![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by Elizabeth on August 15, 1999, at 1:32:51
I don't take kindly to being called "naive" just because I bring up professional ethics as though it were a real issue for some researchers. Please try to be more considerate. Thanks.
> David Michelson (lead author) works for Lilly.
A number of the other authors work for universities. So? I think before you accuse people of twisting their results around, you should have some evidence. If studies funded by other sources (say, NIMH) showed differently, then I'd be more convinced by accusations that Lilly fixed this one. As it is, I don't doubt their results. I think they are plausible.
> Also of note are the previous studies involving Prozac in which some of the authors have been involved. All that I have read were funded by Lilly. They also had results favorable to Lilly.
Post hoc, ergo propter hoc...?
> The study does not say there is no weight gain on Prozac. It says the weight gain on Prozac was equal to the placebo group weight gain.
Right; meaning that Prozac does not appear to "cause" weight gain any more often than an inactive placebo "causes" it. That is, people didn't gain weight on Prozac that they wouldn't have gained off it.
> On Prozac 25.4% of the participants had 7% or more increase in weight. In placebo it was 26.7%. The weight gain in the Prozac group was attributed to improvement in appetite after recovery while it was poor nutrition for the unfortunate placebo group.
Weight gain was associated with initial appetite loss. I don't see where it says that it was caused by poor nutrition in the placebo group. As far as I can tell, they attribute it to recovery from depression in *both* groups.
See, they only looked at people whose depression was remitted, whether they were on Prozac or placebo...that's why there were so many placebo dropouts by week 50, because most of the people on placebo relapsed. So they were comparing Prozac responders to placebo responders. IOW, they were controlling for the presence of depression. A study that compared Prozac to placebo without controlling for depression would probably make it appear that Prozac was causing weight gain because more of the placebo group would remain depressed (depressed people weigh less, as a whole, than nondepressed ones, though there are individuals who gain weight while depressed). That would be a design flaw.
> Their statement that "the number of fluoxetine-treated patients with a 7% or greater increase in weight never exceeded that of patients in the placebo group" loses some impact when you consider that only 15 placebo participants were able to finish the study.( It will be a great sound bite though) The results of all participants, whether they completed or not, were a little different.
> Prozac- 13.2% had 7% or greater weight increase.
> Placebo- 7.4% had 7% or greater weight increase.This isn't very impressive. The placebo dropouts had less time to gain weight because they left the study early; of *course* fewer of them are going to. You'd have to look at when they dropped out, and how much weight they gained per unit time, in order to make this meaningful.
Note that they also said: "Weight change did not vary among patients assigned to receive placebo who dropped out before completing 26 total weeks (12 weeks of acute treatment and 14 weeks of continuation therapy) compared with patients receiving placebo who completed 26 total weeks."
> I could go on and on ripping this apart but I think you get the picture. You can make numbers mean whatever you want.You haven't made them mean what you want, though. You haven't ripped anything apart. Adam's "I know my body" argument is far more convincing.
Look, all I'm saying is, this weight gain phenomenon doesn't seem to be well validated. Yes, it probably happens occasionally, but not enough to show up as statistically significant even in large trials. I think it's probably overreported by people who just fear the normal weight gain that comes with recovery. This is unfortunate indeed.
Posted by Racer on August 15, 1999, at 1:54:02
In reply to weight gain on SSRIs - continued, posted by Elizabeth on August 15, 1999, at 1:32:51
That the most popular class at UW for years was "How to Lie With Statistics"? True.
Generally speaking, I'm skeptical. I do look at numbers in reports like that one. If you don't have any reason to trust a source, you'd better find out if you can trust the numbers, right?
On the other hand, I gained over 50 pounds on Paxil, and nothing changed in my eating habits until I'd put on 35 of those pounds. I'd say that points to the drug as a likely cause.
Thanks for the reminder that we have to check the numbers studies are based on. Especially since most of us are in a state that makes resistance seem too hard at times, it's vital to be informed of what tests are based on.
Posted by Elizabeth on August 15, 1999, at 5:14:02
In reply to Did you know..., posted by Racer on August 15, 1999, at 1:54:02
> On the other hand, I gained over 50 pounds on Paxil, and nothing changed in my eating habits until I'd put on 35 of those pounds. I'd say that points to the drug as a likely cause.
As I said, I believe it happens sometimes, but not as often as people might think judging from the "I gained weight" stories. Also, this study used Prozac. I'd like to see a study comparing Prozac to Paxil...I seem to hear a lot more complaints about Paxil than other SSRIs.
Recovery from depression causes weight gain. Hell, the passage of time causes weight gain: people tend to get heavier, at least until age 55 or so.
Posted by janey girl on August 15, 1999, at 8:06:23
In reply to Re: Did you know..., posted by Elizabeth on August 15, 1999, at 5:14:02
Paxil is infamous for significant weight gain,
especially in women.Prozac, Zoloft and Effexor usually show weight loss
in the first few months, which tapers off.I never binged before I started anti-depressants;
I began bingeing when I began taking Zoloft, and
it continued with the Effexor.Most people who have experienced weight gain on
AD's find themselves craving high carbohydrate,
comfort foods -- foods that increase serotonin
levels... Geez, could there be a connection? (tongue-
in-cheek). I'm not expecting a reply on the "connection"
question.
Posted by Racer on August 15, 1999, at 13:56:16
In reply to Re: Did you know..., posted by janey girl on August 15, 1999, at 8:06:23
You're not only right that many things can trigger weight gain which is then blamed on the ADs, but you're right to check into what the numbers mean in those studies. Hell, for me, there are times when I can eat everything in sight and not gain weight, as well as times when everything I eat could more easily have been applied directly to my thighs.
I think that Paxil causes more weight gain than Prozac, but what I remember most from my research the first time I went on it, Prozac was more likely to result in weight loss than weight gain. So, maybe the different drugs are different.
Congratulations on reading studies with a critical mind. That's so important, and so few people do it.
