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    Are you on Antidepressants and Frustrated that you can't Lose Weight?
    Nina T Frusztajer, MD posted:
    If the answer is yes, unfortunately, you are not alone!

    Hi, I'm Nina and new to this vibrant WebMD Depression Community and thrilled to be here. Helping people successfully lose weight while on antidepressants (and preventing it in the first place) is one of my passions in the field of nutrition and health. It's such a common problem and I think everyone on antidepressants should know that it is possible to benefit from the medications AND maintain a healthy weight.

    Antidepressants have wonderfully positive benefits not only in treating depression but increasingly are used also for a number of other conditions such as chronic pain like fibromyalgia, migraines, PMS, and even some urinary symptoms. The down side is that weight gain is an unwanted side effect associated with a majority of the antidepressants out there. And unfortunately, many people are completely unaware of potential weight gain when they start taking their medications - prescribing physicians seem to never mention it!

    And how many of you, when the weight has crept on, have asked your doctor what's going on and gotten no satisfying answers? Or wondered why all of a sudden you can't stop eating chips, bagels, or ice cream? Or been told that all you need to do is stick to a low-carb, high protein diet to lose weight (which only makes you feel worse)?

    Many antidepressants improve mood by making brain serotonin, a chemical that we all have in our brains, hang around longer between the nerve endings. Serotonin is a "feel good" natural chemical. It also is involved in controlling appetite. And for some reason that is not understood, antidepressants can make the appetite control effects of serotonin less effective. The result is that antidepressants can be associated with an out-of-control appetite and, eventually, weight gain.

    For people on antidepressants, common weight loss strategies like keeping a food journal, increasing exercise, or trying a low-carb/high protein diet are less effective than they are for people not on these medications. The reason is that these strategies do not address the fundamental problem: controlling appetite. The good news is that it is possible to naturally raise your brain serotonin by eating the right foods. And it's often music to peoples' ears that carbs are the foods that allow your brain to make more serotonin which controls the appetite.

    Won't eating carbs make me fat?, you wonder. Not if you choose low-fat, non-fruit carbs and eat them at times that you're not eating your daily requirements of protein. MIT research by my colleague Judith Wurtman, PhD showed that when carbs are eaten and insulin is released into the bloodstream, a series of reactions occur that allow serotonin to be made. You have probably experienced the effects of "comfort foods" in making you feel good and satisfying your appetite - grilled chicken and steamed broccoli, while delicious and healthy, are not the foods you reach for when you get food cravings or feel stressed. No, mashed potatoes, a bowl of oatmeal with brown sugar, pizza, or brownies are more like it!

    The problem with cutting out carbs is that your appetite can get out of control. The problem with eating the wrong carbs, like those loaded with fat, is they can make you feel sluggish and add unwanted calories. Or if carbs are eaten with protein, serotonin cannot be made.

    Always check with your doctor first to guide your diet and monitor portions. But you can time your foods for maximum appetite-controlling effects. Levels of serotonin naturally decline by afternoon and evening (which is why the lines at Starbucks increase around 4pm and evenings can potentially turn into a snacking free-for-all). So aim to eat carbs like whole wheat pasta with vegetables for dinner and grab a granola bar as a late afternoon snack, and stick to protein-packed breakfasts and lunches to keep you going during the day.

    Bottom line: on antidepressants, you can control your appetite and lose weight.
    BamaNik responded:
    What about those of us that are gluten sensitive? What kind of carbs are preferred when wheat is not a possibility?

    TCL38 responded:
    What about those of us who struggled to lose weight even before antidepressants despite a carefully controlled diet and exercise regime?

    I have FIVE YEARS worth of diet journals that prove only one thing....I can't lose weight.

    grammyp5 responded:
    Dear Dr Nina: I am 51 (almost 52) and have steadily gained weight since I first started on antipsychotics in 1998. In those 12 years, I have gained 95 pounds. I am uncomfortable, tired, and really disgusted with myself. My husband, although I know he loves me dearly, does not touch me. Passion is not one of our passtimes! I have considered going off my meds (again) but this time under a doctor's care. If I am able to maintain stability without meds, will my body automatically start to lose the weight gained by medications. I need to add that I exercise 30 minutes everyday and walk a mile 3 to 4 times a week. I have been limiting my caloric intake to 1100 calories a day. And I am still not losing a thing. I have been doing this for approximately 9 months. Talk about frustrating!
    Thanks for taking time to respond....
    Patty H.
    fibroinsd responded:
    Would love to hear Dr. P's reaction to this..

    Caprice_WebMD_Staff replied to fibroinsd's response:
    Hi Cece,

    You may want to ask him on the Fibro board.
    Jayne4694 responded:
    Yes I take medication for depression. I take serequel other antidepressents. When I started the Serequel 600mg I instantly gained 50-60lbs. We knocked it down to 300mg and I stopped gaining weight. Now I'm down to 200mg. I'm not a big eater, I'm not a binge eater, I just can't lose weight. I know part of it is because I don't exercise as much as I used to, but I also need to know what to eat and what not to eat. I am a very PICKY eater. No spices etc. just plain food. Any help out there.
    Nina T Frusztajer, MD replied to BamaNik's response:
    Hi Nicole,
    Gluten sensitivity is no obstacle when it comes to boosting brain serotonin to control your appetite. Gluten-free pasta, low fat baked goods, breakfast cereals, and crackers can all be found in supermarkets everywhere. Grains like millet, rice of all sorts, quinoa, amaranth, corn (polenta or corn tortillas), buckwheat (technically a fruit but eaten as a grain and starchy enough to boost brain serotonin), and bean/legumes can give you even more options and plenty of nutrient value.

