December 29, 2023

Teen Attempts to Combat Weight Gain and Sleeplessness from Drug for Depression

Depression

Blog 3

Kristin's Story is continued from Blog 3 on Depression

Kristin finally told her parents she had stopped the Prozac (fluoxetine). She realized she needed the drug, at least for now, and let her parents take her back to the doctor and help her explain her problem with the drug. Her doctor wanted her to continue with Prozac because she had responded well, and he told her the weight gain had to be something that took second precedence. 

 

Borrowing prescription ADHD “Speed” at school 

 

Back on her Prozac SSRI, Kristin started back to school, and rejoined winter sports events. She began secretly using over the counter (OTC) laxatives, including MiraLAX, to cause diarrhea to try to lose weight, but this didn’t help. She continued to gain weight; feeling desperate, she sought help from her friends at school. 

Kristin’s high school was in an affluent resort ski community. Many of her friends went to the doctor and claimed to have trouble concentrating in school, citing symptoms of ADD (attention deficit disorder) or ADHD (attention deficit hyperactivity disorder) so they could get prescriptions for “legal amphetamines,” also known as “legal speed” or “legal meth.” These prescription stimulant drugs are normally used to treat ADD/ADHD. 

Kristin’s girlfriends told her the ADHD amphetamine prescriptions worked great for weight loss, curbed their appetites, and made school more interesting. Her friend offered her some of her Adderall XR. Adderall XR is a mix of amphetamine and dextroamphetamine. The XR means it is long acting and lasts 24 hours. 

Kristin’s weight loss thrilled her! It was exactly what she wanted, and she could see the difference in how her pants fit in just 2 weeks. 

 

 

Kristin’s friend later offered to sell her more Adderall XR if she needed it, and Kristin took her up on the offer. Kristin had turned 16 and could drive. She had plenty of money because she worked part time in the evening as a waitress in an exclusive restaurant for visitors in the ski resorts. She was cute and her tips were great, so she had plenty of income at her disposal. 

 

“Sleepless in Seattle” 

 

At first, Kristin noticed only one problem with the Adderall XR she was taking (without a prescription) for her weight loss: it really kept her awake. She hadn’t been sleeping much before with the Prozac and now it was worse. Before starting the Adderall XR, she had routinely come home from work at 10:00 PM, eaten a snack, gone to bed at 11:00 PM or midnight, and been up by 6:00 to hit the mountain with her sports team for practice. She was truly “Sleepless in Seattle.” Exhaustion was beginning to wear on her nerves, and she found herself getting angrier easier. 

 

The ADD/ADHD amphetamine is an “upper.” 

 

The ADHD amphetamine drug increases the number of impulses in the nervous system and brain, making it hard to sleep. ADD amphetamine drugs are in the same family as speed, the illicit upper drug. Amphetamine drugs used to treat ADHD keep people awake and can aggravate anger. 

 

Out of character anger 

 

While Kristin was taking the Adderall XR, she had bouts of uncontrollable anger. When she would get angry at home, she would fly into a rage when things did not go her way, or she felt she lacked control of her life. During these rages, she threw a coffee mug at the television and kicked the front of a glass cabinet, shattering glass. When she felt that one of her brothers was receiving special attention or being favored in some way, she would hit him. 

Kristin’s anger reactions were new and are out of character according to her family, who shared the following about her: 

Her entire life Kristin has always been the sensitive, compassionate, and understanding sibling. Ever since when she was very young, she had always been concerned if another child fell on the playground. She would be there to help them get up and cheer them on. Her leadership talents combined with her serene peacefulness and flexibility had always made her an attractive leader on her team. 

The Adderall XR Kristin bought from her friend increased her adrenalin levels and made it hard for her to control her anger, disappointments, and aggression. However, Kristin did not tell her family or her psychiatrist about the Adderall XR she was getting at school, so everyone was puzzled by her extreme and sudden change in behavior.

 

 

Slow improvement

 

As is typical for SSRI antidepressants, Kristin’s Prozac (fluoxetine) took effect slowly over a period of weeks. 

 

Sadness 

 

Before the full benefit of Kristin’s SSRI drug for depression kicked in, her boyfriend, Robert, attended an end of school year graduation party. Kristin was unable to go to with him because of family obligations. Robert drank too much and ended up in bed with another girl. Robert later told Kristin what had happened. She was devastated because she was a virgin and had been saving herself for him. They parted ways for three days. 

 

Travel and the screwdriver 

 

As a participant in winter sports, Kristin sometimes traveled with her team to destinations throughout Canada, the US, and other parts of the world. 

