic than to not be beautiful. As for the patient, if I recall correctly, she felt the medication had been very helpful for her and wanted to continue. My initial digs into google have not produced the article for me but if I find it, I'll be sure to share the link."

I stumbled across the same article last night...

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Nia was too beautiful to be in a psychiatric ward. That's what everyone secretly felt, including the blunt, unsentimental nurses. She was willowy and dark-eyed --- not just blandly attractive like teenagers can be. Her parents had delayed signing her into the ward on a section for as long as possible. They couldn't bear the thought that their beautiful girl was going mad.

It was Nia's younger sister who used to be the special one, with a gift for the piano that had no precedent in the family. There weren't any family precedents for what would happen to Nia either. As a child, she had been neither unusually pretty nor particularly unhappy. But adolescence can precipitate unexpected metamorphoses. In Nia, it created a transfixing physical gift and unleashed a terrible mental flaw.

At first her parents thought it was merely a teenage phase. Nia had become aware of the effect she had on schoolmates and teachers. She would either preen under the attention or become twitchy and resentful. It scarcely seemed to be unnatural behaviour --- not at first. She would spend hours in her bedroom or stay out late with her boyfriend in Cardiff. Her school reports began to slide. These weren't excessive problems for an adolescent, especially not for one who had come to realize that people viewed her as special.

Then, as she turned 17, Nia's teenage behaviour began to become something else. She started crying out, shouting at invisible persecutors who came into her room. Her parents didn't know what to do. They were a close family and at first avoided the thought of doctors. They tried to love her more. It wasn't until Nia stopped going to school altogether that they broached the subject with their GP. He immediately referred her to a psychiatrist.

Nia had revealed little to her parents of what was really going on inside her head. But the soft-spoken psychiatrist at the local adolescent mental health centre won her confidence and she began to tell him about the trains. A railway line ran a few hundred yards past the bottom of their garden, far enough away for the family to ignore it. Nevertheless, Nia said she could hear people talking about her inside the painted steel carriages. In the clank of heavy rolling stock she could pick out snatches of conversations about her --- derogatory insinuations that crept into her room through the plastic veneer of the double-glazing. She also told him that she had seen things on television. The newsreaders had begun looking at her. In the corners of their eyes she began to read signs. They were sending her messages; messages that linked up with the voices on the trains.

Nia told the psychiatrist all the things that she had kept secret from her parents. But by the end of the session she began to doubt the wisdom of doing so. She glanced at him with suspicion. He too was insinuating something. There were meanings to be found everywhere in her world. The psychiatrist gave Nia a prescription, which her parents collected from the chemist. She refused to touch it.

On the day before her admission to hospital, Nia had stood at her parents' front door, unmoving, for five hours. They could get no explanation out of her. There seemed to be no explanation for any of this. Nia was disheveled, and had stopped paying attention to her appearance, but that still couldn't disguise her beauty. At their wits' end, her parents agreed to her being forced to accept treatment. Nia procrastinated for an hour outside the mental health trust. Unable to make a decision, she was frozen between following her mother into the gabled entrance and getting back in the car. Her father felt so ambivalent that it was hard to know how to persuade her. The admitting junior psychiatrist asked her mother whether or not there had been a family history of this sort of thing. She thought not. Eventually coming back out to the car, she snapped. "We can't cope with it any more, Derek." Two nurses, a man and a woman, gently took their daughter's arms. The locked door indicated that the decision was made. The section papers were simply a formality.

The unit, a regional centre for young people with severe mental illness, provided curtained individual rooms for the clients. Despite this homely benefit, something of the Victorian institution still hung over the wide linoleum corridors, high ceilings and exposed pipes. Sitting in one of the interview rooms opposite the new arrival, the junior psychiatrist was struck by the patient's beauty: shoulder-length brown hair, slender in hipster jeans and a fitted T-shirt. Apart from her distracted eyes she didn't look unwell. He felt himself giving her more time than usual, fascinated by the experiences she related. Third-person auditory hallucinations, delusions of reference, ambitendency --- it was as if this teenager had read a psychiatry textbook.

