![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Otherworldly on April 1, 2003, at 15:00:36
Hello --
I'm wondering if anybody who is troubled by antidepressant-induced weight gain has ever consulted an endocrinologist to try to sort out what's going on.
Here's my story. I hope, if nothing else, I can get some sympathy from the group. My baseline weight -- into my late 30s -- was about 120, which I sustained effortlessly, eating as much as I wanted. Began a tricyclic, gained 12 pounds in 8 months. Wasn't too concerned, because these were the days when drugs were just prescribed for the short term. Stopped the tricyclic, lost most of the weight. Got depressed again, took trazodone for two years, got back down to baseline weight without dieting. Went on Paxil, gained 20 pounds in five months. No increase in appetite or consumption, just an inexorable gain. Stopped Paxil -- which was quite a mood brightener for me -- because I couldn't stand weighing more than 140 pounds. Lost the weight, got depressed again, started Effexor, gained 40 pounds. Stopped the Effexor, lost most of the weight. Also lost my mind, and had ECT. Since then, have been on various meds, all of which have caused me to pack on pounds. Currently, on Lexapro, am up to 185 -- in another words, more than 50 percent overweight. Started suffering from acid reflux disease (which is known to be weight-related), had an endoscopy, and have now been told that the acid reflux has caused a pre-cancerous condition of my esophagus. My pdoc -- who is considered one of the top psycho-pharmacologists in my city, tells me he almost never runs into a patient like me, and can't suggest anything other than watching my food intake (which I do) and exercise (which I should do more of). But I feel like something is so wrong with my metabolism that all I can do is go off the meds, and fall back into the pits. I'm considering doing it, because I loathe myself at this weight. But I know what it's like to be terribly depressed, and I know that would happen if I went without drugs.
Sorry. I've been babbling. I guess that's what Psychobabble is for, though.
Posted by PamJeanBrunot on April 1, 2003, at 18:51:44
In reply to Anyone seen an endocrinologist for AD weight gain?, posted by Otherworldly on April 1, 2003, at 15:00:36
Hi, you're not rambling I want to help you here-I've been there.
I did see an endocrinologist for the AD weight gain you speak of. Have your doc test your T3, T4, and TSH-all thyroid hormones. Also, maybe a fasting glucose test for diabetes.
THEN, you'll at least know that it isn't your body.
Also, all these psycho meds can make us gain a little weight-I have never heard of anyone not gaining "ANYTHING".
Let me know if I can be of anymore help. This is a topic that interests me and I wish you the best! We're all here for you! :o).................................................
Hello --I'm wondering if anybody who is troubled by antidepressant-induced weight gain has ever consulted an endocrinologist to try to sort out what's going on.
Here's my story. I hope, if nothing else, I can get some sympathy from the group. My baseline weight -- into my late 30s -- was about 120, which I sustained effortlessly, eating as much as I wanted. Began a tricyclic, gained 12 pounds in 8 months. Wasn't too concerned, because these were the days when drugs were just prescribed for the short term. Stopped the tricyclic, lost most of the weight. Got depressed again, took trazodone for two years, got back down to baseline weight without dieting. Went on Paxil, gained 20 pounds in five months. No increase in appetite or consumption, just an inexorable gain. Stopped Paxil -- which was quite a mood brightener for me -- because I couldn't stand weighing more than 140 pounds. Lost the weight, got depressed again, started Effexor, gained 40 pounds. Stopped the Effexor, lost most of the weight. Also lost my mind, and had ECT. Since then, have been on various meds, all of which have caused me to pack on pounds. Currently, on Lexapro, am up to 185 -- in another words, more than 50 percent overweight. Started suffering from acid reflux disease (which is known to be weight-related), had an endoscopy, and have now been told that the acid reflux has caused a pre-cancerous condition of my esophagus. My pdoc -- who is considered one of the top psycho-pharmacologists in my city, tells me he almost never runs into a patient like me, and can't suggest anything other than watching my food intake (which I do) and exercise (which I should do more of). But I feel like something is so wrong with my metabolism that all I can do is go off the meds, and fall back into the pits. I'm considering doing it, because I loathe myself at this weight. But I know what it's like to be terribly depressed, and I know that would happen if I went without drugs.
