The Skinny On Antidepressants

"The Skinny" Content Has a New Home

We've consolidated our "Skinny on Antidepressants" blog with the blog for our book, The Serotonin Power Diet. We'd like to invite you to visit that blog and become a subscriber where you will find tips, news, recipes, insights, stories, and other information our readers and clients find helpful in keeping them on their weight loss course and feeling good about themselves. Please visit The Serotonin Power Diet blog and join our growing blog community. There, we welcome comments, feedback, and questions as we love hearing from our readers.

We wish you all the best,
Judy and Nina

Depression Featured on Oprah

Oprah continues to bring important topics to mainstream America and her show yesterday entitled An Actress, A Supermodel and A Country Star Pull Back the Veil on Depression was no exception. She quoted some important statistics such as that at least 19 million people at any given time are depressed (although some people estimate that number to be as high as 40 million) and that as many as one in four women will suffer from depression at some point in their lives. I hope Oprah continues to use her wise and powerfully influential voice to highlight the vast number of people on antidepressants and other mood stabilizing medications that suffer from weight gain side effects. One of our goals is to let everyone know, patients, family and friends of patients, and health care workers alike, that there is no reason one can't be free of depression, mentally stable, and at a healthy weight, all at the same time.

Sugar for Fibromyalgia Pain Control (and Weight Loss)

We have heard from a number of weight loss clients who also suffer from fibromyalgia that sweet and starchy snacks like breakfast cereal, as well as carbohydrate meals such as pasta, particularly eaten in the afternoon and evening, helped relieve their pain. Of course it is well-known that low doses of antidepressants effectively relieve fibromyalgia pain, and all of our clients with fibromyalgia have been on antidepressants. To remind myself of this form of therapy, I visited this fibromyalgia site which I thought gave a nice overview of the use of antidepressants to treat fibromyalgai: Fibromyalgia Symptoms .

They write "Though antidepressant drugs are typically used to treat mood disorders, they have also proven effective in relieving the pain and sleep-related disorders of fibromyalgia. When people with fibromyalgia receive antidepressant prescriptions, it is typically in order to interrupt pain cycles and restore restful sleep. Antidepressants are prescribed in lower-than-usual doses in order to treat these symptoms. Many people with fibromyalgia also suffer from depression. In these cases, antidepressant medications are prescribed in order to lift mood. However, regular doses of antidepressants are required in order to improve depression."

Judy just shared this story with me:

A few days a weight loss client told me that she eats sugary foods to help her pain. She has been suffering from fibromyalgia for decades and her treatment has included a variety of antidepressants. “They work,” she told me, “to control pain most of the time. But every so often the pain breaks through and then I have to eat something sweet. The sugar takes away the pain for about 30 minutes and it’s enough of a reprieve so I can deal with it when it comes back.”

Our client was afraid that if she went on a diet, she would no longer be able to use sugar when her pain again became intolerable. But to her immense relief, we told her that our diet plan insisted that she eat carbohydrates either in the form of a sugary or starchy snacks at least twice at day. And if she followed the plan, she could count on much longer periods of relief from her pain.

“It isn’t the sugar itself that is taking away the pain,” we explained. ”But sugar and other starchy carbohydrates trigger the production of serotonin in the brain. And this brain chemical, serotonin, will diminish the pain you are feeling.”

“Well I guess I won’t be losing any weight on your diet,” she told us sadly, "but if the pain goes away, I guess it is worth it.”

“Au contraire” we answered (using our very limited French), on the contrary, you will lose weight very easily. Because serotonin not only takes away pain, it takes away appetite and gives you back a better mood. But you don’t have to eat sugar. Any carb except fruit will get the brain to make new serotonin. You just have to be careful and eat the carbs on an empty stomach. Avoid eating protein with the carbs when you need to make serotonin for pain and appetite control because the protein prevents serotonin from being made.”

“What is a sweet snack I could eat on my diet?” she asked. “Well," we answered, “how about those sugary crunchy very low fat breakfast cereals?”

“You mean like Captain Crunch?” she asked.

“Sure,” we answered. “But you can’t eat the whole box. You have to follow the diet guidelines and measure your portions. You only need a certain amount for the brain to make serotonin. Any extra will just add unnecessary calories.”