Posted by Adam on August 15, 1999, at 16:20:11
In reply to weight gain on SSRIs - continued, posted by Elizabeth on August 15, 1999, at 1:32:51
Accusations of naivite or unethical behavior are ones I certainly never wanted to make or insinuate. Having seen grant money in action, all I can say is that where it comes from
can have an influence. I think, in general, all parties are aware of this and do their best to behave impartially. Research is conducted by human beings. A healthy dose of
skepticism is always warranted, which does not mean one should be paranoid or dismiss everything that a party with a certain vested interest has to say. I've seen brilliant
competitors in academia hurl various ideological and philosophical spitwads at one another, produce totally contradictory results in attempts to repeat the other's experiments,
accuse one another of being idiots, shitheads, what have you. I've yet to hear these diametrically opposed individuals refer to one another as liars, or try to sick the ORI on
each other (though I guess this happens sometimes). Science is just full of this stuff though. Everyone tries to do the right thing, and they mostly succeed. You take the
true love of the scientific process and throw money and egos and dogma into the mix, and it gets complicated. I still and always will have faith in the process, mostly because
of the necessity of reproducibility in science as a condition for acceptance. I take one paper, lots of anecdotal information, and my own experience and conclude that the truth is
out there, and I hope someone finds it. My assumption is that SSRI-induced weight gain is real and could be teased out as a bona fide side effect in some individuals, including me.Tegretol use has been associated with agranulocytosis and aplastic anaemia. If I were to conduct a tegretol study and monitor 1000 individuals for a year I might never see
these terrible side effects and conclude they do not occur. Of course, these conditions are exceedingly rare and can't be equated with something as mundane as putting on weight. I
think because of the severity of such side effects few physicians would be prepared to dismiss the Tegretol connection. There is certainly a higher incidence of, say, agranulocytosis
among Tegretol users than among the general population. For good resons, the association is considered real despite the fact that there might be little justification for such a
conclusion on the grounds of certain statistical tests. This is a hypothetical situation, I know, but I think a plausible one.Perhaps real SSRI-induced weight gain is rare. I should think, though, that there might be a number of exceptonal cases one could focus on that could help separate the signal
from the noise. Certainly weight gain is common. Is 20% weight gain in six months with no change in diet or activity common? If not, how uncommon is it? Does this sort of thing
happen in individuals who don't take psycotropic medications? If so, how often? I don't do experiments on people, and perhaps I am suggesting a study that would be unfeasibly large
and complex. But such a study could help one, perhaps, identify a subtype with a specific sensitivity to SSRIs that is manifested as weight gain. Maybe one could gain valuable
information from such individuals that could be used to design better drugs, or at the very least teach us some fundimentals about the mechanisms of weight gain. Perhaps we could
learn more about this serotonin/carbohydrate association I keep hearing about. Personally, using the assumption that increased carbohydrate intake somehow increases serotonin levels
or mimicks this in some way, I would think that everybody ought to lose weight on an SSRI. This doesn't happen. Perhaps it's not serotonergic mechanisms that are involved but the non-
specific receptor binding that does occur to a greater or lesser degree with all these drugs.Sometimes it's the rare cases, perhaps the results of uncommon genetic polymorphisms, that yield the most information. I hope that, based on studies such as the one Elizabeth has cited,
people do not ignore the SSRI/weight gain connection or write it off. I think it still deserves further study, and I have the utmost sympathy for anyone who has experienced it. It's
not a fun thing.> I don't take kindly to being called "naive" just because I bring up professional ethics as though it were a real issue for some researchers. Please try to be more considerate. Thanks.
>
> > David Michelson (lead author) works for Lilly.
>
> A number of the other authors work for universities. So? I think before you accuse people of twisting their results around, you should have some evidence. If studies funded by other sources (say, NIMH) showed differently, then I'd be more convinced by accusations that Lilly fixed this one. As it is, I don't doubt their results. I think they are plausible.
>
> > Also of note are the previous studies involving Prozac in which some of the authors have been involved. All that I have read were funded by Lilly. They also had results favorable to Lilly.
>
> Post hoc, ergo propter hoc...?
>
> > The study does not say there is no weight gain on Prozac. It says the weight gain on Prozac was equal to the placebo group weight gain.
>
> Right; meaning that Prozac does not appear to "cause" weight gain any more often than an inactive placebo "causes" it. That is, people didn't gain weight on Prozac that they wouldn't have gained off it.
>
> > On Prozac 25.4% of the participants had 7% or more increase in weight. In placebo it was 26.7%. The weight gain in the Prozac group was attributed to improvement in appetite after recovery while it was poor nutrition for the unfortunate placebo group.
>
> Weight gain was associated with initial appetite loss. I don't see where it says that it was caused by poor nutrition in the placebo group. As far as I can tell, they attribute it to recovery from depression in *both* groups.
>
> See, they only looked at people whose depression was remitted, whether they were on Prozac or placebo...that's why there were so many placebo dropouts by week 50, because most of the people on placebo relapsed. So they were comparing Prozac responders to placebo responders. IOW, they were controlling for the presence of depression. A study that compared Prozac to placebo without controlling for depression would probably make it appear that Prozac was causing weight gain because more of the placebo group would remain depressed (depressed people weigh less, as a whole, than nondepressed ones, though there are individuals who gain weight while depressed). That would be a design flaw.
>
> > Their statement that "the number of fluoxetine-treated patients with a 7% or greater increase in weight never exceeded that of patients in the placebo group" loses some impact when you consider that only 15 placebo participants were able to finish the study.( It will be a great sound bite though) The results of all participants, whether they completed or not, were a little different.
>
> > Prozac- 13.2% had 7% or greater weight increase.
> > Placebo- 7.4% had 7% or greater weight increase.
>
> This isn't very impressive. The placebo dropouts had less time to gain weight because they left the study early; of *course* fewer of them are going to. You'd have to look at when they dropped out, and how much weight they gained per unit time, in order to make this meaningful.
