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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 18 to 42 of 54. Go back in thread:
Posted by MB on July 11, 2001, at 1:58:16
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 9, 2001, at 19:04:01
> Some people say they didn't have carb cravings or eat more on SSRIs (or Effexor), but gained weight anyway, presumably due to some sort of metabolic change. I wonder about their activity level, though. (Paxil seems to be the worst of the SSRIs in the weight gain department, although this is just my impression -- I haven't looked at statistics or anything. < g >)
>
> -elizabeth
I remember when Prozac first came out there was a theory that depressed people craved carbohydrates (in an attempt to raise serotonin levels through diet) and that SSRIs would actually *lower* these carbo cravings by increasing serotonin levels. I don't remember my experience with Prozac all that well, but my experience with Paxil was, "bring on the pasta, baby, and pass the box of donuts!"
Posted by super on July 11, 2001, at 13:12:28
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 11, 2001, at 1:58:16
Don't you get constipated if you don't eat any high fiber foods?
>
> > Some people say they didn't have carb cravings or eat more on SSRIs (or Effexor), but gained weight anyway, presumably due to some sort of metabolic change. I wonder about their activity level, though. (Paxil seems to be the worst of the SSRIs in the weight gain department, although this is just my impression -- I haven't looked at statistics or anything. < g >)
> >
> > -elizabeth
>
>
> I remember when Prozac first came out there was a theory that depressed people craved carbohydrates (in an attempt to raise serotonin levels through diet) and that SSRIs would actually *lower* these carbo cravings by increasing serotonin levels. I don't remember my experience with Prozac all that well, but my experience with Paxil was, "bring on the pasta, baby, and pass the box of donuts!"
Posted by Elizabeth on July 11, 2001, at 15:38:17
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 11, 2001, at 1:58:16
> I remember when Prozac first came out there was a theory that depressed people craved carbohydrates (in an attempt to raise serotonin levels through diet) and that SSRIs would actually *lower* these carbo cravings by increasing serotonin levels.
There's a guy at MIT (well, I'm not sure if he's still there) who was really trying to push the serotonin-carb connection hypothesis (he had a major interest in Redux, of course).
Thing is, this idea doesn't explain why so many depressives stop eating and lose interest in food (carbohydrate or otherwise)!
> I don't remember my experience with Prozac all that well, but my experience with Paxil was, "bring on the pasta, baby, and pass the box of donuts!"
I didn't lose weight on Prozac, but I didn't gain back the weight I'd lost while depressed. Paxil seems to be worse than the other SSRIs as far as causing weight gain.
-elizabeth
Posted by Elizabeth on July 11, 2001, at 15:39:34
In reply to Re: Weight gain and SSRIs, posted by super on July 11, 2001, at 13:12:28
> Don't you get constipated if you don't eat any high fiber foods?
If you don't get any fiber, yes, you're liable to get extremely constipated. This is a big problem with the Atkins diet, although I think there's a way around it.
-elizabeth
Posted by MB on July 11, 2001, at 18:30:34
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 11, 2001, at 15:38:17
> There's a guy at MIT (well, I'm not sure if he's still there) who was really trying to push the serotonin-carb connection hypothesis (he had a major interest in Redux, of course).
Doesn't Meridia work on Serotonin? I just watched an online video called "Metabolic effects of Atypical Antipsychotics"(check it out if you haven't already: http://www.mentalhealth.ucla.edu/opce/gr.html ). It mentioned antagonism of 5HT-2c as a possible mechanism for neuroleptic weight gain. It also mentioned that stimulation of this site might lead to appetite reduction...in fact, I think the guy stated that this was the puted mechanism of Meridia. Anyway, it's interesting that Meridia was originally tested as an antidepressant. I assume that the action of SSRIs indirectly leads to stimulation of the 5H-2c sites in the brain. I wonder why they make people fat...> Thing is, this idea doesn't explain why so many depressives stop eating and lose interest in food (carbohydrate or otherwise)!
I gorge myself when I'm dysthymic or anxious, but I barely eat when i'm *really* depressed. I think I might be atypical (eat and go to bed when my mood is low). However, I am *worse* in the morning and sometimes peaceful and euphoric at night (calm, not manic...although I *did* think I was Buddha one time). That would go against an atypical dx, wouldn't it?
> I didn't lose weight on Prozac, but I didn't gain back the weight I'd lost while depressed. Paxil seems to be worse than the other SSRIs as far as causing weight gain.
>
> -elizabethYeah, I gained about 30lbs while taking Paxil. I've gotten my body fat back down to about where it was before I started, but my body is just stockier and heavier...shaped differntly...it's like the Paxil just permanently changed my body type, or something. Or, maybe it's just hitting 30 yrs old that did it.