Afterwards, he discussed Nia with the unit's consultant, a man of compromise with a small chin. He was interested in these symptoms when they appeared in those under 18. Early-onset psychosis, usually a fairly rare phenomenon, was, behind these doors, commonplace. "Does she smoke cannabis?" he asked. Like all her friends, Nia had done the odd spliff. "Hard to tell if it's drug-induced or something more sinister." They decided to observe her without medication. "If it's cannabis, she might improve."

Nia spent the days isolated in her room. The other young people in the unit found her intriguing. One boy of similar age who had been admitted with mania became instantly infatuated with her. His adolescent urges and manic disinhibition were a fertile mix and the staff found him trying every trick in the book to get into her bedroom. It's remarkable what can be contrived, even in a locked ward. One night, they were found in bed together. Nia was put on one-to-one observation.

In fact she got worse. She wouldn't talk to the staff and her meals were brought to her room. For hours on end she lay with her head under the pillow, the radio quietly on. The clinical team was now faced with the difficult decision of which medication to prescribe. Antipsychotics were discovered almost by chance in the middle of the 20th century. Now, at the beginning of the 21st, they comprise a broad church of chemical compounds that all have the effect of dampening, if not completely removing, the symptoms of psychosis.

Psychopharmacological research has shown that dopamine, widely distributed in the brain, is a central component in psychotic reactions. This has led to the classical dopamine hypothesis of schizophrenia, which sees psychosis as being caused by a chemical disorder. The deeper dilemmas of causation --- of whether a problem begins in the brain and extends to the mind, or vice versa --- need not detain psychiatrists working at the front line of mental illness. It is known that antipsychotics can block D2, one of the five dopamine receptors in the brain, and that this has an effect. Very often, the main effect is beneficial. Equally often, the side-effects are troubling.

The consultant favoured Olanzapine for Nia; he had found the drug to work well in her age group despite concerns about weight gain and diabetes. Other modern choices include Quetiapine, though many clinicians think it a weaker drug, and Risperidone, which can also cause weight gain and stiffness. The older drugs like Chlorpromazine and Haloperidol were felt to be "dirtier" and to have worse side effects, including the irreversible lip-smacking and protruding tongue movements of tardive dyskinesia. Seasoned skeptics argue that not much, fundamentally, has changed since the 1950s, apart from refining the choice of side-effects. The young psychiatrist wrote Nia up for Olanzapine --- 10mg, the regular dose. The drug being a sedative, Nia took it at night. She began to sleep.

Not much changed for five days. Then, one morning, Nia was transformed. She left her bedroom, came to meals, had normal conversations with staff. Her face filled out with ordinary human expressions. A day later she was even laughing. A young woman, an intelligent teenager, had reappeared; the psychosis seemed to have left her. To see a patient respond to a drug in this way made the young psychiatrist feel like a real doctor. Almost ashamed of himself for feeling this, he noticed that he felt grateful towards Nia --- for getting better.

What the staff didn't pick up immediately was Nia's hunger. The nurses were so encouraged by her regular appearance in the dining room that they didn't question the heap of beans and potatoes. But soon it became apparent that insanity had been replaced by appetite. Within three weeks she put on three stone [approximately forty pounds]. Now, for the first time, Nia's features were being corrupted. She started to take on the shape of many of the chronically mentally ill. Her jawline collapsed below puffed-out cheeks. Her stomach sagged above her jeans. Even the consultant found the contrast alarming. "Get a dietitian to see her; tell the staff to watch what she eats; change her to Quetiapine." The Olanzapine leached out of the tissue of Nia's central nervous system and made way for the new compound, Quetiapine. But now the illness began to resurface. She was eating less, but the paranoia had returned. "Put up the dose," said the consultant. "Quetiapine hardly ever works below 750mg."

Despite a month-long trial on the highest dose, the relapse of Nia's psychosis was untouched. She became so vulnerable that one-to-one nursing became necessary. Isolated in her room, the voices tormented her.

The young psychiatrist's early optimism collapsed under the grinding reality of Nia's dilemma. The first drug had worked. But the change in her appearance seemed intolerable --- and potentially devastating for the self-esteem of a 17-year-old girl. The second drug hadn't made her fat, but nor had it treated her illness. The consultant felt there was no option but to put her back on the Olanzapine. Again, it worked. The terrors of persecution vanished, the voices quietened down. Even her parents said that this was the old Nia. They cried over her.