>
> Note that they also said: "Weight change did not vary among patients assigned to receive placebo who dropped out before completing 26 total weeks (12 weeks of acute treatment and 14 weeks of continuation therapy) compared with patients receiving placebo who completed 26 total weeks."
>
>
> > I could go on and on ripping this apart but I think you get the picture. You can make numbers mean whatever you want.
>
> You haven't made them mean what you want, though. You haven't ripped anything apart. Adam's "I know my body" argument is far more convincing.
>
> Look, all I'm saying is, this weight gain phenomenon doesn't seem to be well validated. Yes, it probably happens occasionally, but not enough to show up as statistically significant even in large trials. I think it's probably overreported by people who just fear the normal weight gain that comes with recovery. This is unfortunate indeed.
Posted by Brandon on August 15, 1999, at 17:19:54
In reply to Re: weight gain on SSRIs - continued, posted by Adam on August 15, 1999, at 16:20:11
Having seen grant money in action, all I can say is that where it comes from can have an influence.
This statement is not far from the truth. Despite what most people believe or want to believe a lot of what we and physicians here about a medication depends on the amount of resources allocated for its promotion. As the son of a clinical research physician and a med student I have witnessed first hand the pampering and catering that is given to physicians to push their product. I'm not saying that are medical institutions are corrupt, but a huge amount of resources used by pharmacuetical giants goes into the promotion of their medication.
Posted by Ania on August 15, 1999, at 18:25:19
In reply to Re:Well said, posted by Brandon on August 15, 1999, at 17:19:54
My Two Cent's Worth,
The amount of my frustration with all this ( i.e. antidepressants-benefits-side-effects) is un measurable. Everywhere I turn I read
about contradicting theories and opinions. Everyone seems to have different results and side-effects.
As far as the research data and statistics go, I work for the Census Bureau and I wouldn't bet my dog's poop on the results... :)
I'm not saying that all the studies are wrong, just that they are not thorough enough to include all variations of human chemical
make up.From my own experience, I started Prozac about 7 years ego with great results, at first. I had increased energy, weight loss,
and lessened depression. As time went on the results started to wear off. Now I'm on Effexor XR 150mg, and Prozac 20mg.
When I started Effexor, it worked great for a few months. Now, I have physical, mental fatigue, weight gain, extreme
sleepiness, return of depression, no motivation, no energy to do anything, etc.
I'm at the point of giving it all my (the meds. that is). I'm beginning to feel that I'm better of with out all the synthetic chemicals
and be better of fending for myself. I stopped the Prozac at the beginning of this week and the Effexor two days ego. Not
much difference yet.
I'm also on other meds. for my migraines and allergies. I'm giving them up also. I might look into taking herbs, instead.
We'll see what happens.Cheers,
Ania
Posted by Annie on August 15, 1999, at 22:46:13
In reply to Re: weight gain on SSRIs - continued, posted by Adam on August 15, 1999, at 16:20:11
You speak truth from the heart, Adam. I didn't mean to impugn the ethics of the authors (my doctor is one of the authors), nor to cast doubt on their other independent research studies, but as you eloquently put it, to encourage a healthy dose of skepticism. I worked in funded research for three years. I would not have been permitted to turn down funded projects except (I hope) for illegal or immoral requests. I was "encouraged" to consider future funding as I did my work. I sometimes had to make an apple look like an orange. I did not enjoy that aspect of my job, but it was a fact of life. People should review any study and interpret the numbers for themselves rather than listen solely to the positive sound bites that will surely be culled from it.
I agree with you that there is some variable not yet explored that causes certain people to gain weight while on antidepressants.
Another subset is people who gain weight while depressed, medicated or not, and whose metabolism shuts down so they are unable to lose the weight even when medication ameliorates their depression. I wonder if it has anything to do with typical vs atypical depression? Perhaps if there were more research into the biochemical differences between the typical and atypical? I'm not certain if atypical depression is acknowledged as a valid diagnosis in the DSM IV. It wasn't in previous versions. I think it is a modifier now, i.e., Depression with atypical features. Until a difference is acknowledged, inclusion of both subsets into generic depression studies may be skewing results to the detriment of both.
Good luck in the Selegiline Patch study. I have my fingers crossed you aren't on the placebo!Annie
> Accusations of naivite or unethical behavior are ones I certainly never wanted to make or insinuate. Having seen grant money in action, all I can say is that where it comes from
> can have an influence. I think, in general, all parties are aware of this and do their best to behave impartially. Research is conducted by human beings. A healthy dose of
> skepticism is always warranted, which does not mean one should be paranoid or dismiss everything that a party with a certain vested interest has to say. I've seen brilliant
> competitors in academia hurl various ideological and philosophical spitwads at one another, produce totally contradictory results in attempts to repeat the other's experiments,
> accuse one another of being idiots, shitheads, what have you. I've yet to hear these diametrically opposed individuals refer to one another as liars, or try to sick the ORI on
> each other (though I guess this happens sometimes). Science is just full of this stuff though. Everyone tries to do the right thing, and they mostly succeed. You take the
> true love of the scientific process and throw money and egos and dogma into the mix, and it gets complicated. I still and always will have faith in the process, mostly because
> of the necessity of reproducibility in science as a condition for acceptance. I take one paper, lots of anecdotal information, and my own experience and conclude that the truth is
> out there, and I hope someone finds it. My assumption is that SSRI-induced weight gain is real and could be teased out as a bona fide side effect in some individuals, including me.
>
> Tegretol use has been associated with agranulocytosis and aplastic anaemia. If I were to conduct a tegretol study and monitor 1000 individuals for a year I might never see
> these terrible side effects and conclude they do not occur. Of course, these conditions are exceedingly rare and can't be equated with something as mundane as putting on weight. I
> think because of the severity of such side effects few physicians would be prepared to dismiss the Tegretol connection. There is certainly a higher incidence of, say, agranulocytosis
> among Tegretol users than among the general population. For good resons, the association is considered real despite the fact that there might be little justification for such a
> conclusion on the grounds of certain statistical tests. This is a hypothetical situation, I know, but I think a plausible one.
