Are you frustrated with the weight gain caused by antidepressants and mood stabilizers? You’re not alone. As a psychiatrist, I often receive questions about this issue. While we don’t have a full understanding of the mechanism, there are two proposed ways that these medications contribute to weight gain. In this article, we’ll explore these mechanisms and discuss potential solutions.
The Role of Histamine 1 Receptors
Histamine 1 receptors play a crucial role in the way antidepressants and antipsychotic medications affect our appetite and weight. Normally, we associate histamine with allergies and immune responses. However, in specific parts of our brain, histamine is responsible for wakefulness and alertness. When these medications block histamine 1 receptors, the region responsible for making us feel full, known as the satiety center, is affected.
Certain medications, such as paroxetine, quetiapine, and olanzapine, can induce intense carbohydrate cravings, often referred to as the “munchies.” This is because these drugs interfere with our ability to feel satisfied and full. As a result, we continue to eat, mistaking our hunger for a lack of satisfaction. Over time, this can lead to gradual weight gain.
Additionally, blocking histamine 1 receptors can interfere with thermogenesis, the process of burning fat and calories to produce heat and energy. When thermogenesis is impaired, the accumulation of fat increases, resulting in a higher body mass index (BMI).
The Role of 5HT2c Receptors
Another mechanism that contributes to weight gain involves blocking 5HT2c receptors, which are a type of serotonin receptor. Studies conducted on mice have revealed that activating these receptors leads to weight loss and reduced food intake. Conversely, blocking these receptors can cause obesity.
Several newer antipsychotic medications, such as olanzapine, clozapine, and quetiapine, block 5HT2c receptors and are known to cause significant weight gain. Similarly, certain serotonin-enhancing antidepressants, like paroxetine and mirtazapine, have a higher likelihood of causing weight gain due to their strong histamine receptor-blocking properties.
Solutions for Weight Management
While medications can contribute to weight gain, it’s important to consider non-medication approaches as well. Following a strict diet and engaging in vigorous exercise can help counteract the effects of impaired thermogenesis. Incorporating resistance training, either at a gym or using your own body’s resistance, can build muscle and boost fat-burning potential.
If you’re open to medication options, adding bupropion to your treatment regimen may be beneficial. Bupropion is known to be weight-neutral and can even lead to weight loss in some individuals. Another medication, Orlistat, decreases fat absorption and has shown modest weight loss benefits in clinical trials. However, it’s important to consider the potential side effects, such as fatty stools and diarrhea, before deciding to take this drug.
Metformin, commonly used for diabetes, and topiramate, used for seizures and migraines, are also potential options for weight loss. These medications work by reducing food cravings but may come with cognitive side effects such as confusion and memory problems.
Lastly, it’s essential to recognize that the underlying illness itself can contribute to weight gain. Inactivity and lack of energy caused by depression, for example, can hinder exercise and physical activity. Before attributing weight gain solely to medication, consider the impact of your illness.
Remember, maintaining a healthy weight is a journey that requires a multifaceted approach. By understanding the mechanisms behind weight gain caused by medications and exploring various solutions, you can take charge of your weight management.