Sorry. I've been babbling. I guess that's what Psychobabble is for, though.
Posted by KRM123 on April 1, 2003, at 19:07:01
In reply to Anyone seen an endocrinologist for AD weight gain?, posted by Otherworldly on April 1, 2003, at 15:00:36
Otherworldy- I totally feel your pain about AD weight gain. I suffer from dysthymia but have never gotten help from the AD's because I would always quit when my weight got too uncomfortable for me to handle. It is sad that I put my weight before my happiness, but I have been struggling with my body image for a long time and the weight gain doesn't help with the depression at all!
I strongly believe that AD's alter metabolism. There hasn't been enough research done on it but you might find these links interesting:http://www.ocfoundation.org/ocf_0030.htm
http://www.mvelectric.com/inositol/METABOL.HTM
I have done a ton of research!!! I've tried Prozac, Zoloft and now Lexapro (3rd week only). On Zoloft I was the most active I've ever been- could get up real early in the morning and work out for 2 hours. I remember having some anxiety so I was maybe eating a bit too much- I lost that "full" feeling and craved carbs. I would always jump on the scale and no matter what I did could not even lose a 1 lb. That was NOT normal for me. That is when I knew- this is messing up my metabolism!!! I will admit that I have a been caught up in the diet/binge cycle for awhile. I am an emotional eater- the AD should have helped with my anxiety therefore making me overeat less but it didn't. My result after a binge was always a diet- wouldn't eat much- and would lose a few lbs. Wasn't able to do that on the meds.
I don't know if I plan on staying on the Lexapro because of the extreme tiredness. I haven't been able to exercise in a month. I will hold out another week though and drink lots of coffee. Lex is supposedly supposed to have fewer side effects- but who knows if that even has to do with weight. Time will tell I guess. I pray that I can find a med that doesn't induce weight so I can be happy. I would go through the worst of worst side effects just do be able to eat and maintain weight normally.
I guess the answer for most of us is extra exercise. Pick healthy natural foods and don't overeat. Good luck to all with the same probs. God Bless.
Posted by noa on April 1, 2003, at 19:35:54
In reply to Anyone seen an endocrinologist for AD weight gain?, posted by Otherworldly on April 1, 2003, at 15:00:36
Two thoughts:
1. Someone just brought forward a thread from 1999(!)--it is here somewhere on this page--that talks about how a some meds caused increased stomach acid which leads people to feel more hungry and eat more, and that it can be treated with antacid (a certain kind of antacid vs. another, I don't remember why exactly). Your mention of the acid reflux made me think of this.
2. I saw an endo to get the to the bottom of my hypothyroidism problem and while I was there, he checked me for a number of other endo problems, inclduing insulin resistance syndrome, which turned out positive. I beleive that some ADs lead to weight gain of a certain kind--around the middle, where fat cells tend to store lots of hormones, which leads to the cells of the body being resistant to the action of insulin, leading to more weight gain, etc. etc. I can't tell you if the doctor told me all of this, or I read it somewhere, but maybe someone else here can come up with some citations. If not, take this for what it is--my vague recollections of something I *believe* I heard or read, etc.
I guess a consult with a good endo couldn't hurt.
(oops, that's three thoughts, and I promised just two).
Posted by jerrympls on April 1, 2003, at 20:11:14
In reply to Anyone seen an endocrinologist for AD weight gain?, posted by Otherworldly on April 1, 2003, at 15:00:36
I recently saw an endocrinologist for other possible causes underlying my treatment resistant depression which includes severe fatigue and weight gain. For the better part of my life, I was a skinny boy and even through college weighed no more than 135 lbs. Obesity does not run in my family btw. I started gaining weight while on Luvox. I went from 135 to 150 to 200 all the way to 220 in about a year. I was devistated by this. Eventually I was put on a stimulant to augment the Luvox and I lost 40 lbs in about 3 months. However, once I went of the stimulant I gained it all back. That was about 5 years ago and ever since - even with different meds my fatigue got worse and I continued to gain weight and couldn't lose any of it.
About 2 years ago I was put on Adderall to help augment my meds again and I was able to stay below 200 at around 190lbs. However, as I adapted to the effects of the Adderall I began to gain a pound a month. I was switched to Dedxedrine and Lexapro and I've continued to gain weight. I am currently 245lbs and I am in disbelief many days at how large I have become. I've only known myself to be a skinny guy. The weight as also caused severe acid reflex problems.