“Pas de problem.” she answered in her limited French. “Not a problem. When can I start?”

Each person needs to experiment with their eating to find a diet that best controls their symptoms. For anyone, we always recommend a balanced diet that includes wholesome carbohydrates, lean proteins, and healthy fats whether your goal is pain control, weight loss, or general well-being. We just like to let people know that a little sugar can go a long way in making you feel good.

Still 250 pounds thinnner

A wonderfully inspiring story from Judy:

A few days ago I bumped into a former weight loss clinic of mine who I had not seen for about 3 years.  I was so happy to see her, and what she looked like, that I almost cried with delight.  For this client was not your ordinary individual seeking weight loss help.  She was special; someone who fought many obstacles to lose over 250 pounds.  Alyssa (not her real name) had been a thin, active attractive young adult before she experienced a variety of severe emotional disorders which effectively stopped her normal life.  She was hospitalized for an extensive period for psychiatric treatment.   Alyssa told us that it was common practice at the inpatient facility for her and the other patients to order vast quantities of take-out foods such as pizza and Chinese food that they consumed most evenings.  Alyssa, like nearly every other fellow patient on mood stabilizing medications, developed new seemingly insatiable food cravings and an inability to ever feel full.  So she ate and ate.   Ultimately Alyssa recovered from her emotional disorders, but the medication regime, which caused her to eat almost constantly, left her weighing over 500 pounds.  She could barely walk without being out of breath and experienced an almost constant need to eat.  As she began to resume life outside the hospital, she resolved to lose the weight she had gained.  But she feared that an ordinary diet would leave her desperately hungry, and she did not know how to begin to exercise.

While she continued to take her medications, we helped her over almost two years with our weight loss plan that took away the incessant food cravings she had been experiencing.  At first we told her to eat 5 meals a day and three high carbohydrate snacks so she would not feel hungry.  The foods were considerably lower in fat and calories than what she had been consuming, and as the weight came off, we reduced the number of meals and calories she was eating.  We also found a personal trainer who worked with her weekly to improve her stamina and increase her muscle strength which was weak due to her almost total inactivity.  At first, she could not walk up and down the three steps in front of her apartment building without holding on for support. One of the first things the trainer did was help her buy walking shoes to support her weight.  She could only walk around the apartment with difficulty when she first started to exercise but after several months, she was able eventually to walk 3-4 miles each day. And most importantly as she lost weight, she gained confidence in her ability to live a life without any restrictions due to weight or lack of fitness.  As we worked together, I felt privileged to learn and share in her plans of what her future life would be like when her weight would no longer restrict her.  And seeing her a few days ago, happy with her work, looking radiant, exuberant and full of good humor, I felt doubly privileged to learn that her future had  arrived.

Adjunctive Antidepressant Treatment for Bipolar Depression not found beneficial

Is more medication of benefit in alleviating depression symptoms in Bipolar Disorder? Such was the question raised by researchers whose study was published in the April 26, 2007 issue of The New England Journal of Medicine. The study looked at patients treated with mood stabilizers (Depakote, Tegretol, Lithium, or another FDA-approved mood stabilizer) and either an antidepressant (Wellbutrin or Paxil) or a placebo. There was no statistical significant difference in remission, therapy effectiveness, incidence of manic or hypo-manic episodes, or other treatment outcome.

If one can avoid additional medications, great. However, we want to emphasize that each situation must be evaluated and addressed individually, and a medication regimen must be carefully determined and carried out between a qualified prescribing physician, the patient, and any others who might be involved.

Antidepressants can Disrupt Sleep

Judy just ran into someone whose 40-ish year old daughter on antidepressants has been following "The Serotonin Power Diet". She told Judy that, for the first time in years, her daughter is sleeping well.

Depression is associated with sleep disturbances such as frequent awakenings and decreased quality of sleep. And while antidepressants can act on the central nervous system to relieve some sleep disturbances, they often disrupt REM sleep leaving the antidepressant user feeling less rested. A study published in The Journal of American Geriatric Society showed that the risk of sleep disturbances among elderly women on SSRI's was increased. Studies on other classes of antidepressants show similar findings.