Posted by TomV on July 11, 2001, at 22:04:29
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 11, 2001, at 18:30:34
> I'm certain my eating habits haven't changed; I do work out at the gym frequently; that being said I've gained about 10 pounds in 6 weeks on Celexa. I've tried alot of other meds (all the other SSRI's and many others i.e. wellbutrin, effexor)but none have worked like Celexa so it looks like its here to stay for a little while. I'm currently up to 20 mg a day.
Now that I'm certain my weight gain is strictly associated to a metabolic change from Celexa my question is: Is it safe to combine Metabolife, or another similar "supplement" to Celexa? I really have no signs of nervousness, anxiety, insomnia on Celexa so I don't think it could aggravate me in that sense. I also wonder if it's just not safe to combine the two.
Any advice would be greatly appreciated.
Posted by Elizabeth on July 12, 2001, at 19:02:14
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 11, 2001, at 18:30:34
> Doesn't Meridia work on Serotonin?
It's a serotonin-norepinephrine reuptake inhibitor, just like Effexor. It even resembles venlafaxine structurally There's no reason it wouldn't be just as good an AD as Effexor -- it wasn't marketed for this indication because the market for ADs was already saturated. But in early literature on sibutramine, it's referred to as an "antidepressant," not as a weight loss aid. (I would bet that it's a crappy diet pill, BTW. < g >) =
> It mentioned antagonism of 5HT-2c as a possible mechanism for neuroleptic weight gain.
Well, they're strong antihistamines too (hence the sedation). Do "typical" antipsychotics block the 5HT-2c receptor? Or is weight gain from these drugs attributed solely to the H1 blocking?
I'll take a look at that site.
> in fact, I think the guy stated that this was the puted mechanism of Meridia.
(You mean "putative," right?" I'm skeptical of that, since no other mechanisms have been IDed for Meridia besides monoamine reuptake inhibition, AFAIK.)
BTW, SSRIs and Effexor don't "make people fat" across the board, and it's not clear that it's even a majority side effect. The people who gain weight are the ones who complain. As I mentioned, I took Prozac for between two and three years, and I didn't gain weight beyond my baseline weight *or* regain the weight that I'd lost while depressed.
> I gorge myself when I'm dysthymic or anxious, but I barely eat when i'm *really* depressed.
Perhaps you have two different problems going on at the same time. I think this might be what's happening with me (although I have fewer and subtler "atypical" symptoms).
> That would go against an atypical dx, wouldn't it?
Yes, but the subtypes haven't been defined perfectly yet. Constructing subtypes based on medication response is simply the most pragmatic way to go about doing clinical research until we have a better understanding of how the brain works (and how it malfunctions).
> Yeah, I gained about 30lbs while taking Paxil. I've gotten my body fat back down to about where it was before I started, but my body is just stockier and heavier...shaped differntly...it's like the Paxil just permanently changed my body type, or something. Or, maybe it's just hitting 30 yrs old that did it.
People do tend to get heavier as they age. I easily lost all the weight I gained on Nardil -- I call it "the depression diet" -- but because I switched directly to Parnate, the weight from Marplan hasn't gone away completely. Losing weight is *hard*.
-elizabeth
Posted by Elizabeth on July 12, 2001, at 19:06:36
In reply to Re: Weight gain and SSRIs - Metabolife?, posted by TomV on July 11, 2001, at 22:04:29
> Is it safe to combine Metabolife, or another similar "supplement" to Celexa?
I *think* that the main active ingredient in Metabolife is ephedrine (similar to Sudafed, but less reliable). Ephedrine is a weak stimulant related to amphetamine, and it won't work long-term. Personally, if I were going to use stimulants as appetite suppressants, I'd go with phentermine, phendimetrazine, or some such.
But yeah, it's safe with SSRIs, so far as I'm aware (don't use it with MAOIs and use caution with TCAs). Ask your doctor to be sure. I think that Celexa has fewer drug-drug interactions than other SSRIs (Prozac and Paxil in particular) due to more metabolic pathways.
-elizabeth
Posted by MB on July 13, 2001, at 13:37:14
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 12, 2001, at 19:02:14
> > Doesn't Meridia work on Serotonin?
>
> It's a serotonin-norepinephrine reuptake inhibitor, just like Effexor. It even resembles venlafaxine structurally There's no reason it wouldn't be just as good an AD as EffexorThe excuse I've heard for it's not being marketed as an AD is the half-life issue and consequently frequent dosing schedule (or something like that). But, if they can solve that problem with Wellbutrin by making SR, they could have solved it with sibutramine also (couldn't they have?)
> it wasn't marketed for this indication because the market for ADs was already saturated.
That sounds more plausible.
> But in early literature on sibutramine, it's referred to as an "antidepressant," not as a weight loss aid. (I would bet that it's a crappy diet pill, BTW. < g >) =Well, there must be something more to it; it's scheduled as a class IV, isn't it?