I finally was referred to an endocrinologist who tested me for everything and found this:
1) My testosterone (I am a 31 year old male) was LOW
2) My thyriod was LOW (he said most likely due to the Seroquel I take to help me sleep)
3) My cortisol levels were LOW
4) My iron levels/hemoglobin was LOWHe started me on testosterone replacement (Androgel) and a small amount of oral hydrocortisone. A second and third round of blood tests revealed that my testosterone is back to normal but my cortisol is still low as is my hemoglobin.
I think the testosterone has helped a little - however, he said it may take 2-3 months to really show an effect. I'm not sure about the hydrocortisone and its effeect on my mood. But I have noticed that my hands don't hurt in the morning (I've had chronic tendonitis - joint problems - I'm a musician).
So - I'm still waiting to see what will happen if anything from these other treatments. One thing my endocrinologist did comment on were the red stretch marks on my stomach from the weight gain. He said that that was a clear indicator of an endocrine disorder/imbalance.
so....we'll see...hope this helps.......
Posted by KRM123 on April 1, 2003, at 21:58:08
In reply to Re: Anyone seen an endocrinologist for AD weight gain?, posted by noa on April 1, 2003, at 19:35:54
Noa- where exactly is that forward from 1999? Sounds interesting...
Posted by noa on April 1, 2003, at 22:39:21
In reply to Re: Anyone seen an endocrinologist for AD ? Noa, posted by KRM123 on April 1, 2003, at 21:58:08
Re: Disclaimer from Dr. Stahl
Posted by PamJeanBrunot on April 1, 2003, at 23:57:11
In reply to Re: Anyone seen an endocrinologist for AD weight gain, posted by KRM123 on April 1, 2003, at 19:07:01
Hi,
Thanks for posting these links KRM123.
I'm going to go look at them.
May I ask if you have tried the AD Celexa?
I never gained weight on that med.
All the best and God Bless!
Pam> Otherworldy- I totally feel your pain about AD weight gain. I suffer from dysthymia but have never gotten help from the AD's because I would always quit when my weight got too uncomfortable for me to handle. It is sad that I put my weight before my happiness, but I have been struggling with my body image for a long time and the weight gain doesn't help with the depression at all!
> I strongly believe that AD's alter metabolism. There hasn't been enough research done on it but you might find these links interesting:
>
> http://www.ocfoundation.org/ocf_0030.htm
>
> http://www.mvelectric.com/inositol/METABOL.HTM
>
> I have done a ton of research!!! I've tried Prozac, Zoloft and now Lexapro (3rd week only). On Zoloft I was the most active I've ever been- could get up real early in the morning and work out for 2 hours. I remember having some anxiety so I was maybe eating a bit too much- I lost that "full" feeling and craved carbs. I would always jump on the scale and no matter what I did could not even lose a 1 lb. That was NOT normal for me. That is when I knew- this is messing up my metabolism!!! I will admit that I have a been caught up in the diet/binge cycle for awhile. I am an emotional eater- the AD should have helped with my anxiety therefore making me overeat less but it didn't. My result after a binge was always a diet- wouldn't eat much- and would lose a few lbs. Wasn't able to do that on the meds.
> I don't know if I plan on staying on the Lexapro because of the extreme tiredness. I haven't been able to exercise in a month. I will hold out another week though and drink lots of coffee. Lex is supposedly supposed to have fewer side effects- but who knows if that even has to do with weight. Time will tell I guess. I pray that I can find a med that doesn't induce weight so I can be happy. I would go through the worst of worst side effects just do be able to eat and maintain weight normally.
> I guess the answer for most of us is extra exercise. Pick healthy natural foods and don't overeat. Good luck to all with the same probs. God Bless.
Posted by PamJeanBrunot on April 2, 2003, at 0:02:08
In reply to Re: Anyone seen an endocrinologist for AD weight gain? » Otherworldly, posted by jerrympls on April 1, 2003, at 20:11:14
Hi jerrympls,
This is a subject I want to better understand. I can relate to all of what you are saying."2) My thyriod was LOW (he said most likely due to the Seroquel I take to help me sleep)
3) My cortisol levels were LOW"WHAT??? :-( I also take Seroquel and ever since, my weight has never been the same.
