Why do you gain weight with antidepressants and mood stabilizers?

Why do you gain weight with antidepressants and mood stabilizers?

– Why do you gain weight with antidepressants and mood stabilizers? That’s what I’m talking about today. I’m Dr. Tracey Marks, a psychiatrist and I make a mental
health education videos. Today’s topic is based on
several viewer questions for me to talk about this. The short answer is we don’t
know the full mechanism. But here are two proposed
ways that antidepressants and antipsychotic medications that we use for mood stabilization cause weight gain. I will also talk about
what we do about it. The way these drugs cause weight gain is by blocking histamine 1 receptors. We usually think of histamine as something that is associated with allergies
and your immune response. If you’re exposed to something
your body is sensitive to, you get a histamine response
that can look like itching, runny nose or even shortness of breath. And then you can take an
antihistamine like Benadryl, it slows down that allergic reaction to make you feel better. That’s how it works
though from the neck down. Histamine works differently in your brain. In certain parts of your brain, it’s responsible for wakefulness or the ability to be alert. That’s why if you take an anti-histamine it may reduce your allergic reaction, but if it crosses the blood brain barrier, it can also make you sleepy
because it’s blocking histamine’s stimulating
effect in your brain. There are four histamine receptors, I’m gonna talk about H1 receptors. In your brain, H1 receptors do a lot. They’re involved in the sleep wake cycle, body temperature,
endocrine regulation, pain, cognition and the relevant
one here: appetite. What researchers have seen
is that blocking H1 receptors affect the region in your brain responsible for making you feel full. It’s called the satiety center. We see this with certain
medications like paroxetine, quetiapine and olanzapine. These medications give you the munchies. People can get terrible
carbohydrate cravings on some of these medications But it’s not enough to
say just don’t overeat. It’s because when you tamper
with your ability to feel full, you don’t see your eating
as stuffing down extra food. You’re eating because you’re still hungry. You don’t feel satisfied. This is what happens in the short term. But with some of these medications, there’s a longer-term creep effect where you continue to gain weight. That slow increase in weight over time comes from another effect
of blocking the H1 receptors and that effect is interfering with a process called thermogenesis. Thermogenesis is the
process of producing heat and creating energy by
burning fat and calories. When you burn less fat, it accumulates. The more fat you have, the
higher your body mass index, also called the BMI. And that’s your ratio of body fat to lean muscle tissue. So that increases when you get this decrease in thermogenesis. So that’s histamine blocking. Bad stuff. A second mechanism is
blocking the 5HT2c receptors. This is just a type of serotonin receptor. It’s been shown in mice that if you activate
their 5HT2c receptors, they lose weight because they eat less. And if you block the
receptor they became obese. Many of the newer
antipsychotic medications block this receptor. Of all the antipsychotic medications, the worst offenders when
it comes to weight gain are olanzapine, clozapine and quetiapine. And all three of these drugs block 5HT2c. Some of the serotonin
enhancing antidepressants are more weight gaining than others. Paroxetine and mirtazapine
are heavy hitters because they strongly
block histamine receptors. Many of the medications that
are considered weight neutral may still result in a two kilogram or four pound weight gain. But medications that
cause a lot of weight gain can cause 50-60 or even
70-pounds of weight gain. The research studies like the ones I have in the description, don’t always report this level of weight gain. They may report it as
five to six kilograms. But these are based on 12-week studies. 12 weeks doesn’t allow
for the creeping up effect that you can get with long-term effect of histamine blocking. So that’s the problem,
what do we do about this? The Non-medication approach
is to have a very strict diet and vigorous exercise. The vigorous exercise is to overcome the slowed fat burning
process that I talked about with impaired thermogenesis. We’re talking about a gym workout. This is not just walking your dog. That’s still great exercise, but it’s not really enough
to keep the pounds off. Also, if you’re trying to
offset the fat accumulation, you need to build muscle
that will burn the fat. This would come from resistance training. And you don’t have to
literally go to a gym. You could use your own body’s resistance. There are apps that can help
you create your own workout. Some examples are Zova and Sworkit. Medication options are to add buproprion if you can handle taking that medication. There may be reasons you
can’t take buproprion like you have bipolar 1 disorder or you’ve tried it in the past
and you’ve had side effects. Buproprion does not cause weight gain and some people can even
lose weight with it. In fact, Contrave is an
FDA-approved medication for weight loss. It’s a combination of
buproprion and naltrexone. It came to market in 2014, but in 2018 the company
filed for bankruptcy. So I’m not sure what’s gonna happen with the availability of that drug. Another weight loss
medication is Orlistat. It decreases fat absorption. The average weight loss
in the clinical trials was about 10% of your body weight. Which may or may not be
that significant to you depending on how much you gained. If you gained 40 pounds and
now you’re up to 200 pounds. That means you may only
lose 20 of those pounds. That’s a modest benefit,
but you do have to look at the side effects to
determine if it’s worth it for you to take the drug. The main side effects are
fatty stools and diarrhea. Fatty stools tend to be
bulky, a weird pale color, and are very foul smelling and they have a greasy film on top. And greasy stools don’t flush well. So if you don’t want to offend
the people in your household, you probably need your own bathroom. So some people decline this option. Two other options are metformin which is a drug used for diabetes. You would take this even if
you didn’t have diabetes. You’d be taking it just for weight loss. And then there’s topirimate. That’s a medication that’s used
for seizures and migraines. It helps you lose weight by
reducing your food cravings. But it can have significant
cognitive effects like confusion and memory problems. Keep in mind your illness itself
can also cause weight gain. If you’re depressed, it
can make you inactive and have no energy to exercise. So consider that possibility
before looking to stop or change your medication because you think it’s
making you gain weight. That’s it. Thanks for watching.