> > It mentioned antagonism of 5HT-2c as a possible mechanism for neuroleptic weight gain.
>
> Well, they're strong antihistamines too (hence the sedation). Do "typical" antipsychotics block the 5HT-2c receptor? Or is weight gain from these drugs attributed solely to the H1 blocking?The typicals are potent H-1 blockers, yet they don't seem to carry the 30% risk of 20% weight gain that the typicals carry (especially clozapine). I think the blockade of 5HT-2c receptors in the striatum is one of the things that makes the atypicals different. Blockade at these sites increases dopaminergic activity in the striatum, hence the fewer incidences of tardive dyskinesia...or so it has been hypothesized.
> I'll take a look at that site.
>
> > in fact, I think the guy stated that this was the puted mechanism of Meridia.
>
> (You mean "putative," right?" I'm skeptical of that, since no other mechanisms have been IDed for Meridia besides monoamine reuptake inhibition, AFAIK.)Uh...yeah...putative. Sometimes I accidently make up new words (LOL!) When the guy mentioned 5HT-2c interaction as a possible mechanism for Meridia's anorexigenic effects, I think he was referring to the indirect *stimulation* of these sites by monoamine (in this case serotonin) reuptake inhibition. I was a little ambiguous about that. I'm sure the indirect NE-a1 activation (from NE reuptake inhibition) might also contributes to the anorexigenic effects.
> BTW, SSRIs and Effexor don't "make people fat" across the board, and it's not clear that it's even a majority side effect. The people who gain weight are the ones who complain. As I mentioned, I took Prozac for between two and three years, and I didn't gain weight beyond my baseline weight *or* regain the weight that I'd lost while depressed.
Right, and there's also the theory that it's the alleviation of depression (and it's comorbid anorexia) that is behind the SSRI-weight correlation (and that the correlation is not directly causative). Anecdotally, I eat more when depressed, and still gained weight on SSRIs. Maybe, at some point, we just have to admit that nobody really knows?
> > I gorge myself when I'm dysthymic or anxious, but I barely eat when i'm *really* depressed.
>
> Perhaps you have two different problems going on at the same time. I think this might be what's happening with me (although I have fewer and subtler "atypical" symptoms).
>
> > That would go against an atypical dx, wouldn't it?
>
> Yes, but the subtypes haven't been defined perfectly yet. Constructing subtypes based on medication response is simply the most pragmatic way to go about doing clinical research until we have a better understanding of how the brain works (and how it malfunctions).I'm starting to think that for a classification system to truely be accurate, there would need to be a subtype for every ill individual! < g > Like you said, it seems that the best that doctors can do is to classify based on medication response. So the question that begs asking is whether these subtypes are really discrete disorders, or whether there is really a multiaxial spectrum upon which every individual falls (I assume that the axial nexus would be "normalcy," whatever *that* is).
> > Yeah, I gained about 30lbs while taking Paxil. I've gotten my body fat back down to about where it was before I started, but my body is just stockier and heavier...shaped differntly...it's like the Paxil just permanently changed my body type, or something. Or, maybe it's just hitting 30 yrs old that did it.
>
> People do tend to get heavier as they age. I easily lost all the weight I gained on Nardil -- I call it "the depression diet" -- but because I switched directly to Parnate, the weight from Marplan hasn't gone away completely. Losing weight is *hard*.
>
> -elizabeth(losing weight is hard)
Amen to that!Peace,
MB
Posted by DebbieLynn on July 13, 2001, at 22:49:08
In reply to Re: Weight gain and SSRIs - Metabolife? » TomV, posted by Elizabeth on July 12, 2001, at 19:06:36
> > Is it safe to combine Metabolife, or another similar "supplement" to Celexa?
>
> I *think* that the main active ingredient in Metabolife is ephedrine (similar to Sudafed, but less reliable). Ephedrine is a weak stimulant related to amphetamine, and it won't work long-term. Personally, if I were going to use stimulants as appetite suppressants, I'd go with phentermine, phendimetrazine, or some such.
>
> But yeah, it's safe with SSRIs, so far as I'm aware (don't use it with MAOIs and use caution with TCAs). Ask your doctor to be sure. I think that Celexa has fewer drug-drug interactions than other SSRIs (Prozac and Paxil in particular) due to more metabolic pathways.
>
> -elizabeth
I hate to butt in here, I was specifically told by my doctor to stay away from metabolife. I asked to be put on a diet med (like phentermine) and he said NO because it is a CNS stimulant. It may have unwanted side effects.
I am currently in nursing school, going into psychiatric nursing. I take Effexor XR 225 mg, and I have gained weight,(@10 lbs) but I have to admit that I do crave carbs! Thanks for the info. I am going to restrict them to see what happens!Good Luck!
