Antidepressants and weight gain

If you're coming directly to this blog instead of linking through my website, you may be interested in a chart I have posted on that website, listing references referring to antidepressants and their potential for causing weight change (gain or loss). This particular chart ONLY covers antidepressants, but it is a very popular page and I wanted to let you all know about it.

The medications included to date are: Celexa/citalopram, Cymbalta/duloxetine, Effexor/venlafaxine, Elavil/amitryptyline, Ludiomil/maprotiline, Nardil/phenelzine, Norpramin/desipramine, Parnate/tranylcypromine, Paxil/paroxetine, Prozac/fluoxetine, Remeron/mirtazapine, Doxepin/sinequan, Tofranil/imipramine, Wellbutrin/bupropion, and Zoloft/sertraline.

The link to this chart is http://afterthediet.com/antidepressant_medications.htm

About the ads

I'm experimenting with Google Ads...as a way to offset the cost of researching and writing the material I present. (I hope you can see I spend quite a bit of time on this!). The Google terms of service explicitly stated that pharmaceutical companies will not be allowed to advertise, which was my main concern about "going commercial". However, I am closely watching the ads pop up anyway, to be sure that for the most part they are appropriate.

Since my job here is to serve you, the reader, if you feel in any way that any ad that pops up in the process of getting information that is helpful and useful, is offensive, insulting, or counterproductive, I NEED TO HEAR FROM YOU.

Please let me know when you see anything that does not fit with the overall energy of better mental health through informed choices.

Thank you!

Is Fibromyalgia A Real Disease? Does It Need Its Own Medication?

If you are interested in this debate, you may be interested in this New York Times article that was published today:

http://www.nytimes.com/2008/01/14/health/14pain.html?th&emc=th

Lyrica (pregabalin), the medication that is mentioned in this article, is a medication I've been researching for my psychotropic medication publication. This drug was first approved for use in the US in 2005, for the treatment of epilepsy, diabetic neuropathy pain and post-herpetic neuralgia. In 2007 it was also approved for treating fibromyalgia.

In addition, in my own research, I found publications describing 10 off-label (non-FDA approved)uses for this medication. One of these off-label uses, anxiety disorder, is actually an approved use in the European Union but not the United States. The references for these off-label uses, excerpted from my CD, are posted below.

Pregabalin is supposedly a more potent form of another popular medication, gabapentin (Neurontin). The use of this medication has been questioned, as at one point, it was estimated that 90% of its prescriptions were written for off-label uses. From what I could see when I was researching pregabalin, the trend with the newer version is not dissimilar.

From a biochemical standpoint, many of the off-label uses do make sense, as many of these issues have very similar biochemical origins. Off-label uses are not always inappropriate. However, it is important to make sure you know exactly WHY you are being prescribed a medication. You are entitled to ask your physician whether or not the medication you are being prescribed is FDA approved for your diagnosis, or if the use she is asking you to try is off-label. It's your body, and you have a right to make the most informed decision possible.

REFERENCES

http://en.wikipedia.org/wiki/Pregabalin
http://en.wikipedia.org/wiki/Gabapentin

Jatzko A, Stegmeier Petroianu A, Petroianu GA. Alpha-2-delta ligands for singultus (hiccup) treatment: three case reports. J Pain Symptom Manage 2007 Jun;33(6):756-60.
Yokoyama T, Maeda Y, Audette KM, Sluka KA.Pregabalin reduces muscle and cutaneous hyperalgesia in two models of chronic muscle pain in rats. J Pain 007 May;8(5):422-9.

Zesiewicz TA, Ward CL, Hauser RA, Pease Campbell JA, Sullivan KL. Pregabalin (Lyrica) in the treatment of essential tremor. Mov Disord 2007 Jan;22(1):139-41.
Zesiewicz TA, Ward CL, Hauser RA, Salemi JL, Siraj S, Wilson MC, Sullivan KL. A pilot, double-blind, placebo-controlled trial of pregabalin (Lyrica) in the treatment of essential tremor. Mov Disord 2007 Jun 19.

Maizels M, McCarberg B. Antidepressants and antiepileptic drugs for chronic non-cancer pain. Am Fam Physician 2005 Feb 1;71(3):483-90.

Crofford LJ, Rowbotham MC, Mease PJ, Russell IJ, Dworkin RH, Corbin AE, Young JP, LaMoreaux LK, Martin SA, Sharma U,Pregabalin 1008-105 Study Group. Pregabalin for the treatment of fibromyalgia syndrome: results of a randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2005 Apr;52(4):1264-73.
Rooks DS. Fibromyalgia treatment update. Curr Opin Rheumatol 2007 Mar;19(2):111-7.

Owen RT. Pregabalin: Its efficacy, safety and tolerability profile in fibromyalgia syndrome. Drugs Today (Barc). 2007 Dec;43(12):857-63.

Pande AC, Crockatt JG, Feltner DE, Janney CA, Smith WT, Weisler R, Londborg PD, Bielski RJ, Zimbroff DL, Davidson JR, Liu Dumaw M. Pregabalin in generalized anxiety disorder: a placebo-controlled trial. Am J Psychiatry 2003 Mar;160(3):533-40.

