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amitriptyline
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Anon_4527 posted:
was recently prescribed amitripyline for depression. however, upon reading reviews I was discouraged to read how many others who have used this drug have encountered signficant weight gain. can you elaborate on this? is the weight gain a result of hunger increase or metabolic changes? thank you.

Note: I am a bulimic attempting recovery so I can't be on a drug that encourages binge eating or unanticipated weight gain.
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Anon_4527 responded:
Also, any suggestions for anti-depressants that do NOT cause weight gain?
 
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Anon_4527 replied to Anon_4527's response:
sorry to keep replying to my own post...but i frequently come across wellbutrin as an ideal drug (not weight gain, no sexual side effects)...but it is contraindicated for people with eating disorders. please comment.
 
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Jane Harrison Hohner, RN, RNP replied to Anon_4527's response:
Dear Anon: You are correct, bupropion/Wellbutrin has seemed to have less association with weight gain than many of the older tricyclic antidepressants (eg amitripyline/Elavil). Some of this is dose dependent ( eg 50 mg of Elavil vs 150mg) and can also vary depending upon the person taking the medication.

I did a lit search at the National Library of Medicine site on the use of Wellbutrin in eating disorders, this is the best citation I could find:

Cochrane Database Syst Rev. 2003;(4):CD003391.
Antidepressants versus placebo for people with bulimia nervosa.
Bacaltchuk J, Hay P.


Department of Psychiatry, Universidade Federal de S?o Paulo, Rua Casa do Ator 764 apto 102, S?o Paulo - SP, Brazil, 04546-003.

BACKGROUND:

Bulimia Nervosa (BN) represents an important public health problem and is related to serious morbidity and even mortality. This review attempted to systematically evaluate the use of antidepressant medications compared with placebo for the treatment of bulimia nervosa.
OBJECTIVES:

The primary objective of this review was to determine whether using antidepressant medications was clinically effective for the treatment of bulimia nervosa. The secondary objectives were:(i) to examine whether there was a differential effect for the various classes/types of antidepressants with regard to effectiveness and tolerability(ii) to test the hypothesis that the effect of antidepressants on bulimic symptoms was independent of its effect on depressive symptoms

MAIN RESULTS:

Currently the review includes 19 trials comparing antidepressants with placebo: 6 trials with TCAs (imipramine, desipramine and amitriptyline), 5 with SSRIs (fluoxetine), 5 with MAOIs (phenelzine, isocarboxazid, moclobemide and brofaromine) and 3 with other classes of drugs (mianserin, trazodone and bupropion). Similar results were obtained in terms of efficacy for these different groups of drugs. The pooled RR for remission of binge episodes was 0.87 (95% CI 0.81-0.93; p<0,001) favouring drugs. The NNT for a mean treatment duration of 8 weeks, taking the non-remission rate in the placebo controls of 92% as a measure of the baseline risk was 9 (95% CI 6 - 16). The RR for clinical improvement, defined as a reduction of 50% or more in binge episodes was 0.63 (95% CI 0.55-0.74) and the NNT for a mean treatment duration of 9 weeks was 4 (95% CI 3 - 6), with a non-improvement rate of 67% in the placebo group. Patients treated with antidepressants were more likely to interrupt prematurely the treatment due to adverse events. Patients treated with TCAs dropped out due to any cause more frequently that patients treated with placebo. The opposite was found for those treated with fluoxetine [PROZAC-JHH}, suggesting it may be a more acceptable treatment. Independence between antidepressant and anti-bulimic effects could not be evaluated due to incomplete published data.
REVIEWER'S CONCLUSIONS:

The use of a single antidepressant agent was clinically effective for the treatment of bulimia nervosa when compared to placebo, with an overall greater remission rate but a higher rate of dropouts. No differential effect regarding efficacy and tolerability among the various classes of antidepressants could be demonstrated.

Bottom line Anon, only your psychiatric provider can give you the most "for sure" guide lines about the use of Wellbutrin. I know from my own clinical practice that it would not be my first choice if the woman also had an anxiety disorder. I would urge you to be direct with your MD and express concern about weight gain as a side-effect. Even within a class of antidepressants (eg SSRIs) some drugs seem to have more tendency to weight gain--and your psychiatrist will know which ones these are. Hopefully you can find a med that works both for the depression and avoids weight concerns.

With Respect,
Jane


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