>
> Perhaps real SSRI-induced weight gain is rare. I should think, though, that there might be a number of exceptonal cases one could focus on that could help separate the signal
> from the noise. Certainly weight gain is common. Is 20% weight gain in six months with no change in diet or activity common? If not, how uncommon is it? Does this sort of thing
> happen in individuals who don't take psycotropic medications? If so, how often? I don't do experiments on people, and perhaps I am suggesting a study that would be unfeasibly large
> and complex. But such a study could help one, perhaps, identify a subtype with a specific sensitivity to SSRIs that is manifested as weight gain. Maybe one could gain valuable
> information from such individuals that could be used to design better drugs, or at the very least teach us some fundimentals about the mechanisms of weight gain. Perhaps we could
> learn more about this serotonin/carbohydrate association I keep hearing about. Personally, using the assumption that increased carbohydrate intake somehow increases serotonin levels
> or mimicks this in some way, I would think that everybody ought to lose weight on an SSRI. This doesn't happen. Perhaps it's not serotonergic mechanisms that are involved but the non-
> specific receptor binding that does occur to a greater or lesser degree with all these drugs.
>
> Sometimes it's the rare cases, perhaps the results of uncommon genetic polymorphisms, that yield the most information. I hope that, based on studies such as the one Elizabeth has cited,
> people do not ignore the SSRI/weight gain connection or write it off. I think it still deserves further study, and I have the utmost sympathy for anyone who has experienced it. It's
> not a fun thing.
Posted by Annie McNeil on August 15, 1999, at 23:53:12
In reply to Re: weight gain on SSRIs - continued, posted by Annie on August 15, 1999, at 22:46:13
Hello All,First off, there seems to be 2 Annie's posting to this thread. I always use my last name or intial so as not to confuse anyone.
Secondly, I was put on prozac for anxiety, not depression. My doctor felt they (depression & anxiety) are often linked, so I was tested for depression and was given a clean bill of health, in that regard, anyway. I have never exhibited the symptoms of depression, as far as I can recall. Doctors prescribe SSRI's for a variety of conditions, not only depression. I gained 35 pounds in 3 months. This was after taking prozac for approx. 11 months. During the first 6 weeks of treatment I lost 10 pounds. I maintained that loss until I started gaining 10 months, or so, later. I went back to my doctor, who I've been seeing for 16 years. He told me that about 7% of prozac users gain a considerable amount of weight. Where he got this figure from, I have no idea. He reviewed my records and told me that from age 20 to 35 I had gained 9 pounds. So, yes, I am gaining weight as I age. However, I think 35 pounds (or 25, if want to look at baseline weight increase) in three months cannot be attributed to an aging, slowing metabolism. My metabolism grinded to a halt--it turned tail and ran!!
In addition, it can't be due to recovery from depression, since I don't have it.
My eating and exercise habits have been consistent throughout my adult life. So where has this weight come from?? My doctor believes it was the prozac and I now agree. At first, I was sure it was my thyroid, but I tested within the normal range.I was a pharmacuetical rep for several years and am familiar with the attitudes in the industry. It's a business, like any other. They want to make money, they can't be sued for weight gain. They know if weight gain is considered a side-effect people will discontinue using thier medication or opt not to use it at all. They'll lose money and they'll do what they can to prevent that-- that's the bottomline.
> You speak truth from the heart, Adam. I didn't mean to impugn the ethics of the authors (my doctor is one of the authors), nor to cast doubt on their other independent research studies, but as you eloquently put it, to encourage a healthy dose of skepticism. I worked in funded research for three years. I would not have been permitted to turn down funded projects except (I hope) for illegal or immoral requests. I was "encouraged" to consider future funding as I did my work. I sometimes had to make an apple look like an orange. I did not enjoy that aspect of my job, but it was a fact of life. People should review any study and interpret the numbers for themselves rather than listen solely to the positive sound bites that will surely be culled from it.
> I agree with you that there is some variable not yet explored that causes certain people to gain weight while on antidepressants.
> Another subset is people who gain weight while depressed, medicated or not, and whose metabolism shuts down so they are unable to lose the weight even when medication ameliorates their depression. I wonder if it has anything to do with typical vs atypical depression? Perhaps if there were more research into the biochemical differences between the typical and atypical? I'm not certain if atypical depression is acknowledged as a valid diagnosis in the DSM IV. It wasn't in previous versions. I think it is a modifier now, i.e., Depression with atypical features. Until a difference is acknowledged, inclusion of both subsets into generic depression studies may be skewing results to the detriment of both.
> Good luck in the Selegiline Patch study. I have my fingers crossed you aren't on the placebo!
>
> Annie
>
>
> > Accusations of naivite or unethical behavior are ones I certainly never wanted to make or insinuate. Having seen grant money in action, all I can say is that where it comes from
> > can have an influence. I think, in general, all parties are aware of this and do their best to behave impartially. Research is conducted by human beings. A healthy dose of
> > skepticism is always warranted, which does not mean one should be paranoid or dismiss everything that a party with a certain vested interest has to say. I've seen brilliant
> > competitors in academia hurl various ideological and philosophical spitwads at one another, produce totally contradictory results in attempts to repeat the other's experiments,
> > accuse one another of being idiots, shitheads, what have you. I've yet to hear these diametrically opposed individuals refer to one another as liars, or try to sick the ORI on
> > each other (though I guess this happens sometimes). Science is just full of this stuff though. Everyone tries to do the right thing, and they mostly succeed. You take the
> > true love of the scientific process and throw money and egos and dogma into the mix, and it gets complicated. I still and always will have faith in the process, mostly because
> > of the necessity of reproducibility in science as a condition for acceptance. I take one paper, lots of anecdotal information, and my own experience and conclude that the truth is
> > out there, and I hope someone finds it. My assumption is that SSRI-induced weight gain is real and could be teased out as a bona fide side effect in some individuals, including me.
