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“I gained so much weight this past year from my antidepressant that I no longer have a social life,” writes a reader. She goes on to say that she used to be thin and never worried about what she looked like. “But now I look at my bulging body and see how dreadful I look in jeans and feel like crying. Except for going to work and doing errands, I refuse to leave the house. I even feel too fat for the gym. My antidepressant was supposed to improve my mood, not leave me even more depressed.” Unfortunately, this woman’s story is not unique. Millions of people are on antidepressant and related drugs for mood problems. Many of them discover, to their despair, that these drugs have a very unwelcome side effect. They find themselves unable to control their eating. And often even before their moods are improved, they find their bodies carrying unwanted and unexpected extra pounds. “Diets were for other people,” a client told me. “I never had problems controlling my eating. When I was full, I stopped. I didn’t eat between meals and could not understand why my friends were always complaining about how hard it was not to snack. You should see me now. About two months after my divorce proceeding started, I started on the snacks. Something inside me keeps telling me to keep putting food in my mouth.” This woman, let us call her Jane, knew that she was eating her way through her anxiety but couldn’t stop. “My divorce is getting me down but what really is making me depressed is my weight.” Whether the pounds come on because of antidepressant use or an emotionally disastrous situation, the effect may be the same: feeling depressed, hopeless and helpless at the inability to stop overeating. Telling such a person to eat less and exercise more is not going to work. It will simply make the weight gainer feel even more depressed about getting her eating under control. It is hard enough to lose weight when everything is fine on your life. Imagine how much harder it is when you are depressed and everything seems bleak. And that is something few diet programs and fewer doctors seem to understand. When people start on a diet, they are optimistic and hopeful that it will change their life. They are eager to lose weight because they see themselves looking and feeling better and enjoying life with a thinner, healthier body. But optimism and depression are like oil and water. It is hard to work up enthusiasm for a diet when just getting through the day is work enough. But if weight gain is a cause for depression and depression then becomes an obstacle to losing weight, what is the answer? Actually the solution is not that difficult. The would- be dieter whose weight came on because of antidepressant-caused cravings will find it easy to lose weight once the cravings stop. After all, this is someone who never had a weight problem until the meds were started. The solution is to get the brain to shut off the urge to eat excessively. The way to do that is to get the brain to produce more serotonin. As we point out in The Serotonin Power Diet, our brains contain their own appetite suppressant. Serotonin chemical works on specific brain cells to make us feel full and satisfied. Getting serotonin to be more proactive in shutting off our appetites is not difficult. Simply following a therapeutic schedule of eating carbohydrates will ensure that serotonin is made. In fact, the only time this brain chemical is synthesized is after we eat sweet or starchy foods without any protein. The relief at no longer being a victim of antidepressant-induced cravings will make it easy to resume a healthy diet and an exercise regimen. And any depression over the weight gain will evaporate once the number on the scale starts going down again. Engaging the brain to stop the munching can also help to shut off emotional overeating. Nonetheless, emotional overeating is harder to overcome. Even if your brain is telling you not to eat, it is still possible to look at food as the only thing that gives pleasure and distraction. For emotional overeating to be overcome, the stress that caused it must be identified and ways found to diminish it. But taking the first step of relying on your brain to help you do this is extremely important. Your depression over your weight will decrease and you will find it easier to deal with the psychological components of the overeating. And eventually the pain of depression over your weight will be replaced by the pleasure in our weight loss. | permalink | related link |    ( 3 / 2754 )Combating Antidepressant-Related Weight Gain Gaining weight on antidepressants is all too common. To the horror of many formerly thin patients, six or more months on any of the commonly prescribed medications for depression, panic attacks, anxiety or even chronic pain like fibromyalgia leave them with 15 or more unwanted pounds. And some of those medications cause even greater weight gain— often upwards of 50 or more pounds. An acquaintance of mine who lives in Europe was put on a medication for anxiety that has a profound affect on weight. This individual was thin and muscular with a body fat percentage of about 9% before starting on the medication. I did not see him for several months and when I did, his weight gain made him unrecognizable. “I can’t stop eating,” he said. “ I eat a meal and an hour later, I am ready for another. It’s ironic, given the medication I take, but I am getting very anxious about this weight gain.” He is not alone in his worry because of his medication. A recent scan of side effects of medications used for depressive illness reveals that almost all of