Kristin’s team rented condos where the team members, coaches, chaperons, and cooks stayed. 

Three days after Robert told Kristin about his infidelity, the winter sports team flew to Chile to train for and compete in their first of 3 summer camps for the season. 

Travel added additional stress to Kristin’s sports training with the team in addition to her stress from continuing to be sleepless on Prozac antidepressant and the Adderall XR she had “borrowed” for weight loss. Lack of sleep is a cause of increased aggression. 

(1158) Stimulants like Adderall XR and ADHD amphetamine prescriptions can also increase aggression and anger because they raise adrenalin levels. (1260) 

After two days of training on the Chilean slopes, Kristin was overcome by her sadness and disappointment in Robert. 

After dinner, Kristin walked out to the condo garage where Robert was tuning his skies to get ready for the next day of ski racing. She told him how disappointed and upset she was. As they talked, she flew into a rage. Without warning, she picked up a spare screwdriver and threw it at Robert. It narrowly missed his head and stuck in the wood post beside him.  

Kristin didn’t realize it, but the team coach and several other team members had witnessed the event. That evening, the coach called Kristin’s father and told him: 

“Bill, that daughter of yours has a great pitch. The screwdriver is still stuck in the post. And I am sure Robert had it coming, but you need to fly Kristin home tomorrow. She is expelled from the team for 45 days.” 

 

Marijuana for sleep 

 

Back home, disappointed in her outburst in Chile, Kristin described her

sleepless plight to a friend who had graduated and was now on the ski jumping team at the local university. Her friend told her he had found that smoking marijuana just before bedtime helped his sleep and offered to bring her some. 

 

Marijuana slows sports reaction times. 

 

Not recognizing that marijuana has similar slowing effects on sports reaction times as the “benzo” sleep medication she had previously been prescribed by her doctor, Kristin accepted the offer from her friend. She began to smoke the marijuana before bedtime, either outside the family home or in her car on the way home from work. At first it seemed to help her sleep. But the marijuana was not consistent. Plus, she started to like it and began using it frequently-almost nightly. 

 

Marijuana munchies 

 

Acute marijuana use is classically associated with snacking behavior (colloquially referred to as “the munchies”). A well-controlled residential study found even low dose THC increased food intake by 35% to 45% and decreased verbal interactions. Tolerance developed to feeling “high” but not to food intake or decreased verbal interactions. (1746) 

However, other studies found that people who use marijuana do not weigh more or have higher BMIs (Body Mass Indexes) than people who do not use marijuana. (1261, 1262) Chronic marijuana users have more fat tissue around their waistline, and more fat tissue insulin resistance, but normal response to sugar intake (glucose tolerance) and normal insulin sensitivity. (1262) It is more likely that Kristin’s weight gain was associated with her use of Prozac (fluoxetine) than with her marijuana use. 

 

Marijuana is stored in fat 

 

Marijuana is a fat-soluble drug, like most sleep medications. The brain is 50% fat. Marijuana tends to hang around in the brain and “get stuck” in the fat in the brain. (1644, 1660, 1661) Later, marijuana can leach out from the brain fat and be released unexpectedly at inconvenient times, like under the stress of athletic competition. 

 

 

Chronic marijuana use increases injury car crashes 9.5X 

 

As is the case with benzodiazepines, people who use marijuana have more car wrecks than people who have not taken the drug. Chronic marijuana users were 9.5 X (9.5 times) more likely to be involved in a car crash that resulted in death or injury requiring hospitalization in New Zealand (Odds Ratio (OR) 9.5, 95% CI 2.8–32.3). (1712) 

A meta-analysis in the United States of marijuana use by drivers revealed a significantly increased risk (2.66X) of being involved in motor vehicle crashes. (meta-analysis 1714) Motor vehicle crashes are the leading cause of death for young people in the United States. (1715) Marijuana can cause potential for sporting accidents in high-speed sports like skeleton racing. 

In the US and Europe, the concentrations of THC in marijuana cigarettes has risen sharply from 8.9% in 2008 to 17.1% in 2017. The average concentration of THC in hash oil increased from 6.7% to 55.7% from 2008 to 2017. Similar increases were seen worldwide. (1749) Popularity and sales of extracts of THC for inhalation are rising rapidly and typically contain at least 3X (three times as much) THC as cigarettes. In Washington state the average concentration of extracts was 68.7% THC. (1748) 

 

Marijuana and extreme vomiting (Cannabinoid Hyperemesis Syndrome) 

 

A perplexing new cycle of events began occurring in Kristin’s health. She began having severe bouts of unexplained nausea and vomiting accompanied by abdominal pain. Sometimes she could alleviate the nausea and abdominal pain if she soaked in a very hot bath. (158) She began taking lots of hot baths to try to control her nausea and stomach pain. Her mom found rings around the bathtub when she cleaned. Prior to this Kristin had always just taken a quick shower before she started her day and was off to winter sports and skeleton practice, school, or work. 