> >
> > Tegretol use has been associated with agranulocytosis and aplastic anaemia. If I were to conduct a tegretol study and monitor 1000 individuals for a year I might never see
> > these terrible side effects and conclude they do not occur. Of course, these conditions are exceedingly rare and can't be equated with something as mundane as putting on weight. I
> > think because of the severity of such side effects few physicians would be prepared to dismiss the Tegretol connection. There is certainly a higher incidence of, say, agranulocytosis
> > among Tegretol users than among the general population. For good resons, the association is considered real despite the fact that there might be little justification for such a
> > conclusion on the grounds of certain statistical tests. This is a hypothetical situation, I know, but I think a plausible one.
> >
> > Perhaps real SSRI-induced weight gain is rare. I should think, though, that there might be a number of exceptonal cases one could focus on that could help separate the signal
> > from the noise. Certainly weight gain is common. Is 20% weight gain in six months with no change in diet or activity common? If not, how uncommon is it? Does this sort of thing
> > happen in individuals who don't take psycotropic medications? If so, how often? I don't do experiments on people, and perhaps I am suggesting a study that would be unfeasibly large
> > and complex. But such a study could help one, perhaps, identify a subtype with a specific sensitivity to SSRIs that is manifested as weight gain. Maybe one could gain valuable
> > information from such individuals that could be used to design better drugs, or at the very least teach us some fundimentals about the mechanisms of weight gain. Perhaps we could
> > learn more about this serotonin/carbohydrate association I keep hearing about. Personally, using the assumption that increased carbohydrate intake somehow increases serotonin levels
> > or mimicks this in some way, I would think that everybody ought to lose weight on an SSRI. This doesn't happen. Perhaps it's not serotonergic mechanisms that are involved but the non-
> > specific receptor binding that does occur to a greater or lesser degree with all these drugs.
> >
> > Sometimes it's the rare cases, perhaps the results of uncommon genetic polymorphisms, that yield the most information. I hope that, based on studies such as the one Elizabeth has cited,
> > people do not ignore the SSRI/weight gain connection or write it off. I think it still deserves further study, and I have the utmost sympathy for anyone who has experienced it. It's
> > not a fun thing.
Posted by Adam on August 16, 1999, at 17:34:11
In reply to Re: weight gain on SSRIs - continued, posted by Annie McNeil on August 15, 1999, at 23:53:12
I hope that the discussion of weight gain and SSRIs can be
continued, because I would be very interested in the
experiences of others who have dealt with this issue.I would also like to say that I greatly appreciate the
lively discussion and the viewpoints presented by what I
consider to be an exceptionally intelligent and insightful
group of people.I hope most of all that nobody is put off by the somewhat
tangential discussion of ethics as it relates to the subject
and clinical trials. I feel rather responsible, and realize
upon reflection that my emotions on the subject (the whole
thing kind of upsets me, frankly, given my unahppy experience)
may have brought a certain level of stridency to my posts
that I probably should rein in a bit.Anyway, just felt like saying that...:)
Posted by Elizabeth on August 16, 1999, at 20:08:20
In reply to Re: weight gain on SSRIs - continued, posted by Adam on August 15, 1999, at 16:20:11
First, my thanks to Racer for the flattery .
Second, to Adam....
> Accusations of naivite or unethical behavior are ones I certainly never wanted to make or insinuate.
No...I didn't mean to imply that you were. Annie had called me "naive" and seemed to be saying that we should assume unethical behavior since we can't prove there wasn't any.
One of the authors of the study under discussion, Frederic Quitkin, has actually put a great deal of effort into what one might call "meta-research" - researching ways to make research more reliable (for example, by studying the "placebo effect"). I've always been very impressed by the innovative work of Quitkin and his colleagues, and also by their apparent devotion to making clinical research more accurate.
> Having seen grant money in action, all I can say is that where it comes from can have an influence.
Oh, c'mon, you can say more than that. Tell us some scandalous stories. :-)
> A healthy dose of skepticism is always warranted, which does not mean one should be paranoid or dismiss everything that a party with a certain vested interest has to say.
This is something that I think people do in regard to Lilly-funded studies. Not that it's totally unwarranted (as I noted before, *nobody* trusts Lilly!), but I do think people should look at who's doing the actual research. The chief author listed here is a Lilly researcher, but others are affiliates of respected teaching hospitals (such as Mass. General).
> I've seen brilliant competitors in academia hurl various ideological and philosophical spitwads at one another, produce totally contradictory results in attempts to repeat the other's experiments, accuse one another of being idiots, shitheads, what have you.
Yeah, isn't it great? Makes me feel better about occasionally losing my temper.
> My assumption is that SSRI-induced weight gain is real and could be teased out as a bona fide side effect in some individuals, including me.
Yes. I think you and I are 100% in agreement on this one. Reading on...
> Tegretol use has been associated with agranulocytosis and aplastic anaemia. If I were to conduct a tegretol study and monitor 1000 individuals for a year I might never see these terrible side effects and conclude they do not occur. Of course, these conditions are exceedingly rare and can't be equated with something as mundane as putting on weight.
No, they can't be equated with it, but perhaps weight gain is also rare..."below the statistical radar," I like to say. Another example of this is the controversy over whether SSRIs cause increased aggressive-impulsive behavior in some individuals: if they do, it's very rare, but it should be watched for because it is serious.
Indeed, I think physicians don't take weight gain seriously enough, perhaps because they write it off as "just" a self-image issue. Actually, though, it's a serious health risk...young people who gain weight are at increased risk for cardiovascular problems and diabetes mellitus later in life.
> I think because of the severity of such side effects few physicians would be prepared to dismiss the Tegretol connection. There is certainly a higher incidence of, say, agranulocytosis among Tegretol users than among the general population. For good resons, the association is considered real despite the fact that there might be little justification for such a conclusion on the grounds of certain statistical tests. This is a hypothetical situation, I know, but I think a plausible one.
