weight gain?

[randomdoc1]

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Anyone have any input on medications used in psychiatry and risks of weight gain (be it personal experience or literature)? I'm not asking about the obvious big offenders of course (e.g. olanzapine). But per up to date, duloxetine at higher doses is actually associated with substantial weight gain. From some of my patients I've seen some with gabapentin too and if you look up lyrica on up to date, it says weight gain is not an uncommon side effect? Just wondering what other people's thoughts are. And...if duloxetine can be associated with weight gain, does that mean other SNRIs may have higher risk of weight gain compared to SSRIs?

 

[LadyHalcyon]

Anyone have any input on medications used in psychiatry and risks of weight gain (be it personal experience or literature)? I'm not asking about the obvious big offenders of course (e.g. olanzapine). But per up to date, duloxetine at higher doses is actually associated with substantial weight gain. From some of my patients I've seen some with gabapentin too and if you look up lyrica on up to date, it says weight gain is not an uncommon side effect? Just wondering what other people's thoughts are. And...if duloxetine can be associated with weight gain, does that mean other SNRIs may have higher risk of weight gain compared to SSRIs?

This is completely anecdotal but I was prescribed Gabapentin for a bulging disk/pain and I gained weight after a couple of months. When I went off of it I also lost the weight. Oh...and, although I will never be certain, it likely caused rhabdomyolysis. I found one study about rhabdomyolysis in mice who were administered pregabalin. Considering myalgia is a common symptom of rhabdo, I always wonder about my patients who are taking pregabalin and complain of increased myalgia after extended periods of time on Lyrica/Gabapentin. Sorry, kind of went off on a tangent. That beings said, Wellbutrin often can cause weight loss so I'm not so sure it is a simple as SNRI's cause more weight gain etc, although I know Bupropion is an NDRI.

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[chajjohnson]

This is completely anecdotal but I was prescribed Gabapentin for a bulging disk/pain and I gained weight after a couple of months. When I went off of it I also lost the weight. Oh...and, although I will never be certain, it likely caused rhabdomyolysis. I found one study about rhabdomyolysis in mice who were administered pregabalin. Considering myalgia is a common symptom of rhabdo, I always wonder about my patients who are taking pregabalin and complain of increased myalgia after extended periods of time on Lyrica/Gabapentin. Sorry, kind of went off on a tangent. That beings said, Wellbutrin often can cause weight loss so I'm not so sure it is a simple as SNRI's cause more weight gain etc, although I know Bupropion is an NDRI.

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Just to play devil's advocate, I assume when you had the bulged disc you reduced your activity level, and then when it healed and you stopped needing gabapentin your activity level increased. Reduced activity could cause weight gain, and increased activity can cause weight loss.

 

[LadyHalcyon]

Just to play devil's advocate, I assume when you had the bulged disc you reduced your activity level, and then when it healed and you stopped needing gabapentin your activity level increased. Reduced activity could cause weight gain, and increased activity can cause weight loss.

It's hard to say. My activity level only dramatically changed when I started my pre-doctoral internship (I was working insane amounts). My initial MRI was in 2015, but I was prescribed neurontin in 2017 when I had a flare-up. Either way, I did start to notice weight gain after a month or two on the Neurontin. Could it have been due to other factors? Definitely. But I personally believe it was from the medication. That being said, I could be making an illusory correlation.

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[LadyHalcyon]

Just to play devil's advocate, I assume when you had the bulged disc you reduced your activity level, and then when it healed and you stopped needing gabapentin your activity level increased. Reduced activity could cause weight gain, and increased activity can cause weight loss.

Injury to skeletal muscle of mice following acute and sub-acute pregabalin exposure

But this article here makes me think the neurontin also is to blame for why I was hospitalized for rhabdomyolysis in 2017.

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[PsyDr]

Might be leptin, might be mRNA, might be triglycerides, might be lipid metabolism,

A decent review: Is increased antidepressant exposure a contributory factor to the obesity pandemic?

Others:

Glucocorticoid Receptor and FKBP5 Expression Is Altered Following Exposure to Chronic Stress: Modulation by Antidepressant Treatment

The effect of antidepressants on glucose homeostasis and insulin sensitivity: synthesis and mechanisms. - PubMed - NCBI

https://www.sciencedirect.com/science/article/pii/S0022395605000658?via=ihub

 

[Ceke2002]

Anyone have any input on medications used in psychiatry and risks of weight gain (be it personal experience or literature)? I'm not asking about the obvious big offenders of course (e.g. olanzapine). But per up to date, duloxetine at higher doses is actually associated with substantial weight gain. From some of my patients I've seen some with gabapentin too and if you look up lyrica on up to date, it says weight gain is not an uncommon side effect? Just wondering what other people's thoughts are. And...if duloxetine can be associated with weight gain, does that mean other SNRIs may have higher risk of weight gain compared to SSRIs?

Anecdotal Only:

Deptran

75mgs = weight gain of around 12-15 pounds (seemed to be mostly fluid retention)
25mgs = weight gain of around 5-7 pounds

Seroquel

600mgs+ = weight gain of 40 pounds (due to triggered binge eating, at that dosage it seemed to somehow switch off the satiety signal so despite being physically full I still had an intense drive to eat)
150mgs = weight gain of around 12-15 pounds

Mirtazapine

7.5 mgs = weight gain of around 5-7 pounds

For some reason with Olanzapine I found any weight gain was greatly slowed/reduced with the use of disolvable tablets.

 

[whopper]

I found any weight gain was greatly slowed/reduced with the use of disolvable tablets.

I've noticed that too among some patients. I suspected perhaps some of it was being absorbed sublingually vs through the GI tract where it's known to directly stimulate GLUT receptors.

 

[Ceke2002]

I've noticed that too among some patients. I suspected perhaps some of it was being absorbed sublingually vs through the GI tract where it's known to directly stimulate GLUT receptors.

Yes, that was my understanding of the mechanism as well. I vaguely remember seeing some academic type papers on it a while back as well.

 

[Orgone]

I recently had a pt have over 20lb weight gain in a few months on paxil; pt is as reliable as any and swore up and down there were no other diet or activity changes.

Quick searches on weight data always shows the average weight gain compared to placebo but I've always wanted to see the range of weight gains instead. An average of 5lb weight gain where everybody gains 5lb isn't such a big deal, but if most gain none but one pt out of ten gains 50lbs, that will obviously significantly impact their health.

 

[ryerica22]

If you find a medication that is working well and you're concerned about weight gain just add Metformin or Topamax is what I've seen.