January 01, 2024

Severe Depression - Harbinger of Real Danger   

The Way Out   

How Antidepressant Drugs Cause Weight Gain

Blog 4

Loss of control 

 

Kristin no longer had complete control of her reactions to situations, and her anger showed up at unpredictable times. 

She said she felt absolutely no control over her anger outbursts and felt that they come from outside of herself, as if she was the victim of them. 

Once, during a family outing, Kristin became increasingly upset when her younger brother, who was sitting next to Kristin in the backseat of the family car, began singing along to the music playing on the radio. After her brother refused to stop singing and her mother gently teased Kristin about her taste in music, Kristin began hitting her brother repeatedly. Wise beyond his years, her little brother did not hit her back. His response reflected how concerned her entire family had become about Kristin. 

Kristin began complaining about depression and again threatening to commit suicide. Luckily, her counselor, psychiatrist, and family took her seriously, as her other signs of depression were also worsening. She had admitted only the marijuana use to her counselor and parents. She continued to keep her use of the ADHD amphetamine drug (Adderall XR) she took for weight loss a secret. 

 

Harbinger of real danger 

 

Kristin’s psychiatrist and counselor recognized the impending signs of deepening depression and increased risk of suicide. They recommended that her parents admit Kristin to the university hospital psychological inpatient treatment program for teens quickly. They emphasized to her parents that her depression symptoms were harbingers of real danger of suicide. The doctor was concerned about the severity of her depression. Her physician predicted she would probably need to be in the hospital psychological care unit for one month and then move into a residential treatment center for teens and finally progress to outpatient therapy. 

 

Admission and stopping self-medication 

 

It was the height of winter sports racing season in Chile; Kristin had qualified for “International Races” again, and it was now her junior year in summer high school for winter sports kids. It broke her parent’s hearts to admit her, but they knew how serious the risk was to Kristin and asked for her cooperation. Kristin was stunned and saddened, but she knew they all loved her and agreed to go. The inpatient treatment consisted of taking Kristin off her favorite weight loss ADHD amphetamine, Adderall XR, and preventing her from having access to laxatives and recreational drugs like marijuana. This upset her tremendously at first, but the doctors switched her Prozac (fluoxetine) SSRI antidepressant to Lexapro (escitalopram), another drug for depression in the same SSRI family of drugs, in hopes that she would experience less weight gain. 

 

Anger management 

 

At first, Kristin was so provoked about not getting to use the laxative and ADHD amphetamine for 

weight loss that she became angry and hit a 6’5” tall 300-pound male staff member. The hospital team members tackled her, as is their policy, and gave her an injection to quiet her down. The doctor then prescribed Risperdal (risperidone) tablets, a second generation antipsychotic drug, to help with anger management. Almost all first and second generation antipsychotic drugs used to treat psychosis, stabilize mood, and reduce anger are associated with weight gain, usually quite significant weight gain. 

The weight gain reported with Risperdal (risperidone) in the medical literature is an average gain of 4.62 pounds in 10 weeks. (169) Another study reported that 28% of people gain 7% or more of their baseline weight in greater than 38 weeks (56).

Kristin experienced another side effect of the drug called opisthotonos (repeatedly arching her back backwards like she was doing the limbo, so that the top of her head touched her heels). The drug side effect required the drug be stopped. 

She never had any more serious outbursts of anger; it was just initially upsetting for her to lose control of which prescribed medications and self-prescribed medications she could take. The professional counseling sessions combined with sleep training and a fixed schedule gave her the tools she needed to gain control of her anger. During the counseling sessions, she was able to find the root cause of her anger and deal with it. 

Through the inpatient psychological counseling classes, group therapy, and rest, she learned techniques to take control of her conscious thoughts in ways that then influenced and controlled her subconscious mind. This gave her more control of both her anger and many aspects of her depression. Her doctors suggested that she not return to working part time late at night on school nights when she moved back home so she could maintain good sleep patterns and not be pushed to exhaustion, thus assisting further in giving her control over her anger. 

 

Sleep training 

 

The psychological care unit medical team helped the teenagers practice good sleep hygiene with rest starting at 9:00 PM and lights out at 10:00 PM. The doctors did give Kristin Xanax (alprazolam), a benzo (benzodiazepine), to help with sleep and anxiety, but it was their policy to use it for only two weeks maximum while adjusting and fine-tuning the dose of the SSRI antidepressant to allow sleep. They explained their goal was to carefully minimize the antidepressant dose to prevent sleep problems and avoid having to use sleep medications, which are depressants that can undo the effects of the antidepressant Lexapro SSRI drug she was taking. Chocolate and caffeine (sodas, coffee, tea, Red Bull) were not allowed after 12 noon, because they can interfere significantly with sleep. 