I agree, and at present I think it is the most likely one. I don't mean to say that there aren't people who gain weight as a result of some specific effect of an SSRI, but when people claim that an SSRI "caused" weight gain for them, I'm always tem
Posted by Elizabeth on August 16, 1999, at 20:46:59
In reply to various, posted by Elizabeth on August 16, 1999, at 20:08:20
Oops, I sent that one unfinished. Starting in the last paragraph:
I agree, and at present I think it is the most likely one. I don't mean to say that there aren't people who gain weight as a result of some specific effect of an SSRI, but when people claim that an SSRI "caused" weight gain for them, I'm always tempted to inquire more. Depression and anxiety can both cause changes in eating patterns and metabolism, and people often don't realize when they are eating more, for example.
Posted by Beager on August 16, 1999, at 23:55:36
In reply to Re: weight gain on SSRIs - continued, posted by Annie McNeil on August 15, 1999, at 23:53:12
This is *exactly* what happened to me. First, I lost weight (10 lbs.), then later gained weight, very quickly. And I, too, am not suffering from depression (thyroid has checked out normal). For some of us, these drugs cause weight gain; we're not changing anything about our eating or exercising habits. That's what I'm trying to find out - what causes the weight gain. Otherwise, Prozac and Celexa are great. (Of course, there's that "no orgasm" problem... )
(I love the description of your metabolism grinding to a halt, turning tail and running!)
>>During the first 6 weeks of treatment I lost 10 pounds. I maintained that loss until I started gaining 10 months, or so, later. I went back to my doctor, who I've been seeing for 16 years. He told me that about 7% of prozac users gain a considerable amount of weight. Where he got this figure from, I have no idea. He reviewed my records and told me that from age 20 to 35 I had gained 9 pounds. So, yes, I am gaining weight as I age. However, I think 35 pounds (or 25, if want to look at baseline weight increase) in three months cannot be attributed to an aging, slowing metabolism. My metabolism grinded to a halt--it turned tail and ran!!
In addition, it can't be due to recovery from depression, since I don't have it.
My eating and exercise habits have been consistent throughout my adult life. So where has this weight come from?? My doctor believes it was the prozac and I now agree. At first, I was sure it was my thyroid, but I tested within the normal range.<<
Posted by Robin on August 19, 1999, at 9:07:13
In reply to Re: weight gain on SSRIs - continued, posted by Beager on August 16, 1999, at 23:55:36
> This is *exactly* what happened to me. First, I lost weight (10 lbs.), then later gained weight, very quickly. And I, too, am not suffering from depression (thyroid has checked out normal). For some of us, these drugs cause weight gain; we're not changing anything about our eating or exercising habits. That's what I'm trying to find out - what causes the weight gain. Otherwise, Prozac and Celexa are great. (Of course, there's that "no orgasm" problem... )
>
> (I love the description of your metabolism grinding to a halt, turning tail and running!)
>
> >>During the first 6 weeks of treatment I lost 10 pounds. I maintained that loss until I started gaining 10 months, or so, later. I went back to my doctor, who I've been seeing for 16 years. He told me that about 7% of prozac users gain a considerable amount of weight. Where he got this figure from, I have no idea. He reviewed my records and told me that from age 20 to 35 I had gained 9 pounds. So, yes, I am gaining weight as I age. However, I think 35 pounds (or 25, if want to look at baseline weight increase) in three months cannot be attributed to an aging, slowing metabolism. My metabolism grinded to a halt--it turned tail and ran!!
> In addition, it can't be due to recovery from depression, since I don't have it.
> My eating and exercise habits have been consistent throughout my adult life. So where has this weight come from?? My doctor believes it was the prozac and I now agree. At first, I was sure it was my thyroid, but I tested within the normal range.Has anyone else had this happen?? I took Prozac for three months when it first came out about 1986. I took 20 mgs a day. I felt great and lost 25 pounds. I have since tried taking it again to find it doesn,t work anymore. It makes me very sleepy and moody. I tried taking 10mg for 6 weeks it was like taking a sleeping pill and I gained weight. I was wondering if increasing to 40 mgs would help at all. Anyone had a similar experience with Prozac?
I have also tried about 15 other AD's and nothing seems to work. I wish I could get the feeling I had from taking Prozac the first time. I have talked to manay others who have had a great experience the first time around with Prozac only to be dissapointed when they tried it again
My next drug will be Parnate which I start today. I just tried Marplan and couldn't stop eating gained 8 pounds in 4 weeks.
Posted by Kel on August 22, 1999, at 19:35:29
In reply to weight gain on SSRIs - continued, posted by Elizabeth on August 15, 1999, at 1:32:51
Finally! A group with the same experiences as I have had. Basically I have the same story the loss, the gain, the "poop out" and now one year later and still 40lbs. fatter and becoming more and more obsessed about the weight. I have no solutions but I'm still looking and until I found all of the postings here about to give up hope. Has anyone found any "loosers" after Prozac. I'm to the point where I need an immediate miracle. Please keep this topic going! I need you guys! Best wishes to all!
-Kel
Posted by Annie McNeil on August 23, 1999, at 15:30:09
In reply to Soooo glad I found all of you..., posted by Kel on August 22, 1999, at 19:35:29
> Finally! A group with the same experiences as I have had. Basically I have the same story the loss, the gain, the "poop out" and now one year later and still 40lbs. fatter and becoming more and more obsessed about the weight. I have no solutions but I'm still looking and until I found all of the postings here about to give up hope. Has anyone found any "loosers" after Prozac. I'm to the point where I need an immediate miracle. Please keep this topic going! I need you guys! Best wishes to all!
> -Kel
Hi Kel--What AD are you on now, or are you off them altogether? I've heard that most people do lose the weight eventually, but it doesn't come off as fast as it came on. Apparently, you really have to work at it, too. I was hoping it would be as effortless to lose it as it was to gain it. Ah well, gotta go to the gym now.
See you later.
Posted by Nancy on August 23, 1999, at 20:05:28
In reply to Re:Well said, posted by Brandon on August 15, 1999, at 17:19:54
> Having seen grant money in action, all I can say is that where it comes from can have an influence.
