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Q: latest anti-depressant medications ( Answered,   0 Comments )
Subject: latest anti-depressant medications
Category: Health > Medicine
Asked by: dingodog-ga
List Price: $20.00
Posted: 30 Apr 2005 20:00 PDT
Expires: 30 May 2005 20:00 PDT
Question ID: 516381
I am writing to get your opinion on the latest anti-depressant drugs.
I understand that the Google gang are not doctors or psychiatrists,
but i nonetheless would like to collect as much data and research the
latest meds as much as possible to be more in the know.

What I am specifically looking for are the LATEST anti-depressant
drugs that (a) have proven to be more effective than the ?tried and
trusted? Prozac and Paxil types, and (b) medications that will not
make me gain an incredible amount of weight in record time.

I say this because I have tried Paxil years ago, and I gained 50
pounds in the few months i was on it. I had not changed my exercise or
eating habits at all, so I attribute all of the weight gain solely to
Paxil. (It is a proven side effect, incidentally.) And with Prozac and
other older SSRI drugs I?ve heard that many of them actually now have
suicidal warnings on them, with many users actually experiencing more
sadness and depression while taking them than before!

I am ardent on trying some medications, as opposed to doing any kind
of hypnotherapy/cognitive therapy, exposure therapy, relaxation
techniques, etc etc., because I?ve tried all those and they just
haven?t worked out for ME. In a nutshell, I have tried myriad ways of
combatting my mild depression and social anxiety disorder over the
years, and I am now convinced it is indeed chemical--a lack of
serotonin, whatever--and what I?d like to do is try a safe, modern,
effective anti-depressant without any nasty side effects, like the
weight gain. (Of course I realize side effects are inevitable with any
medication, but the weight gain for me was the worst.)

I appreciate your time and effort, and I look forward to your findings.
Subject: Re: latest anti-depressant medications
Answered By: crabcakes-ga on 02 May 2005 22:41 PDT
Hello Dingodog,

   I?m pleased you want to know more about prescription medicines you
may be taking. A well informed patient is one who will improve faster.

Lexapro (escitalopram) and Wellbutrin (bupropion) are two well known
anti-depressants that reportedly cause little to no weight gain.
Lexapro turns out to be the one with the fewest side effects of all
the anti-depressants. Of course, as you already recognize, your doctor
or therapist will prescribe what is best for you after considering
your medical and mental health history.

Forest Pharmaceuticals, the maker of Lexapro:

?Does LEXAPRO cause weight gain?In studies, people treated with
LEXAPRO experienced no clinically important weight change as a result
of therapy. If you have concerns about any side effects, you should
talk with your healthcare professional or doctor.?

Some people DO gain weight on Lexapro, but it does have the reputation
of being one of the antidepressants that causes fewer people to gain

?Typical Side Effects: The usual for SSRIs - headache, nausea, dry
mouth, sweating, sleepiness or insomnia, and diarrhea or constipation,
weight gain, loss of libido. Most everything but the weight gain and
loss of libido usually goes away within a couple of weeks. The odds
are just lower than the other SSRIs and the effects less severe, even
the weight gain and sexual problems tend to be not as bad with Lexapro
(escitalopram oxalate).?

GlaxoSmithKline, makers of Wellbutrin

Wellbutrin XL

?Although Wellbutrin occasionally causes weight gain, a more common
effect is weight loss: Some 28 percent of people who take this
medication lose 5 pounds or more. If depression has already caused you
to lose weight, and if further weight loss would be detrimental to
your health, Wellbutrin may not be the best antidepressant for you.?

?The etiology of weight gain associated with SSRIs is unclear, but
metabolic factors appear to predominate. "Many patients can't lose the
weight they gain, even with strict dieting and exercise," Dr. Ginsberg
The greatest incidence of weight gain has been seen with paroxetine.
Fluoxetine is associated with somewhat less gain and sertraline with
the least of all. In one study of long-term effects, 26% of 47
patients on paroxetine gained more than 7% of baseline weight,
compared with 7% of 44 patients on fluoxetine and 4% of 48 patients on

?Other new antidepressants may result in long-term weight loss, rather
than weight gain. In clinical trials with bupropion, more patients
lost than gained weight. The drug is structurally similar to a proven
weight-loss agent diethylpropion (Tenuate), Dr. Ginsberg observed.?