Xanax (alprazolam) and other benzodiazepine sleep drugs of the Valium family are depressant drugs and work against the SSRI antidepressant, so the university physician experts worked hard to avoid their use. With careful antidepressant dose adjustment and routine eating and sleeping habits, most people, including Kristin, can sleep without sleep medication while taking a SSRI antidepressant. 

 

“One of the worst cases of depression” 

 

The team acknowledged Kristin’s depression was one of the most severe cases they had seen. However, they recognized that she did not suffer from schizophrenia or bipolar disorder, and she did not have 

personality transfer disorder. The psychological care unit doctors explained to her parents that many kids are admitted to the unit with potential concern for serious illnesses like schizophrenia, but after undergoing a one-month detox from their street drugs, their self-medications, and recreational drugs, most kids do not turn out to have schizophrenia or other serious mental illnesses. 

Kristin responded quickly to withdrawal from the marijuana, laxatives, and Adderall XR. Healthy meals were served on a regimented schedule. Snacks were not available. On Lexapro (escitalopram), she did not gain any weight during her one month stay; she attended all the group sessions, family sessions, and gym exercise sessions. She agreed not to have contact with any friends who had provided drugs to her. The agreement was for both her inpatient stay and when she went to teen residential therapy. 

Soon all the kids in the hospital with her were noted following her around like little ducks. Her leadership and compassion blossomed. She became aware of how much worse other kids’ families and situations were compared to hers. Her empathy and leadership contributed to the group sessions. She became very grateful for her family and friends. 

The psychological care unit explained the need for limiting visitors to those not associated with Kristin’s drug abuse. The doctors requested Kristin’s parents give them a list of visitors they thought would be appropriate. Her parents suggested her visitors be limited to “old fogies,” family friends, and Kristin’s favorite youth minister and his wife. Kristin chose to welcome her visitors even though most of them weren’t her age, and she made the best of the situation. Kristin left the hospital psychological care unit right on time after 4 weeks and taking only one medication—her Lexapro SSRI antidepressant. 

 

Residential unit, counseling and moving back home 

 

Kristin moved into the residential psychological care ward for teens and began attending a new summer high school half of the day and participated in counseling sessions half of the day. Her parents attended parenting classes throughout both her inpatient therapy and outpatient therapy. Kristin was gracious about and complimentary of the entire program. After 1 ½ months in the outpatient residential unit, Kristin moved home and continued counseling at the same unit with multiple weekly outpatient visits. She completed every course she needed for her junior year of high school. She was back on her own high school sport team by winter and competed in winter sports her senior year. 

 

Senior prom and graduation and winter sports university scholarship 

 

Kristin attended her hometown high school senior class dinner and dance.

She proudly marched across the football field at graduation ceremonies with the rest of her winter sports team and classmates at her own high school. Even though she had missed competing her junior year in high school, Kristin had achieved great success athletically. She filled out applications for academic and winter sports scholarships to universities and was well rewarded with a full athletic scholarship to a college near fantastic winter slopes. 

 

 

College dorm food 

 

As a freshman in college, Kristin competed on the university winter sports team, greatly enjoyed her classes, and worked part time as a private tutor. She maintained great grades. Like many other freshmen eating dorm food, Kristin gained 10 pounds in her first 6 months at college. Her coach told her she needed to lose weight. She moved out of the dorm to share a home with her girlfriends and teammates to better control the quality of food she was eating. The plan she had was to eat “live foods” for strength, stamina, and weight control. Kristin studied BATON Diet. She adopted portions of the nutrition program for athletes and especially the section Eat Right for Your Circadian Type. She trained intensely on the mountain slopes and in the gym. She dropped the 10 pounds by spring. She was strong and her figure was perfect for water skiing and swimming in the ocean on her spring break trip. Her favorite power food was sprouted almonds. Kristin was selected to participate in winter sports “Nationals,” only this time she participated as a college student. 

Sweet! Blessing! Here is a text Kristin wrote to her family during this time. 

 

 

"The trip was awesome! It’s such an unexplainable feeling to just surf across the powder, nothing else even comes close. I had a really good weekend being silly with my friends, which is good cuz school’s going to be pretty stressful when I get back. I’m so happy right now in my life Mommy! I can’t thank You and Daddy enough for everything you’ve done for me. Thanks to you and God, I’m living my DREAM life. Will send you pix this afternoon. I love you and miss you."

 

 

It has been more than 7 years since Kristin suffered her deepest depression before graduating from high school. She competed in skeleton as a member of the university winter sports team and graduated from the university with a degree in aerospace engineering. 

After taking her only drug, Lexapro (escitalopram), for 3 years, and avoiding recreational and OTC drugs, she decided she might feel even better and “more herself” if she could wean off the Lexapro. 

