Psycho-Babble Medication Thread 437085

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TCAs and Weight Gain

Posted by tygereyes on January 3, 2005, at 0:35:43

I'm sure this has been asked before, but which tricyclic antidepressant is the least likely to cause weight gain?

I was just released from an inpatient eating disorders unit and I'm in the early stages of recovery from anorexia nervosa, and I think Nortriptyline is making my constant hunger even worse. I know it's caused me to gain weight in the past.

And I have to take a tricyclic because I have Interstitial Cystitis, which is activated by SSRIs. It also activates mood stabilizers, to a lesser degree, so a tricyclic is necessary in order to keep the bladder problems caused by Trileptal (my other med) in check.

I've heard that Desipramine is fairly neutral in terms of weight gain. Is this true? It's so difficult to find information on the tricyclics, because research is so focused on the newer AD drugs.

 

Re: TCAs and Weight Gain

Posted by banga on January 3, 2005, at 2:03:11

In reply to TCAs and Weight Gain, posted by tygereyes on January 3, 2005, at 0:35:43

Funny you should ask, I was just discussing this with someone here a few threads ago.
Ed gave this reference:
You might be interested in this.......

J Clin Psychiatry. 1987 Jan;48(1):27-8.

The effect of desipramine on body weight in depression.

Levitt AJ, Joffe RT, Esche I, Sherret D.

Twenty-six patients with major depressive disorder were treated with desipramine for 4 weeks to determine the effect of the drug on body weight. Responders to desipramine showed a weight gain only at Weeks 3 and 4; nonresponders had a nonsignificant loss of weight. The increase in body weight of the responders was independent of dosage, sex, and hospitalization status. These findings suggest that the small increase in body weight that occurs in patients taking desipramine is associated with treatment response.
In addition, desipramine may be a valuable treatment alternative for those patients in whom excessive weight gain is undesirable.


It sounds as though desipramine has much less effect on weight than say clomipramine. I too am trying to find a TCA--pro-norepinephrine type--that does not lead to much weight gain. I will probably try desipramine next.
It must be difficult to balance the stress caused by your eating disorder tendencies and finding medications that won't stress you out even more at this early stage. Perhaps desipramine could offer help for you. Best of luck to you.

 

Re: TCAs and Weight Gain

Posted by King Vultan on January 3, 2005, at 8:11:05

In reply to TCAs and Weight Gain, posted by tygereyes on January 3, 2005, at 0:35:43

> I'm sure this has been asked before, but which tricyclic antidepressant is the least likely to cause weight gain?
>
> I was just released from an inpatient eating disorders unit and I'm in the early stages of recovery from anorexia nervosa, and I think Nortriptyline is making my constant hunger even worse. I know it's caused me to gain weight in the past.
>
> And I have to take a tricyclic because I have Interstitial Cystitis, which is activated by SSRIs. It also activates mood stabilizers, to a lesser degree, so a tricyclic is necessary in order to keep the bladder problems caused by Trileptal (my other med) in check.
>
> I've heard that Desipramine is fairly neutral in terms of weight gain. Is this true? It's so difficult to find information on the tricyclics, because research is so focused on the newer AD drugs.


Desipramine is regarded as the tricyclic with the lowest tendency to induce weight gain. It has the weakest histamine H1 blockade and is the most powerful of the tricyclics at blockading norepinephrine reuptake. Generally, blockading histamine H1 receptors, which nortriptyline does to a noticeably greater extent than does desipramine, will tend to induce weight gain, while blockading norepinephrine reuptake has a tendency to reduce appetite.

My own experience with nortriptyline and desipramine was that both lowered my appetite, but while my weight remained steady on nortriptyline--which I couldn't tolerate very well and was only on a couple of months--I actually lost a few pounds on desipramine. However, I do believe that both of these drugs slowed down my metabolism; it's just that in my own case, the appetite suppression effectively counterbalanced it. Out of the 10+ drugs I've tried, desipramine had the strongest tendency to reduce my appetite.

You might also want to consider Strattera, which is similar to desipramine, but with no histamine blockade. Reboxetine is another drug similar to Strattera but is not available in the US, if that's where you happen to live.

Todd

 

Re: TCAs, Weight, Eating Disorders

Posted by lia mason on January 3, 2005, at 10:31:11

In reply to TCAs and Weight Gain, posted by tygereyes on January 3, 2005, at 0:35:43

Hello,

You have my sympathies. I recovered from anorexia/bulimia and I have vulvodynia--a pain condition somethimes referred to as IC's "evil sister".

So I have been on all these meds. Are you sure you can't take an SSRI? I found that SSRI's helped my eating disorder the most. They were great at breaking the obsession and stopped me from craving enormous amounts of sugar.

I, too, must take a TCA for my gyn condition. I found desipramine the most activating, but elavil worked best for pain. I didn't gain weight on desipramine or imipramine. Nortriptyline I took only briefly cuz it made me dizzy. Elavil I have gained some weight on, but not much. Be sure to get a blood level with all these drugs if you are hoping for an antidepressant response. Nortrip, especially. With pain it doesn't matter so much, but for depression you really need to know that you are getting enough in your bloodstream for an antidepressant response.

For vulvodynia, a lot of women are taking Effexor and Cymbalta.

My concern for you is that you're at a stage where you're super sensitive to weight changes. Elavil, I believe, increased my sugar cravings. And that was precisely my eatind disorder issue. But I'm 10+ years recovered so I can manage. I would consider desipramine or imipramine.

But do double check that you can't take SSRI's. I'm on a list serv for vulvar pain with a lot of IC people on it and I've not heard that about SSRI's. Have you tried Elmiron for IC? It's supposed to work really well.

I don't know if bulimia was an issue for you, but there is a book called "New Hope for Binge Eaters" by Pope and Hudson. It's old now, but it looked specifically at antidepressants for bulimia.

Good Luck!

Lia

 

Re: TCAs, Weight, Eating Disorders

Posted by tygereyes on January 3, 2005, at 11:34:59

In reply to Re: TCAs, Weight, Eating Disorders, posted by lia mason on January 3, 2005, at 10:31:11

The reason that I can't take SSRIs is because they cause nocturnal enuresis (bedwetting), which is clearly a very strange side effect and doesn't happen to me unless I'm on an SSRI.

And I'm also Bipolar II and SSRIs cause me to cycle far more than tricyclics - although the tricyclics do sometimes induce dysphoric mania, but the Trileptal mostly takes care of this.

I'm concerned about gaining even MORE weight, as I was just hospitalized and refed SO quickly (fifteen pounds in nine days) and I'm trying to deal with that and learning how to eat again and I really really really don't want to have to worry about my meds causing extra weight gain, when I still have more weight to gain on my own.


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