?FDA Approves Wellbutrin XL -- New, Once-Daily Antidepressant with Low
Risk of Sexual Side Effects and Weight Gain?

?The assaults pounded her one after another. Her father's death. A
difficult pregnancy. A divorce. Becoming a single parent to 4-year-old
And then, crash...Donna Johnson realized she was depressed.
"I really struggled with the decision to go on antidepressants,"
Johnson said. "It was just the realization that I could not handle
this on my own without medication."

She worried about the side effects when she started taking Celexa®: a
diminished sex drive, a chance of weight gain and daytime sleepiness
from Celexa. They all had become too much for Johnson. Her doctor
found an answer - Lexapro®.
Lexapro is a new antidepressant, adding to the arsenal of
antidepressants called selective serotonin re-uptake inhibitors
(SSRI). These drugs work on brain chemicals controlling emotion and
thought. Experts believe that serotonin, which normally remains
outside of brain cells, are absorbed by cells in people with
depression, altering mood by changing normal levels of serotonin.
Lexapro promises to help lift depression without the typical side
effects of similar drug giants Prozac and Zoloft. While providing good
results with treatment, SSRIs can cause sexual dysfunction, weight
gain and insomnia. Some 40 percent of people on a given SSRI stop
because of side effects.

Lexapro's maker, Forest Laboratories in New York City, said the only
significant side effect is nausea, which usually goes away as the body
adjusts. Also, the drug's potency is stronger, requiring less
medication to get the same result. With the high cost of patented
prescription drugs, this makes the new SSRI more cost competitive.?

?Wellbutrin XL only antidepressant with low incidence of sexual
dysfunction and weight gain?
?Wellbutrin works differently from the more publicized class of
antidepressants known as SSRIs -- selective serotonin reuptake
inhibitors -- including Eli Lilly & Co.'s Prozac and GSK's own Paxil,
and has different side effects.?

?Current studies suggest that long-term use of SSRIs, Prozac, Zoloft,
and Paxil is associated with weight gain. The purpose of this article
is to list some of the popular psychotropic and seizure disorder
medications on the market today and discuss the relationship, if any,
these medications may have with body weight changes. A review of
several studies regarding exercise and depression will also be
Antidepressants can affect weight in several ways:
·They may increase or decrease basal metabolic rate without changing
caloric intake.
·They may affect hormonal changes and increase appetite.
Unexpected weight gain can increase the difficulties associated with
psychiatric and seizure disorders by further aggravating mood
instability and low self-esteem.
The following paragraphs contain brief descriptions of several classes
of psychotropic and seizure disorder medications.

?Paroxetine (Paxil®) appears to have the most significant impact on
weight gain of all of the SSRIs. Studies show that patients using
Paxil experience an increase in breast size as well as weight gain and
increased serum prolactin. One case report linked cravings for
carbohydrates with Citalopram (Celexa®) while other studies showed an
average weight gain over time of 15-20 pounds with Sertraline
(Zoloft), Fluoxetine (Prozac®), and Citalopram (Celexa®).

However, SSRIs cause less weight gain, fewer anticholinergic symptoms,
and less toxic adverse effects than tricyclic antidepressants (TCAs)
and monoamine oxidase inhibitors (MAOIs). These findings have led to
the increase in SSRI prescriptions by psychiatrists and primary care
providers. Primary care providers are not likely to be familiar with
the difference between the various SSRIs relative to their possible
weight gain side effects.?