She had a few false starts when she tried to reduce the dose too fast. Then she read some blogs from people who had gone much slower in reducing their doses. It took her 6 months to wean off slowly, and now she has been doing well for 5 years. 

She applied to graduate school and enrolled in a 5-year doctoral program. She has chosen a program that includes some international studies. She has exercised daily without fail, claiming the investment is worth it because it clears her mind and lets her get a healthy sleep. 

While she loves winter sports and still participates for recreation and fun, she is truly fascinated by her studies and wants to concentrate on them. The winter sports travel schedule conflicted with her post graduate study plans overseas. Her intrigue with her post grad studies became her focus. 

Kristin grew strong, grounded in her faith, and enjoyed her family, new boyfriend, and studies. 

As Kristin showed us, having a happy outlook on life, strength, peace of mind, and a great figure are best approached through a healthy lifestyle, eating live foods, focusing on spiritual transformation, being a friend, working with doctors to address side effects, and appreciating beauty and people, rather than trying to self-medicate through dangerous drugs. 

In this next section of the chapter, we will explore ineffective and sometimes dangerous gimmicks and herbs used for weight loss, look at antidepressant medications in more detail, and answer some principal questions about these topics. 

 

Principal Question 3: 

3. What are some possible the consequences if physicians and caregivers underestimate the importance of weight gain as a drug adverse effect in teenage girls? 

A. Self-medication for weight loss 

B. Loss of self esteem 

C. Deepening of depression and increase in suicidal tendency 

D. All of the above 

The answer is all of the above. 

 

Typical medical care may not place much importance on weight gain as an adverse effect and its impact on the larger picture of managing a case like Kristin’s. 

Kristin tried working with her first doctor and reported the weight gain to him. However, rather than hearing how devastating Kristin’s weight gain was to her and working with her to find a solution, she was told by the provider that her complaint was not that valid, considering the drug was working to help her depression. Her doctor did not take her complaint seriously. He did not switch her antidepressant, offer a nutrition program, or special exercise program, or consider alternatives with her. The doctor did not suggest that she weigh herself weekly and report changes so they could work together to solve the weight gain problem. 

In effect, he did not address the whole patient. Had her doctor taken the importance of weight gain in an athlete (or any person) seriously and offered her options, Kristin may not have resorted to the self-medication steps she took to manage her weight gain on her own. 

Some of her attempts to help herself turned out to complicate her care, deepen her depression, and to be dangerous steps given her medication and diagnosis. 

If weight gain is not addressed to your satisfaction when taking an antidepressant drug, you may consider getting a second opinion. 

 

Principal Question 4: 

4. Is there an association between depression and overweight / obesity? 

The answer is yes. 

 

Nearly a quarter of obese Americans say they have been diagnosed with depression, a significantly higher percentage than normal weight people. 

23.2% of obese adults report having been diagnosed with depression, compared to 

14.9% of people who are overweight, 

14.3% of people of normal weight, and 

19.1% of underweight people. 

Gallup-Healthways Well-Being Index. Sept. 24, 2010. 

The survey also said that more than one in four American adults who are obese are considerably more likely than people who are a normal weight to report experiencing negative feelings of stress, worry, anger, and sadness. 

Depression is strongly and consistently associated with obesity, less physical activity, and higher food intake in middle aged women. (1859) 

Does the weight gain associated with drugs used for depression put us at further risk for other medical conditions?

 

Compared to the general population, depression is twice as common in people with diabetes. People with depression and diabetes have poorer health outcomes. Moulton C et al, 2015 Lancet Diabetes and Endocrinology (2020). 

Risk of developing diabetes doubled if more than 200 doses of commonly prescribed antidepressants were taken for depression without signs of severe depression. Risk of developing diabetes tripled if a person took more than 200 doses of antidepressant for depression and had signs of severe depression compared to people who did not have depression and who were not taking a drug for depression. This large study in Finland of 151,347 working men and women reported antidepressant users also gained weight (p<0.0001). (2192) 

 

“If you want to make someone diabetic, then make them obese!” 

-Dr. R. Leiblel, Head of molecular genetics at Columbia University 

 

 

Fad Weight Loss Products and Prescriptions 

 

Raspberry ketone 

Fad weight loss herbs, natural products, and prescription drugs can be dangerous and ineffectual means to weight loss. 

Dr. Oz called raspberry ketone a “miracle fat burner in a bottle.” It is purported to help fat metabolism. His claim was that taking 100mg with breakfast helps burn fat and now it is flying off the shelves. This is another of the “take something extra and the weight drops off” fantasies. 