The desire to experiment further with her medication left the consultant and the young psychiatrist. It was likely that the weight gain associated with Olanzapine would be very difficult to treat and that Nia would be fat, if not obese. But more disconcerting to the young psychiatrist was Nia's apparent indifference to her predicament. While those around her worried about the beauty she had lost, she seemed unconcerned. Was she really as well as her family suggested? Had she really rejoined the image-conscious world of her peers? The dietitians came and went to little effect.

As the weeks went by, the routine of the ward took over. Other patients were admitted and discharged. Nia was herself, but not herself. She blended in, lumpenly. Her leave at home was increased. Her section was rescinded. Eventually she was discharged. Classically, in schizophrenia, it is said that your chances can be divided into thirds. A third remain well, even coming off medication; a third continue to relapse and remit; and another third never get better. [* See reference below.] Those with an early-onset psychosis tend to fare worst.

If Nia did remain well, how would her old friends, and her boyfriend, have responded to her? She had been advised to stay on the Olanzapine for the foreseeable future. For a while the young psychiatrist worried about the consequences of the choices they had made in treating her. They had removed a stigma of the mind and replaced it with a stigma of the body. It struck him as strange that the patient had been the only one not to worry about a loss that the team around her found so tragic. Perhaps it didn't matter. Perhaps, in fact, this was a merciful side-effect of medication, or even of the disorder itself; one that liberated Nia from the need to live up to the standards of an image-obsessed world.

The young psychiatrist wasn't sure. The treatment had reversed a Faustian pact in which Nia had been beautiful and mad, and replaced it with another --- in which she was fat and sane. But was it really a blessing that Nia seemed to have no conception of what she had lost?

<font size=1>This article is from the February 2006 issue of "Prospect" magazine 2 Bloomsbury Place London WC1A 2QA
www.prospect-magazine.co.uk
Robert Drummond is a psychiatrist.
Alexander Linklater is deputy editor of "Prospect."
Names, details and locations have been changed.</font>

Source: Lovely Nia


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Classically, in schizophrenia, it is said that your chances can be divided into thirds. A third remain well, even coming off medication; a third continue to relapse and remit; and another third never get better.

<font color=blue>Now, when we talk about subjects who are recovered, we're talking about no medications, no symptoms, being able to work, relating to other people well, living in the community, and behaving in a way that you would never know that they had had a serious psychiatric disorder. And if you have heard of that old belief that one third get better, one third get worse, and one third stay the same, we found that it was not true. In the Vermont Longtitudinal Study, we took the bottom third of this population and found that two-thirds of them also turned around. So that our old views of schizophrenia are considerably different than they have been for the last hundred years.

-- Dr. Courtenay Harding</font>

Source: Schizophrenia & Hope


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Thanks for remembering this! :-) It was good to read.

Does anyone know which anti-anxiety/anti-depressant drugs do not cause weight gain?

Thank you in advance for your consideration in this matter.

Best to All,
Nightbird

I think Effexor is weight neutral but comes with nasty withdrawal effects if you want to get off it because it has a short half life. I'm on Paxil and it hasn't caused any weight gain.

For me, Lexapro didn't cause any weight gain, quite the contrary actually.. It decreased my appetite when I started it.

But that is a side effect, so you might or might not get it.

An another side effect Lexapro has is weight gain. It depends on the person with any anti anxiety/depression med, I think.

I think that most antidepressants are weight neutral.

Hope this shed at least some light on the question.

Katie

Effexor XR will not cause weight gain. Or at least it didnt for me when I was taking it. Actually one of the common side-effects is weight loss or anorexia, when I was on it I wasnt as hungry as usual either.

You are totally right in expressing your displeasure to your doc regarding you med's side effect. There are alternative anti-psychotics to try, and if necessary, meds you can take to decrease your appetite. Personally I think your doc is being lazy or overly cautious. If you are up for the challege of med changes, he/she ought to be as well.

I know a lot of really great docs who are happy to work with patients who express doubt about their med regimen. That's their job afterall! A good doc likes a challenge.

Take care, Slippers