Managing weight gain while taking psychiatric drugs

Although psychiatric medications can be important for improving mental health and well-being, they often come with unwanted side effects. One particular side effect of many psychiatric drugs is weight gain. In this article, we will look at how these medications cause weight gain and what you can do to reduce the effects of this unwanted effect of many psychiatric drugs.

What are the different types of psychiatric medications?

There are five main types of psychiatric prescription drugs: antidepressants, antipsychotics, anxiolytics (also known as anti-anxiety drugs, which may include sleep medications), mood stabilizers and stimulants. Stimulants are not likely to cause weight gain. Moreover, many of them reduce appetite and may cause weight loss as a side effect. These drugs will not be discussed in this article.

Antidepressants can be divided into separate classes:

• SSRIs, or selective serotonin reuptake inhibitors, increase serotonin levels in the brain.
• SNRIs, or serotonin-norepinephrine reuptake inhibitors, increase serotonin and norepinephrine levels in the brain.
• TCAs, or tricyclic antidepressants, increase serotonin, norepinephrine, and dopamine levels in the brain.
• MAOIs, or monoamine oxidase inhibitors, increase serotonin, dopamine, and norepinephrine levels in the brain.

Why do antidepressants cause weight changes?

All of these drugs increase serotonin levels in the brain. Serotonin regulates mood and affects appetite, but this can have different results depending on the length of treatment. Short-term use reduces impulsivity and increases satiety, which can reduce food intake and lead to weight loss. However, long-term use (more than a year) can cause a decrease in serotonin receptor levels, which subsequently causes cravings for carbohydrate-rich foods such as bread, pasta and sweets, which can eventually lead to weight gain. The antidepressants with the highest risk of weight gain are amitriptyline, citalopram, mirtazapine, nortriptyline, trimipramine, paroxetine, and phenelzine.

Why do antipsychotic medications worsen the course of obesity-related illnesses?

Antipsychotics can also be divided into two classes: typical and atypical antipsychotics. Both classes can cause weight gain, but they differ in that atypical antipsychotics cause fewer side effects related to movement disorders. Like antidepressants, antipsychotics affect chemical messengers in the brain associated with appetite control and energy metabolism, namely serotonin, dopamine, histamine and muscarinic receptors. In addition to weight gain, antipsychotics can disrupt glucose metabolism, raise cholesterol and triglyceride levels, and cause hypertension, which can lead to metabolic syndrome and exacerbate obesity-related diseases. The antipsychotics that most commonly cause weight gain are olanzapine, risperidone, and quetiapine.

What about anti-anxiety medications and weight changes?

There is no clear link between traditional anti-anxiety medications, such as benzodiazepines, and weight gain. However, many antidepressants are also used to treat anxiety and can cause weight gain, as discussed above.

Also, not all sleep medications cause weight gain; one that has been linked to weight gain is diphenhydramine (the active ingredient in Benadryl, which is also used in many over-the-counter sleeping pills). Diphenhydramine can contribute to weight gain by causing increased hunger and fatigue, which can make a person less active. Other sleeping pills, such as zolpidem (Ambien) or eszopiclone (Lunesta), have not been associated with weight gain.

Trazodone, a medication used to treat depression as well as insomnia, reduces excess serotonin at some sites while increasing serotonin levels at other sites, which affects appetite, as discussed earlier.

Mood stabilizers are often used to treat bipolar illness; they may increase appetite or cause changes in metabolism. Although some antidepressants and antipsychotics are also used to treat bipolar illness, mood stabilizers such as lithium, valproic acid, divalproex sodium, carbamazepine, and lamotrigine are mood stabilizers commonly used to treat bipolar disorder, and, with the exception of lamotrigine, all are known to increase the risk of weight gain.

There are effective strategies to minimize weight gain

For people on psychiatric medications for mental health, there are strategies to minimize weight gain. Optimizing lifestyle and daily habits is very important. This includes eating a healthy diet using whole foods and limiting processed foods and added sugars, being physically active, minimizing stress and ensuring adequate restful sleep. Physical activity, in particular, can have the double effect of improving mental health and minimizing the weight gain that might otherwise occur. Cognitive and behavioral strategies led by a psychologist can be helpful to resist increased cravings for sweets and carbohydrates.

Another strategy for minimizing weight gain is to work with your doctor to determine if there may be a suitable alternative medication option with a lower risk of weight gain. In addition, the antidiabetic drug metformin has been shown to be effective in treating and preventing weight gain caused by psychotropic drugs. Other medications prescribed for weight loss may also be appropriate to combat weight gain caused by psychotropic medications.

Keep in mind that almost all medications have risks of side effects, and it is important to make sure that the benefits of taking any medications outweigh the risks. Consulting with your doctor, psychiatrist, or obesity specialist can be helpful in determining which options may work best for you.

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