The thing that gives raspberries their smell is raspberry ketone. Raspberry ketone is used as a flavoring agent and a fragrance in cosmetics. Safety is a question—it is safe in small amounts in foods and cosmetics—but higher doses have not been tested in humans. 

Even though it is called “natural,” raspberry ketone is usually made in a lab and not from real raspberries. Raspberry ketone’s structure is like synephrine. Raspberry ketone can raise heart rate and blood pressure. The FDA (US Food and Drug Administration) has received reports of heart palpitations and reduced effects of Coumadin (warfarin) blood thinner drugs from people taking raspberry ketone products. 

Our advice is to steer clear of raspberry ketone supplements. 

 

HCG (Human Chorionic Gonadotropin) 

The FDA (Food and Drug Administration) has taken some OTC (over the counter) weight loss products off the market. The FDA is also concerned about HCG (human chorionic gonadotropin), especially the homeopathic products. Human chorionic gonadotropin (HCG) isn’t an approved homeopathic. The FDA has banned the use of injectable HCG for weight loss. 

Some weight loss clinics are giving prescription HCG injections along with a very low calorie per day diet of only 500 calories that is very high in protein. This use of HCG is counter to FDA rulings for HCG. 

The clinics’ claim is that HCG helps burn fat and maintain muscle, but there is no scientific evidence to support this claim. Instead, the FDA specifically requires that HCG be labeled to say it doesn’t work for weight loss. Using HCG for weight loss is linked to serious health problems including blood clots, depression, heart attacks, and even death. 

 

High-protein low-calorie diets 

Likewise, the high-protein low-calorie diets usually prescribed with HCG (human chorionic gonadotropin) have been proven dangerous because they are clearly associated with intractable (untreatable) irregular heart rhythms that can cause death even in young people. 

 Any weight loss with HCG is most likely due to the very low 500 calories per day high protein diet. Losing weight too rapidly can cause gallstones, electrolyte imbalances, and irregular heart rhythms that can be resistant to the drugs used in the emergency room. 

The HCG products, and the products that contain amino acids that are supposed to stimulate HCG production, have not been shown to help people lose weight. 

Our advice is to steer clear of both homeopathic and injectable prescription HCG for weight loss. 

 

Principal Question 5: 

5. What are some of the popular methods teens turn to for weight loss? 

A. Seeking prescriptions for ADHD (attention deficit hyperactivity disorder) or receiving or purchasing these medications (prescription forms of “speed”) from friends 

B. Throwing up 

C. Purging with laxatives 

D. Taking speed (illegal amphetamines) including meth (methamphetamine) 

E. Using natural products with the stimulant ephedra, also known as ma huang 

F. HCG (Human Chorionic Gonadotropin) and a high protein diet 

G. All the above 

The answer is all the above. 

 

 

Principal Question 6: 

6. What are some of the common side effects of the ADHD drugs, ephedra, (ma huang also known as Ma Huang Tang) and ephedrine when they are used by teens to lose weight? 

A. Inability to sleep or disturbed sleep 

B. Personality changes with tendency to become withdrawn or introverted yet monopolize conversations, emotional instability (emotional lability) and aggressive behavior 

C. Increased heart rate and blood pressure 

D. Increased risk of strokes and heart attacks 

E. All the above 

The answer is E. All the above 

 

 

Principal Question 7: 

7. What are some of the products teens turn to for treating the unwanted side effects, such as inability to sleep, due to their weight loss products like ADHD amphetamines and ephedra products? 

A. Take a benzo (benzodiazepine) prescription sleep medications (Ativan, Xanax, Valium, and others) 

B. Take imidazopyridines for insomnia [Ambien (Zolpidem), Lunesta (eszopiclone)] a sister family of drugs that act similarly to benzodiazepines. 

C. Buy OTC sleep aids with antihistamines that are associated with weight gain. 

D. Smoke marijuana 

E. Practice sleep hygiene including relaxing at 9 pm and lights out at 10 pm. 

F. All the above. 

The answer is F. All the above. 

 

 

Principal Question 8: 

8. How can the products chosen by teens for weight loss, and the products they take in addition to combat the side effects of weight loss products, like inability to sleep, combine to create the perfect storm that frequently deepens depression? 

 

Amphetamine prescription drugs for ADHD, illegal amphetamines, and ephedra each make it hard to sleep. The drugs commonly used for depression that raise serotonin levels SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin and norepinephrine reuptake inhibitors), and some antipsychotic /mood stabilizing drugs for depression also can cause sleeplessness, thus further adding to difficulty with sleeping. When most drugs for depression are taken alone without amphetamines or ephedra, then careful fine tuning of the dose of the antidepressant to the lowest amount needed for treating the depression usually allows for normal sleep without the need for sleeping pills. If ADHD drugs, amphetamines, or ephedra are taken for weight loss along with drugs for depression, not being able to sleep often becomes a problem. 