them cause weight gain. It doesn’t happen immediately but after six months of so of use, a 7-10 pound increase of weight and more have been widely reported. In the words of someone who wrote to our website recently: “It doesn’t make sense. These drugs are supposed to increase serotonin activity and serotonin is supposed to shut off appetite. But I constantly feel the need to put food in my mouth. It doesn’t matter how stuffed my stomach is, my brain keeps telling me to eat. Why is this happening?” The “why” is not really understood. Research has focused on laboratory animals and shown that some drugs called atypical anti-psychotics may block serotonin’s ability to engage certain cell sites involved in controlling appetite. Others have speculated that none of the drugs used for mental disorders is specific in how they affect brain chemicals. There may be other chemicals activated or inhibited by these drugs that have their own impact on food intake. One such neurotransmitter is histamine, which is known to increase eating behavior in laboratory animals. But those who watch their waistlines disappearing from the impact of their medications can’t wait for scientists to figure out why these drugs cause overeating. What they want to know is why nothing shuts off their need to eat. “I used to feel satisfied after a meal or snack. My stomach didn’t even have to be all that full. But I just knew that I had enough to eat. Now I am on the see-food diet. You know, the one in which I see food and eat it, “ a client told me. We know that serotonin normally activates the appetite shut-off “switch” and that this function is separate from its role in mood control. If the antidepressants and related medications are preventing this “switch” from being turned on, then overeating is going to occur. Our clinical and research experience showed us that if serotonin production were increased in general, the stop–eating “switch” would be turned on. Fortunately, increasing serotonin production is as simple as eating a potato, pasta or rice, bagels or bread, oatmeal or grits. As long as any starchy or sweet carbohydrate (with the exception of fruit sugar) is eaten without any protein, serotonin is made. And as we describe in The Serotonin Power Diet, only moderate amounts of carbohydrate need to be eaten: ¾ of a cup of dry breakfast cereal, a toasted English muffin, a moderate-size baked potato. The solution to antidepressant-associated weight gain seems too good (and tasty) to be true. But as our weight-loss clients proved, it works. Many of them found that their eating returned to what it was prior to taking their antidepressants and they had no trouble losing weight. Since their weight gain was specifically caused by their medication and not by underlying stress or a long history of struggles with eating, they returned to eating appropriate portions at meals and stopped nibbling between meals. They also reported that the increase in serotonin due to their carbohydrate consumption increased their energy so they were able to exercise as well. Can people on these weight-gaining medications lose weight by following other diets? Sure, if their will power is extremely strong and able to withstand the pressure from their medications to eat. But it will be like pushing on a door to close off the appetite while a stronger force is pushing the door open to more eating. Why struggle? Your brain already has the ability to turn off your appetite. The way to activate it is as close as your next piece of toast. | permalink | related link | ( 2.9 / 428 )We have a friend who was treated with prednisone ( a form of cortisone) for several weeks before his physicians figured out that he had Lyme disease. He was describing his ordeal and mentioned that along with thinking he had a variety of incurable diseases, he also gained a lot of weight. “ I had a passion for rice pudding”, he told me. “ I would go to the supermarket and buy cartons and cartons of the ready to eat pudding. In fact, I stopped thinking I had a fatal disease because I was gaining so much weight. Of course it was the prednisone. As soon as I went off of it, I stopped overeating and lost all the weight I gained.” Many people have had similar experiences with this drug; not the rice pudding part but the overeating and weight gain. Fortunately people usually don’t have to stay on the drug chronically and they will lose their weight once they stop taking it. But there are many other drugs which are taken chronically and which may also cause weight gain. Drugs used to treat mental and emotional disorders have a long history of causing substantial weight gain. Lithium which has been around for decades was probably the first to be identified but many of the drugs that came along more recently have the same side effect. The more severe the mental illness, the greater the chance that the drugs used to treat the disease will cause weight gain. I have a distant relative by marriage who used to be a model. When she was treated with a class of drugs known as mood stabilizers, she went from a size 2 to a size 18. Her change in weight was not rare and her story is repeated among people who are being treated for schizophrenia, schizo-affective disorder, bipolar depression , depression, anxiety and other mental disturbances. Sometimes the weight gained is only 20-30 pounds but gaining more than 100 lbs in a year or less is well known. To be fair, some of the gain in weight may be caused by lack of nutritional information. If a drug causes a dry mouth and chronic thirst and if the patient satisfies this thirst with juice , soda, or chocolate milk, obviously weight will be