Debbie
Posted by Elizabeth on July 15, 2001, at 17:50:09
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 13, 2001, at 13:37:14
> The excuse I've heard for it's not being marketed as an AD is the half-life issue and consequently frequent dosing schedule (or something like that).
Nope. Sibutramine is very long-acting -- you'd only have to take it once a day.
> Well, there must be something more to it; it's scheduled as a class IV, isn't it?
Yeah. Totally ridiculous.
> The typicals are potent H-1 blockers, yet they don't seem to carry the 30% risk of 20% weight gain that the typicals carry (especially clozapine).
FWIW, Moban is supposed to be better in this department. Some of the newer ones (Seroquel, Geodon) are supposed to cause less weight gain than Clozaril and Zyprexa, but I don't know if that's just hype or what.
> I think the blockade of 5HT-2c receptors in the striatum is one of the things that makes the atypicals different. Blockade at these sites increases dopaminergic activity in the striatum, hence the fewer incidences of tardive dyskinesia...or so it has been hypothesized.
They also help with negative symptoms, which are largely untouched by the older drugs.
> Uh...yeah...putative. Sometimes I accidently make up new words (LOL!)
Me too.
> When the guy mentioned 5HT-2c interaction as a possible mechanism for Meridia's anorexigenic effects, I think he was referring to the indirect *stimulation* of these sites by monoamine (in this case serotonin) reuptake inhibition.
Ahh, ok. That's a looser use of the term "agonist."
> I was a little ambiguous about that. I'm sure the indirect NE-a1 activation (from NE reuptake inhibition) might also contributes to the anorexigenic effects.
I think that it probably just isn't a very good diet pill. < g > Seriously: people don't really lose much weight on SSRIs or Effexor, and a lot of people gain weight on them. I don't see any reason to suppose that Meridia would be any different.
> Right, and there's also the theory that it's the alleviation of depression (and it's comorbid anorexia) that is behind the SSRI-weight correlation (and that the correlation is not directly causative).
I'm sure that accounts for some of it. But I don't think that's all.
> Anecdotally, I eat more when depressed, and still gained weight on SSRIs. Maybe, at some point, we just have to admit that nobody really knows?
(Man, that sucks!)
Yeah, we do. That doesn't mean we should stop trying to figure it out, of course.
> I'm starting to think that for a classification system to truely be accurate, there would need to be a subtype for every ill individual! < g >
No, I don't think so. Looking at which drugs work on which symptoms (or clusters of symptoms) seems to have paid off where it's been tried, but it hasn't been tried much.
> Like you said, it seems that the best that doctors can do is to classify based on medication response.
Yeah. You know, migraine has pretty much been redefined as any headache that responds to sumatriptan!
> So the question that begs asking is whether these subtypes are really discrete disorders, or whether there is really a multiaxial spectrum upon which every individual falls
I think it's a little of both.
> (I assume that the axial nexus would be "normalcy," whatever *that* is).
< g >
-elizabeth
Posted by Elizabeth on July 15, 2001, at 17:56:08
In reply to Re: Weight gain and SSRIs - Metabolife?, posted by DebbieLynn on July 13, 2001, at 22:49:08
> I hate to butt in here,
IMO, there's no such thing as butting in. It's a public forum, and exchanging ideas is what it's here for, right?
> I was specifically told by my doctor to stay away from metabolife.
Well, OTC "herbal food supplements" (i.e., drugs that are sold without being FDA-approved) are notoriously unreliable. So I can see where your doctor is coming from.
> I asked to be put on a diet med (like phentermine) and he said NO because it is a CNS stimulant. It may have unwanted side effects.
You know, any effective drug has side effects. If a drug doesn't have side effects, it often seems to turn out that it doesn't do anything at all. (I'm thinking of the non-drowsy antihistamines here. They aren't *completely* ineffective, but they're pretty lousy compared to Benadryl or Atarax or ChlorTrimeton.)
> I am currently in nursing school, going into psychiatric nursing.
Cool! Good luck with it. I think it's great when people who have personal experience with depression, anxiety, mania, psychosis, etc. go into mental health professions.
> I take Effexor XR 225 mg, and I have gained weight,(@10 lbs) but I have to admit that I do crave carbs!
Nothing to be ashamed of. < g > That happened to me on the hydrazine-type MAOIs (Nardil and Marplan) -- I was constantly obsessing about food, especially sweets. Weird stuff.
-elizabeth
Posted by MB on July 16, 2001, at 1:22:19
In reply to Re: Weight gain and SSRIs » MB, posted by Elizabeth on July 15, 2001, at 17:50:09
> > The excuse I've heard for it's not being marketed as an AD is the half-life issue and consequently frequent dosing schedule (or something like that).