The issue with prescription sleep medications is that they are linked to causing significant depression, injury accidents, and increased risk of death. (756, 757) Because sleep medications are depressants, the sleep medication can “undo” a lot of the antidepressant effect of drugs used for depression and thus lead to even deeper depression. This is the reason that doctors try hard to use the lowest effective dose of antidepressant so sleep medications are not needed. Good sleep habits of resting without back lit light sources like computers, TV, phones, or any bright lights by 9 PM and lights 

out by 10 PM are recommended. These healthy sleep habits are part of sleep training while taking antidepressants. What are the side effects and risks of the most common medications and drugs used to treat sleeplessness and anxiety? 

Benzo (benzodiazepine) sleep medications (Ativan, Xanax etc.) are downers and are officially classified as depressants. They usually worsen depression, slow reaction times, increase risk of accidents and death, and are psychologically addicting. (756) 

Ambien and Lunesta share the same side effects as benzos. 

OTC sleep medications can add to weight gain because they contain antihistamines which cause weight gain. 

Marijuana is a downer, is a depressant drug, and typically worsens depression. 

 

Principal Question 9: 

9. SSRI antidepressants may cause sleeplessness. What is the preferred therapy for this side effect? 

 

The university psychological care treatment program’s choice was to use the lowest dose of SSRI antidepressant that worked for the depression and thus reduce the side effects of sleeplessness and weight gain related to SSRI. Sleep hygiene requires discipline but is considered the best and safest therapy when combined with carefully tuned doses of antidepressants. Studies show bright lights prevent sleep including back lit electronic devices. The suggestions are to dim room lights at 9 PM and turn off phones, text, computers, TV, lower music volume, then read an enjoyable physical copy of a book as opposed to e-book for 30 to 60 minutes prior to “lights out” at 10 PM. The time of day that we eat profoundly impacts sleep and circadian rhythm. We refer you to BATON Diet the section Eat Right For Your Circadian Type for details. 

 

Principle Question 10: 

10. How well do drugs for depression work? 

 

Effectiveness of drugs for depression. 

 

A review of 3 large meta-analysis (2286-2288) studies revealed that most (if not all) of the advantages of taking drugs for treating depression and anxiety are due to placebo effect (the same effect as taking “fake pills” or placebo pills). (2285) Further a book The Emperor’s New Drugs: Exploding the Antidepressant Myth included data from the three meta-analysis studies. (2289) While intense controversy remains in this debate, the data from all the meta-analysis studies published to date report the same results – the effectiveness of drugs for depression appears to be equivalent to taking placebo (no drug therapy or fake pills). (2285) “This is also true of recent meta-analysis of all the antidepressant data submitted to the Food and Drug Administration (FDA) in the process of seeking drug approval.” Irving Kirsch, Harvard Medical School, 2019 Front Psychiatry (2285) Other therapies 

like exercise and psychotherapy produce the same “benefits” as drugs for depression and do so without side effects and health risks of taking drugs. (2285) 

 

How well drugs for depression work remains controversial. 

 

While there is literature based on observation and experimental results that indicates medications for treating depression may work, these drug’s effects on overall wellbeing and health related quality of life (HRQoL) remain controversial. It is known that depression has a strong impact on a person’s health related quality of life (HRQoL). A study published In 2022 was done to find the effect of drugs used for depression via patient reported health related quality of life (HRQoL) in people with depression between the years spanning 2005 to 2016. (2282) Two groups of people who were diagnosed with depression were compared. People who took medications for depression were compared to people with depression who did not take drugs for depression. The data was from the US Medical Expenditures Panel. No significant differences in the mental component summaries (MCS) or physical component summaries (PCS) were found between those who took medications for depression and those who did not. These results remained robust after multivariate D-I-D analysis (difference in differences analysis) ensuring the results of the study. (2282) 

In the US, 17.5 million adults are diagnosed with depression each year. (2282) About 17.3 million US adults had at least one major depressive episode in 2017. (2283) More than 2 out of 3 people diagnosed with depression were females. Six out of ten women with depression received an antidepressant. Overall, 85% of the 17.5 million people diagnosed with depression each year between 2005-2016 received a drug for depression. (2282) 

 

The patient’s point of view 

 

Patient reported health related quality of life (HRQoL) was not improved by taking drugs for depression. “No improvement was seen in our long term follow up (more than one year) with the use of antidepressant medication on either component of the HRQoL.” (2282) There is no persisting impact for these medications on patient’s quality of life. Future studies should include health related quality of life (HRQoL) because it represents the patient’s point of view and the patient’s perspective. The real-world effect of using drugs for depression does not change the most important outcome which is health related quality of life (HRQoL), the results were the same in people who took drugs for depression and in those who did not take drugs for depression. (2282) 

 

What about using antipsychotic drugs for depression? 