68 thoughts on “Why do you gain weight with antidepressants and mood stabilizers?

  1. My weight keeps increasing each year! At least I have learned to fight against Quetiapine’s fattening affect! I am still really proud of the muscle bulk I have!

  2. This is great! Just one minor correction: BMI is not the ratio of body fat to lean muscle tissue. BMI compares total body mass to height… it does not consider body composition at all. That’s why body builders are also classified as obese according to BMI charts.

  3. I gained 100lbs on invega a few years ago and i still havent been able to loose any of it. I wish i had known.

  4. Psychiatrists are abusive to prescribe unhealthy, fat-inducing drugs! And then they blame the patient! It contradicts: "first, do no harm."

  5. Your video covered all of the bases Dr. Marks. Very impressive.Thank you. One question: what dose of Metformin is necessary to lose weight?

  6. I noticed my carb cravings have been insane since I have been on lexapro for depression and anxiety! I’m on the lowest dose but I’ve gained about 10 lbs since I started taking it. Can willpower overcome this? If I track my calories and exercise and know the possible side effects?

  7. What a fantastic video! Thank you so much for posting it was very informative and you definitely know what your talking about that is for sure. I will share a bit of my experience I'm a 29 male and I have Bipolar Disorder type 1. I gained 24kgs (52 lbs) over 1 year on Olanzipine so my doctor switched me to Quetiapine which slowed the weight gain down but i still managed to put on another 14kgs (30 pounds) gradually over 2 years. I thought to myself I really have to do something about it, so my doctor decided to try Ziprsidone but it just wasn't sedating enough, I wasn't getting enough sleep which is never good for any mental illness, and to top it off my moods were a bit all over the place. After giving that a go we decided it'd be best to go back on Quetiapine but something else had to change so I went out and signed up at my local Gym and started going twice a week 1 day I'd do a Boxing work out and on the other I'd do a strength training workout. On top of that I see a personal trainer once a week as well too keep me motivted and learn new lifts and different exercises to do. Since doing this I've gradually lost 6 kg, its a modest amount but I'm certainly on the right track. Its hard to get motivated sometimes but you just really have to push yourself to get the training done and have the discipline to make sure your on a healthy diet. Lastly I've found when i take my meds at night the best way to shut down the munchies is a whey protein shake does the job nicely. Good luck all

  8. When I was on cymbalta I gained 40 lbs in 3-4 months, the most dramatic of all the medications I tried and almost I could do was eat and sleep! I’m very glad my doctor had me do a supervised taper off of antidepressants and onto CBD instead

  9. So why are meds misused prescribed off label for pain or insomnia and the doctors dont care about the side effects and that you dont have the real problem they're made for? Some ppl have nerve DAMAGE and was given elavil and had seizures, vertigo and hallucinations but they still want them to take it first before real pain reducers or they are labeled "non compliant " in another measure to keep real medication from them???
    And why lie about the dangers of benzos? I've heard doctors joke saying you cant die from xanax unless its cause you choked on one… and it's TRUE. So why lie? Be honest so ppl know what's dangerous and what's not!
    And why lie when we say were having a side effect and y'all say NO that's not a side effect… and we go home and look it up and YES ppl are reporting this side effect! Gaslighting man…

  10. Stay away from Mirtazipine! I gained 20 lbs of fat and NO amount of lifting weights and food tracking helped. I got off it after 2 years (with SO many withdrawals), and weight just fell off and I got super ripped. Trazodone is a much better option (no side effects).