>
> Nope. Sibutramine is very long-acting -- you'd only have to take it once a day.Hmmm...I wonder what he was talking about, then. Have you had a chance to watch that video about the metabolic effects of atypical antidepressants? I may not of completely grasped what he was saying about sibutramine. I would be interested to hear your feedback on the lecture.
> > Well, there must be something more to it; it's scheduled as a class IV, isn't it?
>
> Yeah. Totally ridiculous.The way the commercial goes: "...people who abuse Meridia may become dependent," I thought this stuff was like an amphetamine or something. Why do you think they're treating it like this?
> > The typicals are potent H-1 blockers, yet they don't seem to carry the 30% risk of 20% weight gain that the typicals carry (especially clozapine).
>
> FWIW, Moban is supposed to be better in this department. Some of the newer ones (Seroquel, Geodon) are supposed to cause less weight gain than Clozaril and Zyprexa, but I don't know if that's just hype or what.I think some people can actually *lose* weight on Moban!
> > I think the blockade of 5HT-2c receptors in the striatum is one of the things that makes the atypicals different. Blockade at these sites increases dopaminergic activity in the striatum, hence the fewer incidences of tardive dyskinesia...or so it has been hypothesized.
>
> They also help with negative symptoms, which are largely untouched by the older drugs.Negative symptoms...like flat affect, etc?
> > Uh...yeah...putative. Sometimes I accidently make up new words (LOL!)
>
> Me too.heh heh heh...
> > When the guy mentioned 5HT-2c interaction as a possible mechanism for Meridia's anorexigenic effects, I think he was referring to the indirect *stimulation* of these sites by monoamine (in this case serotonin) reuptake inhibition.
>
> Ahh, ok. That's a looser use of the term "agonist."> > I was a little ambiguous about that. I'm sure the indirect NE-a1 activation (from NE reuptake inhibition) might also contributes to the anorexigenic effects.
>
> I think that it probably just isn't a very good diet pill. < g > Seriously: people don't really lose much weight on SSRIs or Effexor, and a lot of people gain weight on them. I don't see any reason to suppose that Meridia would be any different.It will be interesting to see what the outcome of the drug's use is in the long term. I remember when there was discussion in the late eighties (and early nineties) about using SSRIs as diet drugs...whoops!
> > Right, and there's also the theory that it's the alleviation of depression (and it's comorbid anorexia) that is behind the SSRI-weight correlation (and that the correlation is not directly causative).
>
> I'm sure that accounts for some of it. But I don't think that's all.
>
> > Anecdotally, I eat more when depressed, and still gained weight on SSRIs. Maybe, at some point, we just have to admit that nobody really knows?
>
> (Man, that sucks!)
>
> Yeah, we do. That doesn't mean we should stop trying to figure it out, of course.No, of course not...but can it be figured out? If the brain were simple enough to be figured out, would the mind of such a brain be intellegent enough to do the figuring? Did that make any sense? wait...huh...? ;-P
> > I'm starting to think that for a classification system to truely be accurate, there would need to be a subtype for every ill individual! < g >
>
> No, I don't think so. Looking at which drugs work on which symptoms (or clusters of symptoms) seems to have paid off where it's been tried, but it hasn't been tried much.yeah, I was just being a smart allec (sp?) :-)
but kinda serious at the same time...I think treatment plans need to be highly individualized> > Like you said, it seems that the best that doctors can do is to classify based on medication response.
>
> Yeah. You know, migraine has pretty much been redefined as any headache that responds to sumatriptan!That's kinda funny...but if it works and helps people get well...why not use that definition?
> > So the question that begs asking is whether these subtypes are really discrete disorders, or whether there is really a multiaxial spectrum upon which every individual falls
>
> I think it's a little of both.It's a partical, it's a wave, it's...
> > (I assume that the axial nexus would be "normalcy," whatever *that* is).
>
> < g >
>
> -elizabeth
Posted by Elizabeth on July 16, 2001, at 18:31:45
In reply to Re: Weight gain and SSRIs » Elizabeth, posted by MB on July 16, 2001, at 1:22:19
> > Sibutramine is very long-acting -- you'd only have to take it once a day.
>
> Hmmm...I wonder what he was talking about, then.Hmmm back atcha. < g > I'm looking at the PI, and it seems that I was wrong about the elimination half-life (it's only an hour or so). It might be that (like other diet pills) it mainly works in the first few weeks (at most) so steady-state levels aren't an issue. The recommended dosing schedule is once daily.
> Have you had a chance to watch that video about the metabolic effects of atypical antidepressants?
Which video? Did I miss something?
> The way the commercial goes: "...people who abuse Meridia may become dependent," I thought this stuff was like an amphetamine or something. Why do you think they're treating it like this?