>
> This statement is not far from the truth. Despite what most people believe or want to believe a lot of what we and physicians here about a medication depends on the amount of resources allocated for its promotion. As the son of a clinical research physician and a med student I have witnessed first hand the pampering and catering that is given to physicians to push their product. I'm not saying that are medical institutions are corrupt, but a huge amount of resources used by pharmacuetical giants goes into the promotion of their medication.In regards to the weight gain from SSRI meds...I have been on Prozac for 3 years and gained almost 30 pounds. I am in a support group with 5 other women, all whom are also on SSRI meds and EVERY one of them have gained a substantial amount of weight. It is documented that long-term use of SSRI medss DOES cause weight gain. Go to Yahoo and punch in "SSRI weight gain" and there's an interesting quite long article about a couple of shrinks who did a study of it and found that it is so. Anyway, has anyone switched fromo Prozac to Wellbutrin and lost some ofo the weight? I just switched and am hoping it will work. THANKS!
Posted by Beager on August 25, 1999, at 0:18:51
In reply to Re:Well said, posted by Nancy on August 23, 1999, at 20:05:28
Thanks for the article suggestion. I read it and feel better knowing that someone is finally admitting that the weight gain is *extremely* difficult (if not impossible) to take off. My thryoid has been checked several times and is quite normal. But nothing can be done to lose the weight. And for as active as I am, being overweight can be very uncomfortable.
>>Go to Yahoo and punch in "SSRI weight gain" and there's an interesting quite long article about a couple of shrinks who did a study of it and found that it is so.<<
Posted by Barb on September 10, 1999, at 7:41:32
In reply to Re:Well said, posted by Nancy on August 23, 1999, at 20:05:28
This is an old thread so I don't know if anyone will get this, but I switched from Zoloft (weight gain = 18lbs) to Wellbutrin and after six weeks, I feel pretty good, but had my appetite cut by about 75%! And I've lost 16lbs since July 31st. I am not currently "working hard at it" (too many hours at work) but I overall an active person. Hope that's encouraging.
> > Having seen grant money in action, all I can say is that where it comes from can have an influence.
> >
> > This statement is not far from the truth. Despite what most people believe or want to believe a lot of what we and physicians here about a medication depends on the amount of resources allocated for its promotion. As the son of a clinical research physician and a med student I have witnessed first hand the pampering and catering that is given to physicians to push their product. I'm not saying that are medical institutions are corrupt, but a huge amount of resources used by pharmacuetical giants goes into the promotion of their medication.
>
> In regards to the weight gain from SSRI meds...I have been on Prozac for 3 years and gained almost 30 pounds. I am in a support group with 5 other women, all whom are also on SSRI meds and EVERY one of them have gained a substantial amount of weight. It is documented that long-term use of SSRI medss DOES cause weight gain. Go to Yahoo and punch in "SSRI weight gain" and there's an interesting quite long article about a couple of shrinks who did a study of it and found that it is so. Anyway, has anyone switched fromo Prozac to Wellbutrin and lost some ofo the weight? I just switched and am hoping it will work. THANKS!
Posted by Justitia on September 12, 1999, at 1:43:06
In reply to Re: Soooo glad I found all of you..., posted by Annie McNeil on August 23, 1999, at 15:30:09
I got off AD's. I started working out. I got a trainer. I go to Overeaters anonymous. I have started losing the weight. I gained 60 ponds over all. I have about 40 to go. Even though one doesn't think one is eating more, it is those little extra bites, the additional splurge once in a while that occur with much greater frequency then one thinks. I definitely noticed it when I was on AD's and it would stop when I went off. But the stopping is not enough to lose weight just to stop the gaining. To lose weight you have to actually lower your calorie intake and increase your fuel burning, but you don't want to get into a diet, obsessed with weight syndrome. Hence for me a physical trainer and OA (overeaters anonymous) is working for me. I am actually healthier and more energetic than I have been in years.
Posted by Bob on September 12, 1999, at 10:43:14
In reply to Re: Soooo glad I found all of you..., posted by Justitia on September 12, 1999, at 1:43:06
I hadn't looked at this thread because it was a bit dated, too, but I'm glad I did. I knew that weight gain on SSRIs was common (tho, I actually lost weight on prozac and the same for my brother on celexa), what I didn't know was how had it was to take it off. I've cut my caloric intake from around 2800/day to 2200/day and I've been working out hard 2-3 times per week, and *nothing* has come off!
I'm wondering if anyone else has had any cholesterol problems as well. Zoloft and paxil both made my cholesterol jump from 200 to 280 or so, and my triglycerides are off the scale. Anyone else have the same experience?
Cheers,
Bob
Posted by Justitia on September 12, 1999, at 11:51:36
In reply to Re: Soooo glad I found all of you..., posted by Bob on September 12, 1999, at 10:43:14
Hope this message doesn't seem too long.
I am not a nutritionist but 2200 calories a day, even for a man sounds high. I keep my caloric intake to between 1200-1400 a day. (1200 is supposed to be the minimum) Also you need to watch fat content. I keep mine to less than 30% of my calories. I understand that men use even less fat but can have more calories but that range should be in the 1500 - 1800 calorie a day range. It also depends on your age. The older you are the less food you need, even with working out. Also stay away from sugar. They have studies now that show sugar is converted into fat. So those "fat-free" dessert types that still have sugar in them still add fat. People find they are addicted to sugar or sugar fat content, and find withdrawel form it veyr hard to do. That is one of the things, for those who shoose to, that Overeaters Anonymous can help with. It is based on addiction model about food, like AA (Alcholics Anonymous) Alchohol also turns into sugar which then turns into fat. THe issue about these foods is whether you can use them moderately or once you start to continue having more and more and then its best to cut them out altogether. THose 12 step programs are oriented to dealing wiht htose issues.