Van Ameringen M, Mancini C, Pipe B, Bennett M. Antiepileptic drugs in the treatment of anxiety disorders: role in therapy. Drugs 2004;64(19):2199-220.

Baldwin DS, Polkinghorn C. Evidence-based pharmacotherapy of Generalized Anxiety Disorder. Int J Neuropsychopharmacol 2005 Jun;8(2):293-302.

Pohl RB, Feltner DE, Fieve RR, Pande AC. Efficacy of pregabalin in the treatment of generalized anxiety disorder: double-blind, placebo-controlled comparison of BID versus TID dosing. J Clin Psychopharmacol 2005 Apr;25(2):151-8.

Rickels K, Pollack MH, Feltner DE, Lydiard RB, Zimbroff DL, Bielski RJ, Tobias K, Brock JD, Zornberg GL, Pande AC. Pregabalin for treatment of generalized anxiety disorder: a 4-week, multicenter, double-blind, placebo-controlled trial of pregabalin and alprazolam. Arch Gen Psychiatry 2005 Sep;62(9):1022-30.

Keck PE, Strawn JR, McElroy SL. Pharmacologic treatment considerations in co-occurring bipolar and anxiety disorders. J Clin Psychiatry 2006;67 Suppl 1:8-15.

Montgomery SA, Tobias K, Zornberg GL, Kasper S, Pande AC. Efficacy and safety of pregabalin in the treatment of generalized anxiety disorder: a 6-week, multicenter, randomized, double-blind, placebo-controlled comparison of pregabalin and venlafaxine. J Clin Psychiatry 2006 May;67(5):771-82.

Frampton JE, Foster RH. Pregabalin: in the treatment of generalised anxiety disorder. CNS Drugs 2006;20(8):685-93.

Montgomery SA. Pregabalin for the treatment of generalised anxiety disorder. Expert Opin Pharmacother 2006 Oct;7(15):2139-54.

Bendelow B, Wedekind D, Leon T. Pregabalin for the treatment of generalized anxiety disorder: a novel pharmacologic intervention. Expert Rev Neurother 2007 Jul;7(7):769-81.

Owen RT. Pregabalin: its efficacy, safety and tolerability profile in generalized anxiety. Drugs Today (Barc). 2007 Sep;43(9):601-10.

Kitchener JM. Glossopharyngeal neuralgia responding to pregabalin. Headache 2006 Sep;46(8):1307-8.

Hurley RW, Chatterjea D, Rose Feng M, Taylor CP, Hammond DL. Gabapentin and pregabalin can interact synergistically with naproxen to produce antihyperalgesia. Anesthesiology 2002 Nov;97(5):1263-73.

Field MJ, Holloman EF, McCleary S, Hughes J, Singh L. Evaluation of gabapentin and S-(+)-3-isobutylgaba in a rat model of postoperative pain. J Pharmacol Exp Ther 1997 Sep;282(3):1242-6.

Jones DL, Sorkin LS. Systemic gabapentin and S(+)-3-isobutyl-gamma-aminobutyric acid block secondary hyperalgesia. Brain Res 1998 Nov 9;810(1-2):93-9.

Hill CM, Balkenohl M, Thomas DW, Walker R, Mathe H, Murray G. Pregabalin in patients with postoperative dental pain. Eur J Pain 2001;5(2):119-24.

Sommer M, Bachmann CG, Liebetanz KM, Schindehutte J, Tings T, Paulus W. Pregabalin in restless legs syndrome with and without neuropathic pain. Acta Neurol Scand 2007 May;115(5):347-50.

Jefferson JW. Benzodiazepines and anticonvulsants for social phobia (social anxiety disorder). J Clin Psychiatry 2001;62 Suppl 1:50-3.

Pande AC, Feltner DE, Jefferson JW, Davidson JR, Pollack M, Stein MB, Lydiard RB, Futterer R, Robinson P, Slomkowski M, DuBoff E, Phelps M, Janney CA, Werth JL. Efficacy of the novel anxiolytic pregabalin in social anxiety disorder: a placebo-controlled, multicenter study. J Clin Psychopharmacol 2004 Apr;23(2):141-9.

Muller JE, Koen L, Seedat S, Stein DJ. Social anxiety disorder : current treatment recommendations. CNS Drugs 2005;19(5):377-91.

Cottraux J. Recent developments in research and treatment for social phobia (social anxiety disorder). Curr Opin Psychiatry 2005 Jan;18(1):51-4.

Davidson JR. Pharmacotherapy of social anxiety disorder: what does the evidence tell us? J Clin Psychiatry 2006;67 Suppl 12:20-6.

Davidson JR. Pharmacotherapy of social phobia. Acta Psychiatr Scand Suppl 2003;(417):65-71.

Antidepressants and sexual dysfunction

I just ran across a research abstract sharing three case studies in which sexual dysfunction persisted after the individual discontinued taking antidepressant medication. In each case, psychological factors, hormone imbalances, and other medical explanations were ruled out. Two of the men described were not even 30 years old. The problems listed in these three cases included: erectile dysfunction, loss of sex drive, loss of pleasure with ejaculation, and loss of sensation in the genital area.