gained. Some of these drugs cause fatigue and hypersomnia ; i.e. sleeping more than usual. So if a previously active person becomes sedentary, weight can be gained even if food intake has not increased. But many patients who gain weight report that they simply can’t stop eating. Victoria , a botanist told me “ No matter how big dinner is, I want to eat an hour later.” “ I used to weigh 123 pounds and could easily fit into a size 4 or 6. Now I am lucky if I can squeeze into a size 12. I keep telling myself to stay out of the kitchen but I feel as if there is a hand on my back pushing me toward the refrigerator all the time.” The current thinking on why these drugs that act on the brain cause overeating is that they may trigger a brain neurotransmitter, histamine that stimulates hunger. This has been shown for some drugs in research animals. So far no drugs have been developed to stop this side effect even though the gain in weight may lead to obesity related medical problems. We found almost by accident that our approach to weight loss would help those people who weight gain was caused by their medications. While running a weight loss clinic for people who were emotional overeaters, we started to treat many clients who had gained weight on their antidepressants, mood stabilizers and related medications. The clinic’s food plan was based on drinking a carbohydrate beverage twice daily to increase brain serotonin. Since we knew that serotonin was the brain’s natural appetite suppressant, we hoped that the anti-eating effect of serotonin might counteract the pro-eating effect of their medications. And it worked. These clients lost as much weight as those who were not on medications, even though the first group were on drugs that made them want to eat. As we explain in the Serotonin Power Diet, a therapeutic amount of carbohydrate will help control eating by potentiating the anti-hunger effect of serotonin. The carbohydrate is eaten as a snack in a calorie and fat controlled amount. The snacking fits into a diet plan which allows a one or two pound weight loss each week. This may not seem like much but for people who are gaining a pound every two weeks or so, the weight loss is significant. And what is just as important is that people do not have to choose between staying on medication that brings about a sense of emotional balance or going off of it in order not to gain weight. The weight comes off; the good mood stays. | permalink | related link | ( 3 / 26 )The woman sitting next to me in the concert hall was fanning herself vigorously with her program. It was not hot in the hall; indeed most people had on sweaters or jackets as the hall was drafty and it was very cold outside. "Hot flushes?" I asked knowingly. "Yes," she replied, "and they never seem to end. Plus I never get a good night’='s sleep. I must wake up every hour hot and sweaty. And then the next day I am so tired, I eat all the time just to stay awake. My doctor suggested I go on antidepressants. He said they might help." At this point the lights dimmed so I said nothing. I wondered if she realized that the therapy for her hot flushes might bring with it another set of problems: weight gain. Just about all the antidepressants available today have the potential to make people gain weight. The amounts range from 10 to upwards of 30 pounds or more. The reason for the weight gain is that these drugs seem to take away a sense of satisfaction after food is consumed. Patients report food cravings, needing to eat larger portions than before they went on the medications, and a loss of satisfaction and satiety. Added to this drug- induced overeating is the effect of menopause itself. Many women start to struggle with their weight as they go into menopause and complain that it is harder for them to lose pounds than when they were younger. As my seatmate was already overweight, the addition of even 10 more pounds would be unwelcome and might even have an impact on her health. So how could going on antidepressants to relieve her hot flushes be a good idea? On the other hand, awakening at night due to frequent hot flushes is unpleasant and leads to daytime fatigue. Disrupted sleep is a well-known trigger for overeating and weight gain. So it was possible that my seatmate was gaining weight because she slept so badly. Was her choice between taking an antidepressant so her hot flushes would go away, she would be able to sleep but might gain weight or not take anything, have her sleep disrupted, and then eat too much because she was so tired? Fortunately, antidepressant-associated weight gain does not have to be inevitable. Although research studies have not yet identified why these drugs cause overeating, studies that my colleagues and I conducted have shown that there is an easy and natural way to stop it. The same brain chemical on which the antidepressants work, serotonin, is involved in appetite control. Unfortunately, the antidepressants do not make serotonin work harder at controlling eating. If they did, everyone on these drugs would never have to worry about eating too much. That is the bad news. The good news is that everyone can make serotonin work harder at preventing overeating simply by choosing the right foods to eat. Serotonin is produced only when carbohydrates are eaten. Complex carbohydrates such as rice, potatoes, pasta, bread, cereal, crackers, tortillas, cornbread and simple sugar all activate a process in the body that leads to more serotonin in the brain. (Fructose, the sugar in fruit is the only exception.) When protein is eaten either by itself or with carbohydrate (a chicken sandwich for example) the protein part of the