A recommended plan for exercise is 5 days a week of cardio (weight-bearing, i.e. treadmills or some standing exercise, no peddle bikes) where you get your heart rate up to what is 90% of your maximum for your age within the first 20 minutes and continue exercising for another 25 minutes. It is important to invest in a first rate heart moniter, the kind that goes around your chest, not your wrist so you know what your heart rate is. The machines that read off of your palms are extremely unreliable. And the same level of exercise does not produce the same heart rate each time you do it. It varies depending on your body that day. It is critical not to go over your recommended arate because you can put yourself into fibrilation and die. That is why you need a heart rate monitor They tend to cost around $100 but last forever. According to studies, the health and weight loss benefits of cardio drop off dramatically after 45 minutes, so for efficiency purposes there is no point in continuing longer. A trick
with the treadmill, if you can't or don't like running, is to increase the incline and walk rather than run. Exactly the same cardio and weight loss effect as running. (Better for your spine and knees and helps significantly with lower back pain as well.) The other is to do weight-training 2 -3 times a week to build up your muscle mass. That not only gives you enormous amout of energy but muscle burns more caloris than a body with a higher proportion of fat and because muscle "weighs" more than fat, the same amount of body weight that is a higher proportion of muscle is "thinner" (wears smaller size clothes) than the equivalent weight that is a higher proportion of fat. You tend to stay muscular when you are younger but you have to work at maintaining or rebuilding the muscle once you are past 30. It doesn't matter what age you start at, however, you can always rebuild muscle, even into your 80's. It just takes longer as you get older. But everyone can get into shape within a year. You always start noticing results within a few weeks. You lose the benefits when you stop more rapidly when you get older. You stop exercising for a month you have lost it all if you are past 40. If in stress periods and time crunches you can doone each, weight and cardio each week you can go a long way to maintining until you can back to your regular routine. You need an excellant trainer to teach you strength training properly. Most out there do no know what they are doing, or even if they do, they really don't pay attention to you while you're working out, getting glazy-eyed and counting reps for you without paying attention to the nuances of your body form, which is critical for success. Finding a first rate trainer is like finding a first rate doctor. It is hard to do. It helps if you have one who is a good motivator as well. I have also found that exercise does more for my mood than any drugs I have ever taken, but I still would take AD's if I didn't have such bad side-effects (chronic fatigue, sleeping 14 -16 hours a day, no sex drive, and compulsive eating.) The positive psychological benefits from the AD's were great but I could not live with the negative side effects.
Good luck all. And I have an incredible referral in Houston for a trainer where I used to live...if anybody is interested.
Posted by Bob on September 12, 1999, at 16:24:55
In reply to Exercise and calories, fat, for men and women, posted by Justitia on September 12, 1999, at 11:51:36
One nutritionist I saw six or seven years ago gave me this rule of thumb: you need 10 calories per pound you weigh to maintain your weight. More recently (this past year), I saw a nutritionist who was part of an obesity research center here in NYC (St.Lukes/Roosevelt). She had higher numbers than that. Given my stature, she thought 2800 cals would be more of a maintenance level. In any event, the first nutritionist gave me an 1800cal/day diet plan for diabetics that is published by Eli Lilly. No particular reason for choosing a diabetic plan other than it's a very sound eating plan for *anyone*, not just diabetics. On that diet and vigorous exercise 4x/week, I was able to drop 40lbs in three months and drop my cholesterol to 170. If anyone is interested in the plan, please email me (instead of posting "send me a copy" messages here!) and I'll see what I can do with my scanner and Acrobat.
I liked your exercise advice, too, Justita. I was working on a pure aerobic workout, but I'm switching back to weights. Like you said, muscle burns more calories to maintain than fat, so adding muscle actually raises your resting metabolic rate. If anyone out there is wondering about weight training but clueless about starting up, Ellington Darden (one of the co-inventors of Nautilus equipment) has a great book out called Living Longer Stronger (ISBN 0-399-51900-9). A couple of the principles he talks about are things to take to heart. The most important, I feel, is knowing how and when to increase the amount of weight you use on a machine. What he advocates is a "double progression". Take leg curls as an example. First you need to find the heaviest weight you can curl for a set of 8 reps. You only do one set at each machine per workout, and you keep pushing to do more reps in a set. You stay at that weight until you can do 12 reps. Next time, you increase the weight by 5%. You'll probably be able to do between 8 and 12 reps, so you work at reaching 12 again. The first progression is the number of reps; the second progression is the weight you're lifting. This method is designed more for toning than for bulking up. Another principle he stresses is working pairs of muscles. If you do crunches, then do back extensions. If you do leg curls, then do leg extensions. He has a number of recommended workouts that help you pair these up ... they also increase in the number of machines you work with over time.
Finally, one really cool (figuratively and literally) thing he talks about is water. He recommends drinking about a gallon a day, working up to 1.5 gallons eventually. You may think you could never drink that much water, but it you drink one 12 oz. glass an hour, you can do it easy. He also recommends drinking water that's as cold as you can bear. Simple thermodynamics -- you'll pull your core body temperature down, so your body will have to burn calories to heat it up to normal.
Cheers,
Bob
Posted by Justitia on September 13, 1999, at 9:10:07
In reply to Re: Exercise and calories, fat, for men and women, posted by Bob on September 12, 1999, at 16:24:55
Yes, water is great. But I am only able to make it up to half a gallon a day sometimes more sometimes less. I am glad you found a food plan that works for you. Nautilus equipment is the best. Even the old stuff is still great. I have moved ont to free weights my self. I find it more efficient plus it works on my balance. But I was doing nautilus for a number of years when I first got started. I have neard different debates on whether the water should be cold or room temparature, that the cold water acts as a shock to the system and is not assimilated as well. But I think none of these points of view have been scientifiaclly verified, just the reasoning form someone's head. But everyone always recommends lots of pure water. Form weight loss (eases fat out of your body quicker) medical (facilitates your organs functioning better, particularly kidneys) and asthetics (it makes your skin dewyier and healthier--that I find visibly obvious--after a week or two of diligent drinking--my skin gets much more youthful.) SO I think there is no debate about the health benefits of water. Well I am off to the gym for my cardio. Good luck all. Justitia
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