 

In another study the use of antipsychotic medications to treat depression was found to be less effective than use of antidepressant medications when the drugs were given alone without simultaneous clinical psychotherapy treatments. (2284) 

 

What about psychotherapy alone?

 

A review article that included three meta-analyses was completed for the purpose of comparing between placebo, psychotherapy, and antidepressants. The review showed that there was no statistically significant difference between placebo treatment and psychotherapy; patients who were receiving either placebo or psychotherapy showed lower relapse rate than those who were on antidepressant medications (2285).

 

Principal Question 11: 

11. Which concerns are the most important with natural products that contain ephedra, (ma huang)? 

A. Too rapid weight loss 

B. Temporary weight loss 

C. Depression of the immune system 

D. Rapid heart rate and pulse 

E. Death 

F. All of the above. 

The answer is F, all of the above. 

 

Ephedra and ma huang are natural products that contain ephedrine, which is a stimulant. Ma huang and ephedra can cause significant suppression of the immune system and can raise heart rate thus placing extra stress on the heart. People who take these natural products can complain of infections that they cannot shake even while taking antibiotics. They become susceptible to infections and stress. 

Some people have died while taking ephedra/ma huang due to heart effects and stress on the heart, therefore the FDA (Food and Drug Administration) required the food supplement products containing ephedra (ma huang) be removed from the market. 

Women who have experienced weight loss with ephedra are often reluctant to give up its use even when they are counseled that it is negatively affecting their overall health. The other concerns listed in the question are also possibilities. 

 

Principal Question 12: 

12. Is ephedra still available in the U.S.? 

A. Yes 

B. No 

C. Under certain conditions, but not as a food supplement 

The answer is C: Under certain conditions, but not as a food supplement. 

 

Prior to 2004, ephedra, also known as a Chinese botanical, ma huang (Ma Huang Tang), was sold as an ingredient in weight-loss and energy supplements used to enhance athletic performance. In 2004, ephedra and ephedrine were banned from use as a dietary supplement by the FDA in the US. Ephedra and its plants compounds were banned from sales as a dietary supplement because of several deaths and other serious side effects and the potential for abuse. Ephedra may also be used as a precursor in the illicit manufacture of methamphetamine. (774) A wide variety of alkaloid and non-alkaloid compounds have been identified in various species of ephedra. Of the six ephedrine-type ingredients found in ephedra the most common are ephedrine and pseudoephedrine. (776) 

Ephedrine is listed as a banned substance by both the World Anti-Doping Agency and the International Olympic Committee. (770) 

Ephedra is also banned by the National Basketball Association. (769) The National Football League banned players from using ephedra as a dietary supplement in 2001 after the death of Minnesota Vikings offensive tackle Korey Stringer. Ephedra was found in Stringer’s locker, and lawyers for the team contended that it contributed to his death. (765) (771) 

However, ephedra remains widely used by athletes. In 2006, a survey of collegiate hockey players found that nearly half had used ephedra, believing it enhanced their athletic performance. Ephedra popularity continues despite a lack of evidence that it improves athletic performance. 

Ephedrine and pseudoephedrine stimulate the brain, increase heart rate, increase blood pressure (constrict blood vessels), and make breathing easier (expand bronchial tubes). Their temperature raising (thermogenic) properties cause an increase in metabolism, as evidenced by an increase in body heat. 

Ephedrine is still available. Products like Primatene and Bronkaid for treating asthma and breathing issues are still sold in pharmacies, but sales are limited by regulations. The ephedrine available is synthetic, manufactured in the laboratory and sold and regulated as a drug, not as a dietary supplement. Ephedrine is currently sold primarily as a bronchodilator for use in asthma and other disorders that cause tightening and spasms of the bronchial tubes, which make breathing difficult. 

Medications containing any form of ephedra or ephedrine should be taken only under the supervision of a physician. 

 

 

How do SSRI antidepressants cause weight gain? 

 

Simply, serotonin is thought to play a role in mood, and brain levels are low in many depressed people. SSRI drugs that treat depression raise serotonin levels in the brain. SSRI is the abbreviation for selective serotonin reuptake inhibitor. While increased levels of serotonin may reduce appetite other effects of SSRI antidepressants may prevail resulting in weight gain as described below.