When I first started pych meds, I weighed 166, now I weigh 247
:-( I am not happy about this.
Can you please tell me more about what your endocrinologist said about the Seroquel adding to weight gain?
And what can my doc do to find out if my Cortisol levels are low? PLease excuse me if I missed something.....
Thanks so much
Pam
> I recently saw an endocrinologist for other possible causes underlying my treatment resistant depression which includes severe fatigue and weight gain. For the better part of my life, I was a skinny boy and even through college weighed no more than 135 lbs. Obesity does not run in my family btw. I started gaining weight while on Luvox. I went from 135 to 150 to 200 all the way to 220 in about a year. I was devistated by this. Eventually I was put on a stimulant to augment the Luvox and I lost 40 lbs in about 3 months. However, once I went of the stimulant I gained it all back. That was about 5 years ago and ever since - even with different meds my fatigue got worse and I continued to gain weight and couldn't lose any of it.
>
> About 2 years ago I was put on Adderall to help augment my meds again and I was able to stay below 200 at around 190lbs. However, as I adapted to the effects of the Adderall I began to gain a pound a month. I was switched to Dedxedrine and Lexapro and I've continued to gain weight. I am currently 245lbs and I am in disbelief many days at how large I have become. I've only known myself to be a skinny guy. The weight as also caused severe acid reflex problems.
>
> I finally was referred to an endocrinologist who tested me for everything and found this:
>
> 1) My testosterone (I am a 31 year old male) was LOW
> 2) My thyriod was LOW (he said most likely due to the Seroquel I take to help me sleep)
> 3) My cortisol levels were LOW
> 4) My iron levels/hemoglobin was LOW
>
> He started me on testosterone replacement (Androgel) and a small amount of oral hydrocortisone. A second and third round of blood tests revealed that my testosterone is back to normal but my cortisol is still low as is my hemoglobin.
>
> I think the testosterone has helped a little - however, he said it may take 2-3 months to really show an effect. I'm not sure about the hydrocortisone and its effeect on my mood. But I have noticed that my hands don't hurt in the morning (I've had chronic tendonitis - joint problems - I'm a musician).
>
> So - I'm still waiting to see what will happen if anything from these other treatments. One thing my endocrinologist did comment on were the red stretch marks on my stomach from the weight gain. He said that that was a clear indicator of an endocrine disorder/imbalance.
>
> so....we'll see...hope this helps.......
Posted by Ritch on April 2, 2003, at 9:56:25
In reply to Re: Anyone seen an endocrinologist for AD weight gain? » Otherworldly, posted by jerrympls on April 1, 2003, at 20:11:14
....2) My thyriod was LOW (he said most likely due to the Seroquel I take to help me sleep)
.....
Hmmmm. That is very strange, because I switched to Seroquel from Risperdal (because of dystonia) a few weeks before I got my thyroid tumor. This runs in my family, but maybe it was just enough to trigger it (given I was already under a lot of stress at the time)? I had read the monograph on it and did notice the mention about suppression of thyroid (I think it was reduced free T4 or raised TSH or both), but didn't think it would be very significant since I was only taking a tiny dose. The tumor was benign, but it sure grew fast. I still have half a thyroid, yoo-hoo Jerry, did your endocrinologist give you any thyroxine or Cytomel?
Posted by Joanie on April 2, 2003, at 10:15:38
In reply to Anyone seen an endocrinologist for AD weight gain?, posted by Otherworldly on April 1, 2003, at 15:00:36
As a reader of Psycho Babble and occassional "poster" for the last several years, this by far has been one of the most interesting posts to me. I have tried different ad's and have gained about 50 lbs in the past 4 years. It is so sad that we all have to have such a crappy side effect in order to be happy. It is almost comforting although sad to me, that I'm not the only one who suffers from this. I have just quit taking Lexapro (the one that wasn't supposed to make you gain), and am praying I can begin to lose weight. I agree with everyone of you guys that said your metabolism has been affected. I have gained 30 lbs in the last year alone. THAT makes me even more depressed. I'll pray for all of us to be happy and med-free one day! Good luck to all!
