Losing Weight Gained From Psychotropic Medications

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One of the common challenges faced by people with mood disorders is weight gain from their medications—as many as 55% of people who take antipsychotic medications may experience weight gain as a side effect. This weight gain is believed to be caused by a lack of satiety (feeling full) and an increased appetite for foods high in carbohydrates and fat. In addition to being physically dangerous, extra weight can be a stumbling block to good mental health if it affects your self-esteem and comfort in your own body. To make matters worse, weight loss while still taking the medications that caused the initial gain can be notoriously difficult. But there is hope.

Medications That May Cause Weight Gain

Many medications used in the treatment of mood disorders list weight gain as a potential side effect, including:

  • Seroquel (quetiapine)
  • Risperdal (risperidone)
  • Clozaril (clozapine)
  • Zyprexa (olanzapine)
  • Remeron (mirtazapine)
  • Paxil (paroxetine)
  • Lithobid (lithium)
  • Depakene (valproic acid)
  • Depakote (divalproex sodium)
  • Tegretol and Equetro (carbamazepine)

Researchers Try to Tackle Medication-Induced Weight Gain

A presentation by Dr. Rohan Ganguli and Nurse Practitioner Betty Vreeland, related to their 2007 article published in The Journal of Clinical Psychiatry, focused on the issue of weight gain and medications. Dr. Ganguli began by saying he had treated many obese patients for years without really thinking about their weight. Then a colleague did a survey that found that of their patients diagnosed with schizophrenia, less than 20% were in the normal weight range, and fully 60% were considered obese.

Dr. Rohan Ganguli said that, unfortunately, "it has been assumed that people with schizophrenia are socially unaware and that, unlike the rest of us, [their weight] really does not matter to them." Yet when they asked these patients how they felt about their weight, a majority of the overweight and obese patients said they wanted and had tried to lose weight.

Dr. Ganguli and his fellows developed a program that clinicians could easily provide to their patients. It involved 14 weeks of group sessions with training in areas including developing healthy eating habits, burning more calories, and changing snacking habits. Self-monitoring in the form of daily weighing and food and exercise logs was key.

The Results

The results after the 14-week program were very encouraging: Two-thirds of patients lost at least 3% of body weight and around 40% of participants lost 5% of their body weight or more.

In addition to promoting key lifestyle changes in a supportive, collaborative environment, the program also focused on counteracting common thoughts, such as those surrounding the concept of "wasting" food.

A key part of the program's strategy was teaching people that it was OK not to eat the entire meal.

Research on Preventing Weight Gain

Finally, they tested the program with patients who were just starting on some of the medications that are known to cause weight gain, including Seroquel (quetiapine), Risperdal (risperidone), Clozaril (clozapine), and Zyprexa (olanzapine). In all cases, intervention prevented weight gain in more patients than in the control group, although the success rate depended on the medication. In this small study, the most dramatic difference was with Seroquel, where more than 60% of the control group gained significant weight, compared to only 10% of those in the intervention group who gained.

Lifestyle Barriers and Interventions

A unique set of challenges exists for those with mood disorders that might not in other populations, including the metabolic effects of their medications, impact of symptoms on motivation, poor dietary habits, and high rates of sedentary behavior. For example, Ganguli and his team found that many people with schizophrenia eat at fast food restaurants because these are inexpensive and convenient, but these meals are often high in calories and low in nutritional value. Chronic poverty can also be a factor for those with mental illness, which affects quality of life, self-esteem, and the ability to pursue "leisure" activities such as participating in exercise.

A meta-analysis of 17 studies and nearly 2,000 participants looked at successful lifestyle interventions for those living with serious mental illness. The study found that programs of at least a year's duration had more consistent outcomes. Some of these interventions included physical activity, nutritional advice, behavioral programs, and access to free fruits and vegetables. Successful outcomes included improved blood pressure, weight loss, BMI reduction, smaller waist circumference, and lower cholesterol.

The Message

Mental health practitioners of all kinds owe it to their patients to compassionately address the problem of medication-induced weight gain and recognize that their patients do care.

Ganguli and Vreeland's work shows that while people living with mental health disorders face unique challenges, they are not only capable of making healthy lifestyle changes and losing weight but are often motivated with the right support.

A doctor who instructs their patient to simply "join Weight Watchers" to combat weight gain may not realize that some people aren't up for going to meetings when depressed and that some just aren't "group" people. A therapy group with people who have gained weight because of their psychotropic medications might, on the other hand, be helpful. It'll be important for providers to take the time to

A Word From Verywell

Losing weight while on psychotropic medications isn't fast or easy. Although it may be difficult, take encouragement from knowing there is solid research to show it is possible to lose weight and still take your medication. If you're concerned about weight gain caused by the medication you take, consult with your healthcare provider to develop a plan that will work for you.

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