 

Mechanisms of net weight gain with SSRI antidepressant drugs may include: 

 

1. Carbohydrate craving secondary to blocking of histamine effects. 

2. Blockade of histamine effects leading to increased appetite. 

3. Serotonin levels may rise in the synaptic cleft between nerves and reduce appetite. 

 

Clinical Point 

SSRI antidepressants cause increased carbohydrate (carb) intake, carbohydrate craving, and hunger. (58, 2178) 

Serotonin is the hormone that is most often manipulated (increased) with drugs in depression treatment. Serotonin helps regulate appetite and carbohydrate intake usually reducing intake of both. (58) 

SSRI antidepressants block histamine receptors leading to increased appetite. (58) 

Taking SSRI antidepressants leads to an undesirable type of weight gain because eating extra carbohydrates causes weight gain as fat, not muscle weight gain. (58, 2178) 

Most SSRIs, like Prozac, are associated with short-term temporary mild weight loss followed by long-term weight gain. (49, 58, 105, 149, 2187) 

 

Researchers had high hopes that SSRIs would not cause weight gain because other shorter acting drugs that stimulate serotonin receptors had an acute short-term anti-appetite (anorexic) effect. For example, Fen-phen, the weight loss drug combination of fenfluramine/phentermine, that led to so many class action lawsuits, and was removed from the market, was as a serotonin receptor stimulator. 

SSRIs do cause weight gain. This “paradoxical effect” (2178) is not completely understood, though it likely has to do with the complex interaction between serotonin and other appetite regulating mechanisms, including effects on histamine receptors known to control appetite and carbohydrate craving. Weight gain from SSRI use reflects on these medications’ multiple serotonin effects and histamine effects. SSRIs appear to up-regulate carbohydrate intake and can increase food intake. 

SSRIs allow serotonin to stay active longer, contributing to enhanced mood in many people. But this very action is what is thought to potentially be one cause leading to the weight gain. SSRI and SNRI antidepressants are thought to increase the concentration of serotonin in the synapse (space) between nerves. One theory that has been reported is this potentially might result in SSRI and SNRI drugs blocking 5-HT2c (serotonin) receptors in a manner similar, but to a lesser degree, than the second generation antipsychotics (SGAs) that cause significant weight gain. (58, 2204) Weight gain from SSRI use encompasses these medications’ many serotonin and antihistamine effects. Serotonin appears to regulate appetite and carbohydrate intake (58, 2204). Disturbed serotonin signaling is associated with obesity. (2203). SSRIs block histamine and SSRIs have antihistamine effects. (58) Histamine blocking causes increased appetite and results in weight gain. Sussman et al. (2001) found that 17.9% of people treated with SSRIs gained more than 7% of weight in a pooled analysis. (149) Significant weight gain was also seen after long-term treatment with paroxetine (Paxil), another SSRI; it was found to cause greater than 7% weight gain 25.5% of people. 

 

How other families of antidepressants cause weight gain 

 

SNRI (Serotonin Norepinephrine Reuptake Inhibitor)

These Antidepressants cause variable weight loss and weight gain via some of the same paths as the SSRI antidepressants discussed in Kristin’s story. They raise serotonin levels and block histamine like SSRIs. (58) SNRI and SSRI families of antidepressants cause carbohydrate craving. They cause blockade of histamine receptors increasing appetite and they stimulate serotonin receptors which is expected to reduce appetite. 

 

TCAs (Tricyclic Antidepressants)

25% of people who take a tricyclic antidepressant gain more than 7% weight. (149) Antidepressant treatment with TCAs causes weight gain by mechanisms that are largely independent of their action on mood (100). TCAs influence appetite because they have antihistamine effects—blocking histamine histaminergic (H1) pathways. Drugs with high affinity for blocking histamine H1 receptors have been associated with carbohydrate craving and low satiety rates that allow increased calorie intake. Other studies indicate TCAs block differing ratios of serotonin and norepinephrine reuptake pumps, resulting in postsynaptic serotonergic and adrenergic receptor desensitization and later, down-regulation. TCAs with higher serotonin reuptake blockade may increase weight through this desensitization. (58) Tricyclic antidepressants (TCAs) have antihistamine, antimuscarinic, and alpha adrenoceptor-blocking actions; all of these can contribute to weight gain. (57, 58) 

 

TNF-α (Tumor Necrosis Factor alpha).

