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Many men and women are finding that as they gain relief from depression, bipolar and anxiety disorder symptoms, they're also gaining something else -- unwanted pounds.

The connection is not in their minds. "The majority of the most commonly used medications for mental disorders are known to cause weight gain," says Norman Sussman, MD, clinical professor of psychiatry at the New York University School of Medicine. That includes most antidepressants, most of the anticonvulsants/mood stabilizers and virtually all of the antipsychotics.

It's one of the most common reasons patients skip their medication or stop taking it altogether.

"Since I started on lithium and Depakote two years ago, I've gained 35 pounds," said Ann. L. of Seattle. She's not alone. One- to two-thirds of those who take lithium gain weight and Depakote has a bad reputation for it as well. "When I got disgusted with buying bigger clothes every month, I talked it over with my doctor and he switched the Depakote for Lamictal. We decided not to stop the lithium. I haven't lost any weight, but I seem to have stopped gaining."

Weight gain can make mood disorders even worse by contributing to low self-esteem and negative emotions. And, of course, it increases the risk of developing many health problems, including: Type 2 diabetes, heart disease, stroke, cancer and osteoarthritis. One antipsychotic has been implicated in causing diabetes and other metabolic complications.

Why do psychiatric drugs cause weight gain?
The scientific explanations involve the dance of blocked and activated receptors and the drugs' effects on serotonin, histamine, hormones and our metabolism. Sussman says the neurotransmitter affected by SSRIs, serotonin, not only affects mood, it also plays a role in appetite and metabolism in some people. Other drugs used to treat psychological problems may work in different ways to cause weight gain. Drugs such as Clozaril and Zyprexa have been shown to prompt weight gain by affecting insulin resistance in the body.

Anticonvulsants tend to cause elevated insulin in the blood and increased appetite leading to weight gain, says Gay Riley, MS, RD, CCN Antidepressants can affect weight in several ways: They may increase or decrease basal metabolic rate, and they may affect hormonal changes and increase appetite.
"It's multi-factorial, but the main guilty party appears to be the capacity of some antidepressants to block the histamine receptor, and once histamine is not working, we get appetite centers to go on, and we get hungry and eat," says Dr. Samuel Mowerman, a psychopharmacologist who writes on psychotropic medications and their side effects.

How to fight the battle of the Med-induced bulge
There are three ways to fight the battle against weight gain that is caused both by psychiatric medications and also, in some cases, by the disorders themselves. The solutions lie in making changes in your medication regime and in your lifestyle.

Make changes in your medication
New drugs are being developed that are less likely to cause the weight gain of earlier drugs. Wellbutrin is one of the newer antidepressants that doesn't cause many of the side effects of SSRIs, Tricyclics or MAOIs. A new form of the antipsychotic Zyprexa is reported to prevent the weight gain effect by being administered as a melt-in-your-mouth wafer, avoiding stomach serotonin receptors.

For some medications that might cause unwanted weight gain, there is an alternative medication that won't, and a change may help. The mood stabilizer Lamictal (lamotrigine) is less likely than Depakote (divalproex sodium/valproic acid) to cause the weight gain. Using lower doses of medications is another solution to weight gain, if doing so does not risk the effectiveness of treatment. Combining medications in lower doses can also be an improvement.

Jim Phelps, MD author of Why am I still depressed?, a book about the bipolar spectrum, reports that some doctors are adding a weight loss medication to some of the antipsychotics and anticonvulsants that cause weight gain: for example, adding Topamax (topiramate) or amantadine to Zyprexa (Olanzapine) or Glucophage to Depakote. Many patients either lost weight or stopped gaining, he said, however Topamax often caused confusion and memory problems, amantadine caused tremor and Glucophage hasn't been very successful.

Make changes in your lifestyle
"Physical activity and diet can help prevent this weight gain, and sometimes reverse it," says Dr. Phelps, but simply telling patients to eat right and get exercise as a means of coping with the weight gain their medications can induce is pretty close to an insult…. Face it, this is hard enough for people who don't have mood problems, let alone people who have cyclic phases of depression that include being extremely hopeless and unmotivated -- not at all conducive to sticking with either diet or exercise. However, the importance of this step should not be forgotten."

No one who understands psychiatric disorders underestimates how challenging it is to concentrate on exercise and a healthy diet when you're depressed, manic or anxious, and just getting out of bed in the morning takes a major effort. But if we can remind ourselves that getting more exercise and eating better can counteract the weight-inducing effects of the drugs, but also do much to improve our mood and motivation, perhaps we can take some first steps.

Exercise and diet>>>

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