A change in sexual function with the use of antidepressants is a fairly common side effect, but most people expect that discontinuing the cause of this change will restore the function. Apparently, in some individuals, this is not the case.

What I found interesting was that in each of the three cases described, the solution to the new problem, caused by a medication was....a new and different medication. Hmmm...

It is important not to jump to conclusions with this post and assert that all antidepressants cause sexual problems. Some antidepressants can actually HELP sexual problems.

The moral in this post is, that it is very important, as soon as you notice side effects to ANY medication you are on, psychotropic or not, to report these changes to your prescribing physician. Don't allow yourself to be suggested that you just need to accept the side effect. Don't adjust or discontinue the medication independently of your physician, either. Be sure that you communicate what you observe and what you need your physician to do in order to maximize the benefit of your medication while minimizing any short- or long-term side effects.

Csoka A, Bahrick A, Mehtonen OP. Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors. J Sex Med. 2008 Jan;5(1):227-33.

Potential nutritional help for antipsychotic side effects

One of the most distressing side effects of antipsychotics is a syndrome called "tardive dyskinesia," in which a person develops involuntary movements and tics throughout the face and body.

Researchers in India report that rutin, an antioxidant, may actually help lessen the degree of these involuntary movements. In this particular study, the effect of rutin on vacuous chewing movements, tongue protrusions and facial jerking was studied in a population of rats who developed these behaviors after being given the drug Haldol. Rutin significantly inhibited all of these movements.

The researchers hypothesize that in the process of doing the work that it is supposed to do to help the schizophrenia, oxidative damage occurs which degrades the nervous system and induces involuntary movements. Rutin is a powerful antioxidant which appears to directly reduce this particular type of oxidation.

What is rutin? It is a flavonoid that is primarily found in buckwheat, citrus fruits, noni, black tea and apple peel. It is also available as a supplement, though until researchers pursue this relationship more thoroughly, it is probably best to include more of these listed foods in the diet. Sometimes adding too much of a "good thing" can disrupt the therapeutic potential of medications.

An additional note, rutin is also used in some cultures as an emergency contraceptive. So if you are of child bearing age and are on Haldol, it is important to use this information with caution.


Bishnoi M, Chopra K, Kulkarni SK. Protective effect of rutin, a polyphenolic flavonoid against haloperidol-induced orofacial dyskinesia and associated behavioural, biochemical and neurochemical changes. Fundam Clin Pharmacol. 2007 Oct;21(5):521-9.
http://www.phytochemicals.info/phytochemicals/rutin.php

Fish oil, anxiety, and anger

I am noticing in my most recent medication reviews, that more and more psychotropic medications are being tested as treatments for aggressive behavior. I've worked in treatment centers and I know that the kind of aggression seen in substance users is more than just being "a little pushy"...and that this behavior, if it can be intervened on, can help a person with this problem to have more productive relationships and overall life successes.

A recent study found that substance abusers have dietary habits that promote poor omega-3 balance. (Anyone reading this who has attended a 12 Step meeting will attest to the donuts and sugared coffee these meetings are known for!)

In this study, 3 months of using 3 grams per day of fish oil (containing both EPA and DHA), anger and anxiety on test scores decreased significantly.

Interestingly, EPA and anxiety were most closely associated, and DHA and anger were most closely associated. For anyone using fish oil as a supplement, this distinction is likely moot. However, for anyone who is vegetarian and using marine algae or marine algae-supplemented foods as their omega-3 source, they may not see the reduction in anger that a fish-eating person may eat.

I just love it when nature shows us ways to feel better that don't always have to involve medication!

Buydens-Branchey L, Branchey M, Hibbeln JR. Associations between increases in plasma n-3 polyunsaturated fatty acids following supplementation and decreases in anger and anxiety in substance abusers. Prog Neuropsychopharmacol Biol Psychiatry. 2007 Nov 1 [Epub ahead of print]

How many drugs are you taking?

Metabolic syndrome (the cluster of hypertension, hyperlipidemia, and insulin resistance, often seen with weight gain around the midline) is a common side effect of psychotropic medications. A recent study found that when two or more antipsychotics are simultaneously prescribed, the risk of incurring metabolic syndrome significantly increases. The researchers acknowledge that other factors such as weight, gender, race, and age may weaken this association...but the association was still stronger when more than one antipsychotic was being used.

I have noticed with time that the number of medications my clients are on has gradually increased. It is not uncommon for them to show me a basket of prescription medications they are taking, which was rare when I started in this business 25 years ago.

It makes perfect sense that every chemical introduced into a system is going to react not only with the system but with every other chemical that has been artificially induced. It will be especially challenging to figure out where the interaction is occurring if multiple prescriptions are initiated simultaneously.

I know it's not always possible to introduce one chemical influence at a time and wait to see what happens, but it would be nice if, when that IS possible, that we work through diagnosing and treating in a stepwise progression to minimize the risk of serious medical complications.

Correll CU, Frederickson AM, Kane JM, Manu P. Does antipsychotic polypharmacy increase the risk for metabolic syndrome? Schizophr Res 2007 Jan;89(1-3):91-100.