meal prevents serotonin from production. When new serotonin is made, it functions to put a brake on eating. Even though the antidepressants would give my seatmate feel a persistent need to eat, regardless of how much food she consumed, she can prevent this from happening by eating a small amount of carbohydrate before starting a meal. A cup of low-fat cereal, 4 or 5 small graham cracker squares, a low-fat granola bar or two fat-free meringue cookies will boost serotonin levels and spoil her appetite. And if she finds herself nibbling all evening, she ought to eat a dinner of only carbohydrate and vegetables. That way the increased serotonin in her brain will prevent her from snacking until she goes to sleep. Intermission came and we both stayed seated. After a few minutes, I reached into my bag and offered her some cherry Twizzlers, my all-time favorite carbohydrate snack. “Before you start on your antidepressants," I said to her, "there is something you ought to know." "Well," she said, after I gave her my carbohydrate –serotonin boosting suggestions, "if getting rid of hot flushes means snacking on carbohydrates, menopause may not be so bad after all." | permalink | related link | ( 3.1 / 17 )The woman sitting next to me in the concert hall was fanning herself vigorously with her program. It was not hot in the hall; indeed most people had on sweaters or jackets as the hall was drafty and it was very cold outside. "Hot flushes?" I asked knowingly. "Yes," she replied, "and they never seem to end. Plus I never get a good night's sleep. I must wake up every hour hot and sweaty. And then the next day I am so tired, I eat all the time just to stay awake. My doctor suggested I go on antidepressants. He said they might help." At this point the lights dimmed so I said nothing. I wondered if she realized that the therapy for her hot flushes might bring with it another set of problems: weight gain. Just about all the antidepressants available today have the potential to make people gain weight. The amounts range from 10 to upwards of 30 pounds or more. The reason for the weight gain is that these drugs seem to take away a sense of satisfaction after food is consumed. Patients report food cravings, needing to eat larger portions than before they went on the medications, and a loss of satisfaction and satiety. Added to this drug- induced overeating is the effect of menopause itself. Many women start to struggle with their weight as they go into menopause and complain that it is harder for them to lose pounds than when they were younger. As my seatmate was already overweight, the addition of even 10 more pounds would be unwelcome and might even have an impact on her health. So how could going on antidepressants to relieve her hot flushes be a good idea? On the other hand, awakening at night due to frequent hot flushes is unpleasant and leads to daytime fatigue. Disrupted sleep is a well-known trigger for overeating and weight gain. So it was possible that my seatmate was gaining weight because she slept so badly. Was her choice between taking an antidepressant so her hot flushes would go away, she would be able to sleep but might gain weight or not take anything, have her sleep disrupted, and then eat too much because she was so tired? Fortunately, antidepressant-associated weight gain does not have to be inevitable. Although research studies have not yet identified why these drugs cause overeating, studies that my colleagues and I conducted have shown that there is an easy and natural way to stop it. The same brain chemical on which the antidepressants work, serotonin, is involved in appetite control. Unfortunately, the antidepressants do not make serotonin work harder at controlling eating. If they did, everyone on these drugs would never have to worry about eating too much. That is the bad news. The good news is that everyone can make serotonin work harder at preventing overeating simply by choosing the right foods to eat. Serotonin is produced only when carbohydrates are eaten. Complex carbohydrates such as rice, potatoes, pasta, bread, cereal, crackers, tortillas, cornbread and simple sugar all activate a process in the body that leads to more serotonin in the brain. (Fructose, the sugar in fruit is the only exception.) When protein is eaten either by itself or with carbohydrate (a chicken sandwich for example) the protein part of the meal prevents serotonin from production. When new serotonin is made, it functions to put a brake on eating. Even though the antidepressants would give my seatmate feel a persistent need to eat, regardless of how much food she consumed, she can prevent this from happening by eating a small amount of carbohydrate before starting a meal. A cup of low-fat cereal, 4 or 5 small graham cracker squares, a low-fat granola bar or two fat-free meringue cookies will boost serotonin levels and spoil her appetite. And if she finds herself nibbling all evening, she ought to eat a dinner of only carbohydrate and vegetables. That way the increased serotonin in her brain will prevent her from snacking until she goes to sleep. Intermission came and we both stayed seated. After a few minutes, I reached into my bag and offered her some cherry Twizzlers, my all-time favorite carbohydrate snack. "Before you start on your antidepressants," I said to her, "there is something you ought to know." "Well," she said, after I gave her my carbohydrate 'serotonin boosting suggestions,' if getting rid of hot flushes means snacking on carbohydrates, menopause may not be so bad after all." | permalink | related link | ( 1.5 / 2 )Back Next |
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