Posted by Ponder on April 3, 2003, at 0:33:20
In reply to Anyone seen an endocrinologist for AD weight gain?, posted by Otherworldly on April 1, 2003, at 15:00:36
Otherworldly,
I think it's an excellent idea to see an endocrinologist. I have been frustrated by the difficulty of getting coordinated care. Although psychiatrists are medical doctors, they don't seem to be really tuned in to non-psychiatric medical concerns, and other medical specialists don't seem to know much--or want to know much--about psych drugs. But damn, we're trying to live in one body and make all these systems work together smoothly in a reasonably healthy way.Weight gain is one of the most insidiously negative things that can happen to a person's overall health. I gained 45 pounds on Effexor and had ill effects ranging from cardiovascular symptoms to GI problems to osteoarthritis in places where I previously didn't even know I had joints.
Different people require different treatments, so this may not be helpful, but I will share what is currently working for me. I am on 150 mg/day of Lamictal and 400 mg/day of Wellbutrin. This is a pretty activating combination and has not caused any weight gain for me. I have lost all the extra weight and, in fact, weight less than I have since high school. This combo is not particularly good for anxiety. I have a PRN prescription for Ativan, but I rely mostly on a 4-mile walk every day to smooth me out and I take ambien at night for sleep.
Still, my treatment is far from perfect. I still have dips and periods of instability, but I resist my p-docs suggestions to add an SSRI because of this weight issue.
I will be among those hoping to see further posts from you. Your proactivity is admirable.
Posted by ButterflyRaiser on April 4, 2003, at 17:25:55
In reply to Re: Anyone seen an endocrinologist for AD weight gain? » jerrympls, posted by Ritch on April 2, 2003, at 9:56:25
Hi,
I'm new to this board. I have been on Prozac, then Zoloft, for probably 8+ years. Two-and-a-half weeks ago, I was stunned/shocked/dismayed/freaked to find out that I had gained weight up to 198 lbs. About 10 years ago, I threw away my bathroom scales, and made it a point to either say, "Put patient refused to have weight taken" or didn't look when I was weighed at doctor's visits.
After some soul-searching recently, I decided to bite the bullet and look at the poundage when my weight was taken at my OB/GYN. I have been so in denial that I actually thought at first my weight was 148 lbs, not 198 lbs, until I realized the bottom weight was on 150, not 100. I still thought that had to be incorrect, so when I was left alone in the room, I peered over to my chart and it did in fact say 198 lbs. When my blood pressure was taken, it was 140/90, even though I'm on two blood pressure meds (familial history of high blood pressure, even in thin family members). It has been controlled for years, so this was a definite reaction to this huge slap-in-the-face/wake-up-call.
When I got married, I weighed 107. I'm 5'4" (stretching tall). That was 23 years ago. I'm now 48, nearly 49. I would expect some weight gain, and I did have some weight gain prior to starting ADs, but the highest it got was 150 lbs. That was after I began telecommuting from home, never getting out of the house to exercise, and eating for comfort. I had wondered probably three years ago if my AD was changing my weight situation. I asked my then male OB/GYN, and he said, "NO, in fact most women actually lose weight on an anti-depressant. I eat a carrot for lunch every day to control my weight. You need to do the same." I kid you not. This knuckle-head said he ate a carrot for lunch. I'd like to tell you what I wanted to do with said carrot when he told me that. Grrrrrr. So, I switched to the female nurse practitioner in his office. (Guess I showed him, huh???) :)
That day that I weighed, I went home from the doc's office, cried for an hour, collected myself, and took my shattered self back to the office. I began a diet that day, and have been on it since, and have joined the Y and begun using the treadmill. Then, I went to my p-doc for the first time in 4 years. My general practice physician assistant has been prescribing my Zoloft 100 mg a day for all these years inbetween because she has been agreeable and it is easier/cheaper for me.
The p-doc had a family emergency, so I saw the nurse practitioner. When I told her that my OB/GYN said my weight gain could not be related to my AD, she said SSRIs are notorious for weight gain, particularly over a number of years. She has rx'd another drug, Zonegran, to begin slowly increasing. She said she has had some patients (some who have not wanted to lose weight) lose 20-30 lbs. in 3 months or so. She said it works well with the Zoloft, can even out moods, and can reduce appetite. You start out taking it Monday/Wednesday/Friday for two weeks, then go to Monday-Friday, and the every day. I've only taken 4 doses so far. Don't notice anything yet. I'll go for a followup visit in 2 more weeks. She said if this doesn't help at this dosage (think it's 100 mg/capsule/night), she'll dose it up.