  11. After more than fifty years on these poisons, l have finally woken up to the fact that doctors and psychiatrists, who are in bed with the pharmaceutical companies, just want to keep everyone as sick as they can, l am now so disabled through the drugs that l wish to God that l never started on them in the first place.I now do not take sny notice of labels, l refuse to take any more of their drugs apart from a small amount which l am too exhausted to come off, after going through serious withdrawals from the others.Thats another thing they conveniatly forget to tell you, that many of the drugs are addictive.I started out as very slim, but am now described as morbidly obese.My case might be exteme, but its a long slippery slope to ill health on these medications and l would advise extreme caution in starting them.

  12. i had only 50 kg weight.. after using paroxetine i gain weight around 65 kg…. how can i lose weight…plz suggest me something …

  13. DrTracey when I was in the hospital my doctor put me on Remeron can I gain 20 pounds I slowly took myself off of it instill in maintaining the 20 lb don't know how to get it off I have a fused ankle in a knee replacement so I can't ride a bike or do a lot of walking how can I get this weight off I know I needed to have a lower calorie intake do you have any suggestions?

  14. I'm not a doc, just someone who has been on psych meds since I was 12 yrs old. I was in a terrible car accident and woke up an entirely different person. I was wondering if you would do a video about the effects of psych meds on developing brains and what happens to said brains in the long term. Also, I have found that certain drugs, like Seroquel, will always cause weight gain, while others, like Gabapentin, makes one ridiculously hungry. Psychotropic medications effect everyone differently. It's a crap shoot in so many ways.

  15. Holy crap, I've been steadily gaining weight for like, 10 years on Fluoxetine. I've gotten really into running, but no matter what I do I can't seem to drop the added pounds. (I've gained 15 pounds or so.) This really helps. Thank you!

  16. Thank you Tracy. I’m stuck on amitriptyline for nerve pain and the weight gain side effect (70lb) has ruined my life.

    At least now I understand why. The “never feeling satisfied” is literally how I have explained it to people, and now I can prove it with this video.

  17. I was 130lbs when I started taking pills. Got to be 400lbs. Went off of all medications and after a few years I lost over 200lbs. Dont take pills. That extra weight will make you miserable and you will have far more problems than when you started. Also, many medications throw off the gut microbiome and that leads us to eating foods that worsen our depression and issues. Find an alternative healing modality. Explore healing your subconscious mind. Read the book: "Letting Go: The pathway to surrender".

  18. this is so helpful re: SSRIs but benzos? My sister is on a low dose SSRI — has been for years, doesn't really make any difference, never did and she can't get past a minium amount without big time anxiety repercussions and does everything right and still fights cortisol specific weight gain. Benzos which used to be the candy store for distressed housewives are now the demon; how they work in the body is different would be great for a different video. I'm on 1 mg clonazepam for anxiety which hasn't affected weight but it's been 10 yrs and frankly going swimming whenever I can and practising Tai Chi worked, this drug did not but its side effects long term have to do with memory retention; working on it with my doctor but if anyone is thinking about sleep aids, give this stuff a miss. Dependency and addiction are 2 often confused terms; I have no desire to up my dosage of this stuff I now have to take nor does my sis. But trying to remove them … nightmare. Your truly informative videos are invaluable; if someone has a dr without this level of knowledge, recommend it or seek someone with this fantastic level of knowledge to work with — tx for your clarity and generosity !!

  19. I don't understand why you can't get patients to a sunny place with nice ppl and have them eat right and exercise and get good sleep and possibly cold showers if depressed. Why drug them and cause them to have a chemical imbalance in their brain and make them have more problems?

  20. I take citalopram since 10 years now and meanwhile I'm chubby- which I never was before taking these pills. I startet with sports, but it is hard to motivate myself because of the depression and my fiance who is also not very motivatet or motivating. Last weekend I met my parents in law for the third time ever and they said to me, I should loose weight. I was shocked and hurt… ( They dont know about my depression and I don't want them to know it because I believe they want the perfect daughter in law for their son.)
    My depression was getting better and better in the last years, even if I'm very sensitive to words and moods of my fiance or my daughter, I try to be strong and not so emotional. Often I cry secretly after a conversation who hurted my feelings. I'm hyper sensitive in dealing with people.
    I really want to stop taking my antidepressants, but I'm afraid of the hurtfull feelings, because I'm so over sensitive, and the pills help me a lot to feel normal and a bit stronger. Do you think it would be good to cut my pills in a half and take only 20mg of them instead of 40? Could I loose a little weight by doing this ?