My guess: because it's marketed as a diet pill and because some of the preclinical trials showed signs of abuse potential in animal models. There are always some false positives in those models, though.
> I think some people can actually *lose* weight on Moban!
If only in virtue of having gotten off of other antipsychotic drugs.
Moban did something totally weird to me when I tried it. I wasn't asleep (I was taking it for insomnia), but I was totally immobilised. Not comfortable!
> Negative symptoms...like flat affect, etc?
Yes.
> It will be interesting to see what the outcome of the drug's use is in the long term. I remember when there was discussion in the late eighties (and early nineties) about using SSRIs as diet drugs...whoops!
I think that "d'oh!" is the appropriate expression here.
> No, of course not...but can it be figured out? If the brain were simple enough to be figured out, would the mind of such a brain be intellegent enough to do the figuring? Did that make any sense? wait...huh...? ;-P
That's a claim that has been made by some: that we can't use our own consciousness to understand that consciousness. (I don't buy it, of course.)
> I think treatment plans need to be highly individualized
That's true. Everybody's different. (I don't think this is unique to psychiatry.)
> > Yeah. You know, migraine has pretty much been redefined as any headache that responds to sumatriptan!
>
> That's kinda funny...but if it works and helps people get well...why not use that definition?That's mostly my general feeling, too.
-elizabeth
Posted by DebbieLynn on July 16, 2001, at 22:36:29
In reply to Re: Weight gain and SSRIs - Metabolife? » DebbieLynn, posted by Elizabeth on July 15, 2001, at 17:56:08
> > I hate to butt in here,
>
> IMO, there's no such thing as butting in. It's a public forum, and exchanging ideas is what it's here for, right?
>
> > I was specifically told by my doctor to stay away from metabolife.
>
> Well, OTC "herbal food supplements" (i.e., drugs that are sold without being FDA-approved) are notoriously unreliable. So I can see where your doctor is coming from.
>
> > I asked to be put on a diet med (like phentermine) and he said NO because it is a CNS stimulant. It may have unwanted side effects.
>
> You know, any effective drug has side effects. If a drug doesn't have side effects, it often seems to turn out that it doesn't do anything at all. (I'm thinking of the non-drowsy antihistamines here. They aren't *completely* ineffective, but they're pretty lousy compared to Benadryl or Atarax or ChlorTrimeton.)
>
> > I am currently in nursing school, going into psychiatric nursing.
>
> Cool! Good luck with it. I think it's great when people who have personal experience with depression, anxiety, mania, psychosis, etc. go into mental health professions.
>
> > I take Effexor XR 225 mg, and I have gained weight,(@10 lbs) but I have to admit that I do crave carbs!
>
> Nothing to be ashamed of. < g > That happened to me on the hydrazine-type MAOIs (Nardil and Marplan) -- I was constantly obsessing about food, especially sweets. Weird stuff.
>
> -elizabethHi again!
The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
What do you think? I have had success with phentermine in the past!
Thanks for replying!
Debbie
Posted by MB on July 17, 2001, at 2:12:39
In reply to Meridia stuff » MB, posted by Elizabeth on July 16, 2001, at 18:31:45
> > > Sibutramine is very long-acting -- you'd only have to take it once a day.
> >
> > Hmmm...I wonder what he was talking about, then.
>
> Hmmm back atcha. < g >Shall we just hummm a tune... ;-)
> I'm looking at the PI, and it seems that I was wrong about the elimination half-life (it's only an hour or so). It might be that (like other diet pills) it mainly works in the first few weeks (at most) so steady-state levels aren't an issue. The recommended dosing schedule is once daily.
>
> > Have you had a chance to watch that video about the metabolic effects of atypical antidepressants?
>
> Which video? Did I miss something?Try this link:
http://www.mentalhealth.ucla.edu/cgi-bin/av-npi?gr010123jmB
or go here and scroll down to "Metabolic Effects of Atypical Antipsychotics"
http://www.mentalhealth.ucla.edu/opce/gr.html
I thought it was really interesting
> > The way the commercial goes: "...people who abuse Meridia may become dependent," I thought this stuff was like an amphetamine or something. Why do you think they're treating it like this?
>
> My guess: because it's marketed as a diet pill and because some of the preclinical trials showed signs of abuse potential in animal models. There are always some false positives in those models, though.If I were a rat, I'd hit the damned lever too!! Oh, wait, I *am* a rat...but not that kind...
> > I think some people can actually *lose* weight on Moban!
>
> If only in virtue of having gotten off of other antipsychotic drugs.
>
> Moban did something totally weird to me when I tried it. I wasn't asleep (I was taking it for insomnia), but I was totally immobilised. Not comfortable!Thorazine did that to me. I was young and dumb and thought it could be taken recreationally...one of my dumber moments. I could move my eyes around, but couldn't move my body. Very un-fun.