Obese persons have increased plasma levels of TNF-α and its soluble receptor (sTNF-R), which may induce insulin resistance. Activation of the TNF-α system, may promote weight gain by drugs like Elavil (amitriptyline, a TCA antidepressant) or Remeron (mirtazapine), a NaSSA / alpha-2 agonist antidepressant. (58) 

 

NaSSA drugs -- Remeron (mirtazapine)

Mirtazapine increases release of serotonin and blocks H1 histamine effects. It is not a reuptake inhibitor. This increases serotonin levels in the synapse. Remeron (mirtazapine) also has noradrenergic activity thus it blocks alpha 2 receptors. This indirectly enhances serotonin 1a (5HT1a) nerve stimulation. Remeron (mirtazapine) is a potent antagonist of 5HT2c serotonin receptors, and 5HT3 serotonin receptors. (2208) Blocking of histamine H1 receptors and blocking (antagonizing) 5HT2c serotonin receptors results in weight gain, mirtazapine’s most reported side effect. The mechanism is similar to that seen with the SGA (Second Generation Antipsychotic) olanzapine. Weight gain can be impressive with this antidepressant and can lead eventually to development of Type 2 Diabetes. (57, 58) Mirtazapine is associated with an average weight gain of 5.28 pounds in 4 weeks and an average of increase of 35.2 pounds in 5 months (28). However, another controlled study showed only an average gain of 3.3 pounds in 2 years versus placebo (no drug) (700, 720). A third study found 22.2% of people treated with NaSSA antidepressant drugs experienced weight gain exceeding 7% of their body weight. (149) 

 

MAOI Antidepressants

MAOI antidepressants cause impressive weight gain in a similar manner to some of the SGAs (Second Generation Antipsychotics), which are the subject of chapter 4. 

 

How many people gain weight and how much is the weight gain? 

 

7% Weight Gain 

The US Food and Drug Administration (FDA) defines significant weight gain associated with a drug as when weight gain is greater than 7% of a person’s weight before drug treatment.

Significant weight gain was seen after long-term treatment with paroxetine (Paxil), an SSRI, and Mirtazapine (Remeron), an NaSSA (25.5% of people gained more than 7% weight). A pooled analysis study found in the longest-term portion of the treatment: 

17.9% of people treated with SSRI drugs for depression experienced weight gain exceeding 7% in the long-term phase lasting 16 to 46 weeks in a pooled analysis. Sussman et al. 2001 (149).

22.2% of people in the NaSSA antidepressant drug family treated group experienced weight gain exceeding 7% in the long-term phase lasting 16 to 46 weeks. (149)

25% of those in the TCA (tricyclic antidepressant) family drug family treated group experienced weight gain exceeding 7% in the long-term phase of 16 to 46 weeks. (149)

 

What can I do about it? 

 

Alternatives: These should be discussed with your doctor. Some SSRI antidepressants may cause less weight gain than others in certain individuals, and sometimes switching to an alternate SSRI may be discussed with your doctor. You may refer to the Relative Weight Gain for Drugs used for Depression graph in this chapter and in Appendix B to look for alternative prescriptions and families of antidepressants you may discuss with your healthcare provider. You may also look at the Weight Gain Drugs Table in Appendix A to see at weight gain associated with specific drugs. 

Up to 25 percent of people who take certain antidepressant medications report gaining weight, and sometimes a significant amount—more than 7% weight gain or as much as 100 pounds in rare cases. Generally, the effect is more likely to occur after taking medication for six months or longer. (2206)

Most antidepressants can cause weight gain, and different drugs affect individuals differently. You may gain weight on one antidepressant but not on another, even if the second is known to cause weight gain in some people. Mayo Clinic psychiatrist Daniel K. Hall-Flavin, M.D. says some of the drugs that may be least likely to lead to weight gain are Effexor (venlafaxine) and Serzone (nefazodone), while Wellbutrin (bupropion) tends to cause weight loss. One of the antidepressants that seems most likely to cause weight gain is Paxil (paroxetine), an SSRI (selective serotonin reuptake inhibitor). 

 

Losing the extra pounds gained while taking antidepressants is not always easy. 

 

Your healthcare provider may switch to another antidepressant associated with less weight gain. Alternatively, they may recommend a nutrition plan to mitigate the weight gain that is compatible with your treatment. Exercise may be added to the depression therapy program because it has been shown to be effective to reduce depression and it will help build muscle and may even assist with burning calories. You may explore with your physician the possible use of BATON Diet to assist with preventing carbohydrate craving.

 

Clinical Point

If we need to take an antidepressant drug, we can weigh ourselves at home at least weekly in the morning and report gains greater than 5 pounds to medical providers.

Another possibility is that when the antidepressants are effective, you become less depressed and regain your appetite. However, this would only apply in cases where loss of appetite is a symptom of depression. Overeating can also be a symptom of depression that can cause weight gain regardless of taking antidepressants. 

Unwanted weight gain due to antidepressant use is rarely mentioned as one of the causes of the obesity epidemic. However, it could be a significant contributor since these drugs are now among the most prescribed pharmaceuticals in the United States. More than 1 in every 10 people in the U.S. takes an antidepressant drug. (U.S. Centers for Disease Control). In 2005, there were 27 million Americans aged six and older who were taking antidepressant medications. The graph on the next page describes the relative weight gain associated with antidepressant drugs. 

 

 

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