  21. Psychiatrists should prescribe a personal trainer and nutritionist in addition to, or instead of, medication in most cases. There is no replacement for exercise, a healthy diet and good sleep. Get those in order before you prescribe medication.

  22. this is pretty accurate. when I was on mirtazapine I woke up like I haven't eaten in a year, never been so hungry in my life, while on mirtazapine. on the other side – while I was on wellbutrin (Bupropion) – I forgot what it's like to be hunrgy and developed an eating disorder. and now I know why – thanks for the video!

  23. Im on sertraline. I lost weight at first. Then gained weight. Now im building muscle and burning fat. It comes down to discipline. I eat high protein, good carbs, fruit and work out at least 3 times a week with work and school. You can do it, self accountability

  24. I was skinny when I got onto lexapro, over the five years I took it I gained 50 or pounds. Shits terrible and has made me more depressed than I ever was when I was 16. It fucked up my whole body and brain and I dunno how to reverse it

  25. I have to watch my weight for the first time in my life cause meds. Totally worth it for the benefits, I also eat healthier which is great!

  26. Doctor, my sister has schizophrenia and she is in and out hospital all the time. She is 17 and dropped out of school. When she leaves the hospital she stops taking meds and becomes crazy again and tries to kill us all. How do we as family members, give her her meds at home. We can’t force feed her her meds . So what to do? My parents became like zombies and barely live day to day.. and she tries to kill them all the time.

  27. I used Mirtazapine 7.5mg – 15mg about 6 months. I had some insomnia issues which Mirtazapine cured really well. I gained 20 pounds but I was underweight before without appetite. My appetite got really strong, I become lazy and enjoyed food. Now I'm chubby or slightly plump but I feel much better and I like my new added weight. All added weight went straight to my belly, thighs and my butt. I'm off the drug now but weight has stayed the same and I can sleep really well.

  28. If you gain 55 kilos in 6 months, are left permanently scarred all over inner arms thighs hips , have sleep apnea with asthma, constipation requiring medication, is that overkill from medication… ?

  29. This actually is known not to be the case anymore, for some reasons on some antipsychotics and antidepressants actually starve your cells, this is why these particular medications cannot be prescribed to people in prison, because they have fainted do to actual starvation despite a balanced and scheduled diet. After looking at these cases they have discovered the cells are actually starving on these medications. It’s not the case for all of these meds, but for the ones that cause severe weight gain.

  30. I think antidepressants are overrated. The most helpful thing that occurred was having someone that listened and encouraged me to grow. Don’t give up on yourself, take the power back. You can do it. The body achieves what the mind believes.

  31. Can you take Metformin if you have Type 1 diabetes? Oral diabetic medication has only been created for Type 2. And it has always been against recommendation to take by those with Type 1.

  32. Dr. Tracey,
    Thank you for this video. I have been struggling with weight and is very frustrating. Up and Down, Up UP, Down, etc I eat mostly
    90% healthy. I do have a sweet tooth. this is so frustrating. New drugs can make someone a lot of money. Starting to crash….

  33. I don't like that even weight neutral medication can actually cause modest weight gain . As someone with a history of ED weight gain is an absolute deal breaker and I'd be too scared and distrustful to take anything ever .

  34. Weight loss meds for side effects of meds? Exercise for weight loss while on meds? With a family? Hah! I saw an old girlfriend recently, 5’ 6” & 250 lbs. *Unpossible* I had 4 yrs of anti-psychs & SSRI’s in my 50’s. Made everything worse even with no weight gain. Stopped Benzo’s after 3 days. Stopped anti-psychs. 2017, stopped asthma sprays. Wowser, no drugs for anything. I wouldn’t recommend 👆in teens or twenties. 2010, per my P-doc committing sin of truth, “as far as treatment is concerned we’re still in the dark ages.” 9 yrs later? *They’re working on stigma* 2013, separate ghial cell immune system is discovered for the brain. IOW, old news. Is inflammation the cause of psychosis or the effect. My unqualified guess, it’s both.

  35. I don’t think I’ll ever be 90lbs. I’m 4’9 and was excited when I hit 86 again then went back down to 79. I’ve been taking amitriptyline for months now and it makes me hungry but I still can’t hold weight.

  36. I was just put on Sertraline (depression and anxiety yay), it's my first week and so far the side effects haven't been bad but the thought of most foods is unappetizing.
    I already have EDNOS so if I force myself to eat 1000-1200 calories a day, I shouldn't gain any weight should I?
    I do get enough exercise and eat very healthy when I do eat.

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