By eating carbs such as pasta for dinner along with vegetables, followed by a bedtime carb snack such as instant oatmeal, you can increase brain serotonin to help you relax and make it more likely you'll sleep better.

Zyprexa for Treatment of Anorexia

I'm always amazed at the number of off-label uses for drugs. An estimated 23% of prescriptions, to be exact, according to a 2004 article published in US News and World Report. Most off-label uses are for heart medications, anticonvulsants, and asthma medications. According to an article in Forbes.com, 81% of prescriptions for Elavil were for off-label uses.

If you struggle with weight gain from medications such as Zyprexa (Olanzapine) to treat schizophrenia, bipolar disorder, or psychotic depression, it will make perfect sense to you that Zyprexa is being used off-label to treat patients suffering from Anorexia Nervosa. Zyprexa treats the obsessive thoughts of anorexia nervosa as well as the fears (fear of getting fat, fear of getting help, etc.) and dramatically activates the appetite.

Obviously weight gain is dramatic on Zyprexa. But oftentimes it, or another psychiatric medication, is the only medication that effectively treats the psychiatric disorder. So the patient is left between a rock and hard place: overweight and mentally stable, or thin and mentally dysfunctional. Clearly the former is the necessary "evil". But our hope is that with The Serotonin Power Diet, more people will have a third option: thin AND mentally stable.

Antidepressants for Chronic Pain

Antidepressants are gaining popularity as effective pain management therapy. The tricyclic class including amitriptyline (Elavil) and nortrtiptyline (Pamelor) seem to be the most effective. However, because of weight gain and other undesirable side effects of the tricyclics, SNRI's including venlafaxine (Effexor) and duloxetine (Cymbalta), while somewhat less effective, are also used; however, weight gain is a potential side effect from the SNRI's as it is with the SSRI's. SSRI's including paroxetine (Paxil) and fluoxetine (Prozac) are used in the setting of chronic pain but their benefits seem to be in alleviating the depression often associated with chronic pain rather than improving the pain symptoms directly. (And who wouldn't be depressed with chronic pain?)

How antidepressants reduce pain symptoms is not entirely clear but it's thought that they increase levels of spinal neurotransmitters that reduce the flow of pain signals to the brain.

Not all pain responds equally to antidepressant medication. The sharp, burning pain caused by damaged nerves such as that associated with diabetes, strokes, or shingles responds best. Antidpressants are also effective to treat fibromyalgia, and for some people, antidepressants can reduce the frequency and intensity of their migrain attacks.

We have heard reports from clients and readers that The Serotonin Power Diet effectively reduces their pain symptoms because it increases levels of serotonin, the natural feel-good brain chemical. Serotonin not only alleviates their pain, but the added benefit is that because they feel more energetic, the quality of sleep is better, and their mood is improved, they can better tolerate the pain that they do have.

You Are Not Alone

There are tens of millions of people out there baffled and surprised by their weight gain or inability to lose weight since taking antidepressants. Maybe weight gain wasn't immediate, but after a month, or two, or even up to a year, the pounds started to creep on. If this is you, you're not alone. In fact, over 30 million people in the US experience depression at some point in their lives, many of whom take antidepressants to overcome their suffering.

One of the most wonderful things about the release of our book The Serotonin Power Diet is that it's given us a way to let so many people know about an effective way to lose weight associated with antidepressants and other mood stabilizing medications. It's such a relief for readers to learn that there's nothing wrong with them because they eat a second dinner because the first one didn't make them feel full, or that they don't have an eating disorder just because they crave chips, pizza, and cookies all the time. It's chemical. Nobody knows exactly why this happens, but the medications increase cravings, make you think about food all the time, make it difficult to feel full even if your stomach is stuffed, and cause fatigue that gets in the way of exercise.

I just saw this posting on the Mayo Clinic web site so clearly antidepressants and weight gain is a topic on the minds of many of the millions of users of antidepressants. The responder is not aware that weight loss on antidepressants is as easy as eating a handful of pretzels 30-60 minutes before a meal. Or eating pasta and vegetables for dinner instead of chicken. I'd like for every psychiatrist and mental health provider to know about The Serotonin Power Diet so their patients don't have to suffer from weight gain when they are getting such positive results from their medication.