> > Negative symptoms...like flat affect, etc?
>
> Yes.
>
> > It will be interesting to see what the outcome of the drug's use is in the long term. I remember when there was discussion in the late eighties (and early nineties) about using SSRIs as diet drugs...whoops!
>
> I think that "d'oh!" is the appropriate expression here.
>
> > No, of course not...but can it be figured out? If the brain were simple enough to be figured out, would the mind of such a brain be intellegent enough to do the figuring? Did that make any sense? wait...huh...? ;-P
>
> That's a claim that has been made by some: that we can't use our own consciousness to understand that consciousness. (I don't buy it, of course.)How close do you think we are now? It seems like so many advances have been made in the past decade alone.
> > I think treatment plans need to be highly individualized
>
> That's true. Everybody's different. (I don't think this is unique to psychiatry.)
>
> > > Yeah. You know, migraine has pretty much been redefined as any headache that responds to sumatriptan!
> >
> > That's kinda funny...but if it works and helps people get well...why not use that definition?
>
> That's mostly my general feeling, too.
>
> -elizabeth
Posted by Zo on July 17, 2001, at 19:41:08
In reply to Re: Weight gain and SSRIs - Metabolife? Elizabeth, posted by DebbieLynn on July 16, 2001, at 22:36:29
> The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
>
> What do you think? I have had success with phentermine in the past!
>
> Thanks for replying!
> DebbieNo problems with that combo here. Bias against phentermine?
Zo
Posted by Elizabeth on July 18, 2001, at 0:22:39
In reply to Re: Weight gain and SSRIs - Metabolife? Elizabeth, posted by DebbieLynn on July 16, 2001, at 22:36:29
> Hi again!
'Ay.
> The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
They could both raise your blood pressure, yeah. Whether or not it's safe to combine them really depends on how much they raise it by and what your baseline BP is.
-elizabeth
Posted by Elizabeth on July 18, 2001, at 0:25:43
In reply to Re: Meridia stuff » Elizabeth, posted by MB on July 17, 2001, at 2:12:39
> If I were a rat, I'd hit the damned lever too!! Oh, wait, I *am* a rat...but not that kind...
But do you press levers?
> Thorazine did that to me. I was young and dumb and thought it could be taken recreationally...one of my dumber moments.
D'oh!
> > That's a claim that has been made by some: that we can't use our own consciousness to understand that consciousness. (I don't buy it, of course.)
>
> How close do you think we are now?Not very.
> It seems like so many advances have been made in the past decade alone.
More like the past 50 years, I'd say.
-e
Posted by DebbieLynn on July 18, 2001, at 6:42:24
In reply to Re: phentermine and Effexor » DebbieLynn, posted by Elizabeth on July 18, 2001, at 0:22:39
> > Hi again!
>
> 'Ay.
>
> > The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
>
> They could both raise your blood pressure, yeah. Whether or not it's safe to combine them really depends on how much they raise it by and what your baseline BP is.
>
> -elizabethMy blood pressure before I went on Effexor was @100/60 - 110/60. Now it is @120/80. I am 31 years old. I seem to be somewhat medicine sensitive. When I took the phentermine in the past, it gave me lots of energy, but that did go away. I lost about 15 lbs. in 3 weeks. BOY...I need that now. I do not have a weight problem, but I am about 15 - 20 lbs overweight. Most of weight is left over from being pregnant. I am normally small. I have just had a hard time losing this extra weight. Most people tell me "Oh, it's your age"! People blame a lot on age. I know I can lose it, I just need a little push.
Debbie
Posted by MB on July 18, 2001, at 10:47:01
In reply to Re: phentermine and Effexor, posted by DebbieLynn on July 18, 2001, at 6:42:24
> > > Hi again!
> >
> > 'Ay.
> >
> > > The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
> >
> > They could both raise your blood pressure, yeah. Whether or not it's safe to combine them really depends on how much they raise it by and what your baseline BP is.
> >
> > -elizabeth
>
> My blood pressure before I went on Effexor was @100/60 - 110/60. Now it is @120/80. I am 31 years old. I seem to be somewhat medicine sensitive. When I took the phentermine in the past, it gave me lots of energy, but that did go away. I lost about 15 lbs. in 3 weeks. BOY...I need that now. I do not have a weight problem, but I am about 15 - 20 lbs overweight. Most of weight is left over from being pregnant. I am normally small. I have just had a hard time losing this extra weight. Most people tell me "Oh, it's your age"! People blame a lot on age. I know I can lose it, I just need a little push.