The cycle of hyper vomiting would last 2 to 4 days and then go away. All tests, labs, and X-rays were normal. Finally, on the 7th trip to the emergency room a doctor described a new syndrome being seen more and more often related to increased and chronic use of marijuana called Cannabinoid Hyperemesis Syndrome (CHS) or marijuana hyper vomiting. He said that with chronic use marijuana can cause perplexing and severe vomiting and that routinely prescribed anti-nausea drugs do not usually help much in the treatment. (1750) He commented that the hyper vomiting syndrome used to be considered rare but numerous reports and studies now suggest the contrary. (1636, 1640) Cannabis-induced hyperemesis in some people who chronically use cannabis has been well established. (Systematic review, Sorensen CJ et al, J. Med. Toxicol. 2017 (1640) In 2018 Cannabinoid Hyperemesis Syndrome was estimated to affect about 2.7 million Americans. (1692) 

 

1 in 3 heavy marijuana users have hyper vomiting symptoms (CHS) 

 

A survey study was done of urban ER patients who smoked marijuana 20 or more days a month. One third of the people who smoked 20 or more days per month, experienced CHS symptoms (Cannabinoid Hyperemesis Syndrome) or marijuana hyper vomiting. (1692) 

 

Cannabis cessation appears to be the best treatment. (96.8% effective) 

 

“Cannabis cessation appears to be the best treatment.” There is no other effective treatment. Stopping marijuana use is 96.8% effective. Sorensen, CJ et al. (2017) J. Med. Toxicol. (1640) The good news is that people with CHS have quit marijuana on their own or with assistance from health care providers (1644). “Anxious, irritable, and stomach pain” symptoms of withdrawal have been successfully handled by two weeks of assistance with drug therapy while living at home. By 28 days memory and cognitive tests scores showed virtually no differences from the time prior to marijuana use. There were no significant associations between cumulative lifetime cannabis use and memory test scores. (1711) 

The effects of marijuana related to CHS are described in detail in Appendix C (see table of contents). Potential drug interactions between marijuana and common medications like anti-depressants, anti-nausea medications, migraine medications, and pain drugs that can lead to Serotonin Syndrome are also included in Appendix C. Serotonin Syndrome may complicate treatment of CHS. Likewise, dehydration from Cannabinoid Hyperemesis Syndrome (CHS) can complicate treatment of Serotonin Syndrome. 

 

Kristin was not sure she believed the marijuana was the cause of her nausea. 

 

Kristin felt her marijuana was probably fine, so she tried smoking it again and vomited and ended up in the ER. Next, she switched to another supplier and marijuana variety, but most times she smoked, she developed severe vomiting lasting 2 to 3 days and had to go back to the ER. 

 

Yo-yo victim 

 

Kristin also began to yo-yo between her “uppers,” the ADHD speed drug she bought from her friend for weight loss, and her “downer” marijuana for sleep. She also began to yo-yo between the effects of her antidepressant SSRI Prozac (fluoxetine) and the depressant marijuana, depending on which drug she had the most of in her body at the time. 

 

Personality disorders and schizophrenia and marijuana 

 

Kristin’s doctors began to worry that she had some signs of a personality disorder or possibly bipolar disorder. Cannabis (marijuana) use is strongly linked to increases in both the manic and depressive symptoms of bipolar disorder, pure mania disorders, schizophrenia, and antisocial behavior disorder (sociopathy). Meta-analysis Marconi A, 2013 Schizophrenia Bulletin (1685), and (1684, 1716) Marijuana in high doses may worsen depression, (1697) Kristin’s key issue. 

Long-term and medium to high dose marijuana use is associated with nausea and cyclic vomiting in more people than was originally thought. (1636, 1640, 1692) Such use can contribute to an unclear medical situation that may involve other prescription drugs that may cause weight gain. Use of marijuana is not recommended in any event, but especially not in complicated medical situations. Please refer to Appendix C “The SKUNK in Sheep’s Clothing” for details about the above marijuana topics and other effects and drug interactions with marijuana.

 

To find out the beautiful ending of Kristin's story and how she became an overcomer please refer to Blog 5 on Depression.

 

 

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