?Venlafaxine (Effexor®) has been shown to cause weight gain but not as
severe as has been reported with the SSRIs paroxetine (Paxil®),
fuoxetine (Prozac®), and sertraline (Zoloft®).
Mitrazapine (Remeron®) has been associated with significant weight
gain, possibly secondary to interactions with the histamine (H1)
receptor. It is not associated with gastrointestinal symptoms, sexual
dysfunction, or increased heart rate, as seen with the SSRIs.
Trazadone (Desyrel®) is an antidepressant with sedative properties
that is frequently used as a sleep aid as well as treatment for
depression. It appears to cause less weight gain than amitriptyline
(Elavil®) but more than buproprion HCL (Wellbutrin®).
There is currently no information available relating Nefazadone
(Serzone®) to increased appetite or weight gain.
Buproprion HCL (Wellbutrin®) has not been associated with weight gain
and is commonly used with some success in smoking cessation.?

?For all patients who are prescribed antidepressants, the possibility
of weight gain is therefore of great concern. Clinicians should remind
patients that although depression is often accompanied by weight loss,
successful treatment of depression may result in a return to
pre-depression behaviors (Michelson et al., 1999). These may include
more zestful eating habits, socializing in restaurants, and a renewed
interest in cooking, among others. Thus, successful treatment of
depression may actually be associated with weight gain. Treatment of
depression should include the proactive incorporation of healthy
lifestyle behaviors such as responsible dietary choices and routine

In addition, it is imperative to recognize that some antidepressants
appear to increase the risk for weight gain more than others. This
information should be considered when deciding on a particular
medication to treat a patient with depression. Mirtazapine (Remeron)
and the tricyclic antidepressants tend to be associated with
significant weight gain (Montgomery et al., 1998). The SSRIs have
generally been thought not to cause acute weight gain, although some
data suggest that their effect on weight may vary over time, with
long-term treatment resulting in higher-than-baseline weight in
certain patients (Sussman and Ginsberg, 1998). Conversely, nefazodone
(Serzone), bupropion (Wellbutrin) and venlafaxine tend to be
weight-neutral (Ackerman and Nolan, 1998).?

?I recently found an interesting article about weight gain and
antidepressants. Doctors look for short term effects (3 to 6 months)
or long term effects of the medication (more than 6 months). Any
weight gain above 7% of the original weight is considered relevant.
Weight gain due to SSRI is less likely in any short term use. Knowing
the different effects on weight gain is important in making a good
choice before starting antidepressant medication! Doctors should
always inform patients about possible side-effects on weight, and
possibilities of preventing a severe weight gain by sufficient
excerise and health food intake.

Not all SSRI (like Paxil) cause weight gain for all patients. But one
study suggested that there might be differences in weight gain due to
the different types of SSRI. Paroxetine (Paxil) may be more likely
cause a significant weight gain than other drugs of this type (like
fluoxetine or sertraline). Studies about citalopram found no
significant weight changes for most patients (but a minority of about
5% of the patients had a weight gain of more than 5 kg).?
So what are your options?
·	Get appropriate education about the effects of the drugs on your weight
·	Make a food diary to rule out other causes of weight gain 
·	Increase exercise 
·	Talk with your doctor about different treatment options 
·	switching to another SSRI 
·	switching to another antidepressant class 
·	combine your medication with Buproprion (causes appetite loss). For
a small number of patients (with ADHD), the additional therapy with
psychostimulants (methylphenidate) has a similar effect.

?Weight gain on SSRIs · Among the SSRIs, paroxetine causes weight
gain, while the effect of the others is unclear. Studies are
conflicting, but expert opinion suggests they all can cause weight
gain over the long term. · Although some patients experience slight
weight loss during the first few months on some SSRIs, this does not
persist over the long term, and there is no role for SSRIs in the
treatment of obesity. However, reports indicate switching to bupropion
may be useful for weight loss, especially for patients who gained
weight on other antidepressants. Recommendations: If the patient
reports distress about the weight gain, consider switching to another
antidepressant: bupropion, nefazodone, or other SSRIs. Tricyclics
usually cause weight gain so they should be avoided.?

Additional Reading
Antidepressants and Weight gain

These answers may be of interest to you as well:

There you go. I hope this is the information you are seeking. If not,
please request an Answer Clarification, before rating. This will
enable me to assist you further, if possible.
Regards, Crabcakes

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