Anyone else heard of this?
Thanks.
ButterflyRaiser
Posted by Ritch on April 4, 2003, at 20:25:15
In reply to Anyone seen an endocrinologist for AD weight gain?, posted by ButterflyRaiser on April 4, 2003, at 17:25:55
> Hi,
>
> I'm new to this board. I have been on Prozac, then Zoloft, for probably 8+ years. Two-and-a-half weeks ago, I was stunned/shocked/dismayed/freaked to find out that I had gained weight up to 198 lbs. About 10 years ago, I threw away my bathroom scales, and made it a point to either say, "Put patient refused to have weight taken" or didn't look when I was weighed at doctor's visits.
>
> After some soul-searching recently, I decided to bite the bullet and look at the poundage when my weight was taken at my OB/GYN. I have been so in denial that I actually thought at first my weight was 148 lbs, not 198 lbs, until I realized the bottom weight was on 150, not 100. I still thought that had to be incorrect, so when I was left alone in the room, I peered over to my chart and it did in fact say 198 lbs. When my blood pressure was taken, it was 140/90, even though I'm on two blood pressure meds (familial history of high blood pressure, even in thin family members). It has been controlled for years, so this was a definite reaction to this huge slap-in-the-face/wake-up-call.
>
> When I got married, I weighed 107. I'm 5'4" (stretching tall). That was 23 years ago. I'm now 48, nearly 49. I would expect some weight gain, and I did have some weight gain prior to starting ADs, but the highest it got was 150 lbs. That was after I began telecommuting from home, never getting out of the house to exercise, and eating for comfort. I had wondered probably three years ago if my AD was changing my weight situation. I asked my then male OB/GYN, and he said, "NO, in fact most women actually lose weight on an anti-depressant. I eat a carrot for lunch every day to control my weight. You need to do the same." I kid you not. This knuckle-head said he ate a carrot for lunch. I'd like to tell you what I wanted to do with said carrot when he told me that. Grrrrrr. So, I switched to the female nurse practitioner in his office. (Guess I showed him, huh???) :)
>
> That day that I weighed, I went home from the doc's office, cried for an hour, collected myself, and took my shattered self back to the office. I began a diet that day, and have been on it since, and have joined the Y and begun using the treadmill. Then, I went to my p-doc for the first time in 4 years. My general practice physician assistant has been prescribing my Zoloft 100 mg a day for all these years inbetween because she has been agreeable and it is easier/cheaper for me.
>
> The p-doc had a family emergency, so I saw the nurse practitioner. When I told her that my OB/GYN said my weight gain could not be related to my AD, she said SSRIs are notorious for weight gain, particularly over a number of years. She has rx'd another drug, Zonegran, to begin slowly increasing. She said she has had some patients (some who have not wanted to lose weight) lose 20-30 lbs. in 3 months or so. She said it works well with the Zoloft, can even out moods, and can reduce appetite. You start out taking it Monday/Wednesday/Friday for two weeks, then go to Monday-Friday, and the every day. I've only taken 4 doses so far. Don't notice anything yet. I'll go for a followup visit in 2 more weeks. She said if this doesn't help at this dosage (think it's 100 mg/capsule/night), she'll dose it up.
>
> Anyone else heard of this?
>
> Thanks.
>
> ButterflyRaiser
Yes, I have heard of it. My pdoc presented it as an option when it first came out a year or two ago for bipolar. I didn't want to try it because I freaked when the drug monograph showed that 2% of patients treated with the drug showed schizophrenic or schizophreniform symptoms, placebo was 0%. Yes, that would be 1 out of 50, but I didn't want to chance it. Other than that, the med looked like an interesting trial. I heard something about it being used in Japan with bipolar patients and getting a good response. It has a significant side effect of anorexia as well. Perhaps that is why your doc is interested in you taking it. Topamax (another AED) also can cause significant weight loss.
This is the end of the thread.
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