>
> DebbieHow much exercise are you getting? I get really bad fatigue, and people used to tell me to exercise more, and I was like, "yeah, screw you!" but a few months ago in a panic over how much weight I'd gained in the past three years (something like 30 lbs) I decided to *force* myself to exercise. My motivation had an unhealthy tinge of self-loathing to it: with the fatigue, I felt like if I exercised I'd die, and I didn't care (I'm not endorsing this attitude, by the way). Anyway, I started getting my heart rate up 5 times a week for 45 minutes and lifting weights three or four times a week. The fatigue actually got better and I've been losing about 2 lbs/week...and they say that with a slower rate of weight loss, you're more likely to keep it off. So I thought I'd throw some pro-exercise preaching at ya. You can tell me to screw off if you want, I won't mind, I've been there ;-)
Posted by Elizabeth on July 18, 2001, at 17:44:44
In reply to Re: phentermine and Effexor, posted by DebbieLynn on July 18, 2001, at 6:42:24
> My blood pressure before I went on Effexor was @100/60 - 110/60. Now it is @120/80.
That's still well within the safe range. 120/80 is considered "normal," in fact. I would think that it would be okay to try a low dose of phentermine and see what happens to your blood pressure (if anything).
-elizabeth
Posted by jojo on July 18, 2001, at 23:33:21
In reply to Meridia stuff » MB, posted by Elizabeth on July 16, 2001, at 18:31:45
I've been taking SSRIs since Prozac came out, around 1987. Around 1982 I added stimulants
(Ritalin, Adderall, Desoxyn, and now Dexedrine tablets. The stimulants maintain their activating and anorectic properties when taken with an SSRI. I happened to hear this on NPR at the same time that I
was telling someone else of my experience, but not a word about it since then. If the FDA would like to observe my "withdrawal reaction, drug seeking behavior, and physical discomfort", they are welcome to observe me for one week (provided the results are publicized, so that others can benefit from my "addiction" experience) before I resume Dexedrine and get on with my life. As I have experienced
this already, my only reaction will be getting very little accomplished, increased depression, and eating more.
I am told that some people become "addicted" to stimulants, but I have no experience with that
phenomena.
Posted by Elizabeth on July 19, 2001, at 11:32:39
In reply to Re: Meridia stuff, posted by jojo on July 18, 2001, at 23:33:21
> The stimulants maintain their activating and anorectic properties when taken with an SSRI.
If that's true, you should try and get some sort of patent on the combination. :-)
> I am told that some people become "addicted" to stimulants, but I have no experience with that
> phenomena.Rule of thumb: if you don't take enough to get high, you won't become addicted.
(Stimulants, especially cocaine, are by some measures the most addictive drugs of all, much more so than alcohol or heroin.)
-elizabeth
Posted by Fenka on July 20, 2001, at 0:53:54
In reply to Re: phentermine and Effexor » DebbieLynn, posted by MB on July 18, 2001, at 10:47:01
May I jump in.I took phentermine with Effexor and did not notice any side effects. The effexor zoned me out so bad, I thought I was becoming narcoleptic. My doctor has heard of other combonations like Prozac and Ritilan or Prozac and phentermine that seems to work well.
If you do a little digging on the wire I know you will come up with something to either help you be comfortable with your decision, or look for a new route to take.
Best of luck.....
Fenka
> > > 'Ay.
> > >
> > > > The reason my doc will not prescribe a diet pill (phentermine) is because supposively it doesn't *interact well* with Effexor XR.
> > >
> > > They could both raise your blood pressure, yeah. Whether or not it's safe to combine them really depends on how much they raise it by and what your baseline BP is.
> > >
> > > -elizabeth
> >
> > My blood pressure before I went on Effexor was @100/60 - 110/60. Now it is @120/80. I am 31 years old. I seem to be somewhat medicine sensitive. When I took the phentermine in the past, it gave me lots of energy, but that did go away. I lost about 15 lbs. in 3 weeks. BOY...I need that now. I do not have a weight problem, but I am about 15 - 20 lbs overweight. Most of weight is left over from being pregnant. I am normally small. I have just had a hard time losing this extra weight. Most people tell me "Oh, it's your age"! People blame a lot on age. I know I can lose it, I just need a little push.
> >
> > Debbie
>
> How much exercise are you getting? I get really bad fatigue, and people used to tell me to exercise more, and I was like, "yeah, screw you!" but a few months ago in a panic over how much weight I'd gained in the past three years (something like 30 lbs) I decided to *force* myself to exercise. My motivation had an unhealthy tinge of self-loathing to it: with the fatigue, I felt like if I exercised I'd die, and I didn't care (I'm not endorsing this attitude, by the way). Anyway, I started getting my heart rate up 5 times a week for 45 minutes and lifting weights three or four times a week. The fatigue actually got better and I've been losing about 2 lbs/week...and they say that with a slower rate of weight loss, you're more likely to keep it off. So I thought I'd throw some pro-exercise preaching at ya. You can tell me to screw off if you want, I won't mind, I've been there ;-)
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