    So, a great gluten-free afternoon snack could be rice crackers or rice cakes (some of the flavors are terrific). And an evening meal of a large baked sweet potato with stir-fry vegetables and a frozen fruit bar for dessert would be a great way to prevent evening food cravings.

    The good news is that as long as your overall diet is balanced including plenty of protein at breakfast and lunch as well as vegetables and fruits (and it's OK with your doctor if you have specific dietary restrictions), eating these types of carbs to boost serotonin is perfectly safe.


    Nina T Frusztajer, MD replied to TCL38's response:
    Hi Tanya,

    It must be incredibly frustrating to make huge efforts to lose weight and the scale does not budge! There may be a common theme to your weight loss efforts that didn't give you the results you wanted both before taking antidepressants as well as while you've been on them. For example, you may have taken in more calories than you thought at family or holiday functions; stress might have gotten in the way; you may have been getting too little sleep or too little exercise. Or, two things that are really common are first, that you may have needed to take in even fewer calories than you thought you needed to in order to lose weight, or second, that your appetite was simply never controlled and so you may have binged from time to time erasing your efforts to control calorie intake.

    Clients I've worked with have often been amazed at how few calories they need to consistently lose even a pound a week (1-2 pounds of weight loss a week is the most anyone should aim for to keep it healthy and sustainable). As we age, the percentage of body fat increases and people simply need fewer calories as they age starting in their 30's and 40's. So while I would never advise someone what their caloric requirements should be, the scale is the ultimate measure of how many you need to lose weight - if the scale isn't budging, somehow you've got to find a way to consume fewer. You can check with your doctor for suggestions, too.

    And most weight loss regimens do nothing to address how to control appetite which, when unchecked, is usually the reason most diets fail. Controlling appetite, both on medications and without any medications, is essential for weight loss. Especially on low-carb diets (and especially for women who naturally have lower serotonin levels in their brains than men). If you deprive yourself of carbs and your cravings increase, no amount of steamed fish or salad is going to satisfy those cravings. Obviously everyone is different and lots of people have success on low-carb diets. But I have found that clients I've worked with who go on a low-carb diet eventually fail (and often gain back more weight than they lost) because they reach for a box of cookies or chips or a bag of bagels and can't stop eating them. Then they blame the carbs for their weight gain and it can set off a frustrating cycle. For people who feel their cravings are kept in check, we recommend they eat carbs preventatively to keep their appetite under control.

    I hope that helps - don't give up!
    Nina T Frusztajer, MD replied to grammyp5's response:
    Hi Patty,

    Yes, I can imagine it's incredibly frustrating!

    I am glad to hear you would only adjust your medication regime under close supervision by your prescribing physician. A desire to lose weight is definitely not a reason to change anything without professional supervision by your health care provider.

    And daily exercise is terrific as is monitoring your calorie intake. On the exercise: sometimes people exercise daily but do not exert enough effort to really challenge their bodies. It's crucial to make sure you're not over-stressing your heart, breathing (for example if you have asthma), or joints if you have limitations (and again, only your health care provider can advise you on this), but you might discuss with him/her if it would be safe to increase the intensity of what you are doing. you don't necessarily need to spend more time exercising but you do need to make it as much as possible.

    And 1100 calories a day seems quite low - the body seems to hang onto weight when you eat too few calories. Many experts recommend around 1400 calories a day for women but again, that depends on how much you weigh - the heavier you are, the more calories you need, so again, check with your health care provider.

    I wish I could say something more positive, but the answer is no, the weight will not automatically come off just from lowering or eliminating your medications if that is what you and your prescribing physician decide to try.

    But finally, i am going to get to the good news! Whether you are on medications or not on medications, you can experiment with carbs (fat free carbs eaten at least 2-3 hours after consuming any protein which should be a separate essential component to your diet along with fruits and veggies) to see if they reduce your appetite so you can eat less and lose weight. Try an afternoon carb snack like half a bagel with jam. And for dinner in the summertime, a great meal could be a couple of ears of corn on the cob paired with a large mixed salad with low fat dressing and some cannellini beans (the Italian white beans). You would be able to see for yourself if eating carbs strategically to boost serotonin is for you - as we all know, diet is so individual and only you know your body best.

    I hope over time your weight efforts will pay off for you in many ways!
    - Nina
    Nina T Frusztajer, MD replied to Jayne4694's response:
    Hi Jayne,

    50-60 lbs: what an unwelcome side effect to the medication which otherwise I hope has brought many benefits to your life! I am glad to hear you have stopped gaining weight. But yes, of course now the goal would be to lose that weight. The good news is that in our weight loss practice, we've worked with lots of people who have continued to take their medication and successfully lost weight they have gained as a result of their medication.

    If it's been difficult to control your appetite (which is quite universal among people who have gained weight from antidepressants and other psychotropic medications), the amount of exercise you do is probably not a factor in your inability to lose weight. Appetite control is key.

    You may be able to pick up something that speaks to you from the postings above in terms of food choices that will help to boost brain serotonin and control your appetite. Plain pasta with grilled vegetables, baked potato and a salad, rice with stir-fry vegetables, and burritos with beans, rice, fat free cheese, diced tomatoes and spinach are all great dinner options if you want to boost brain serotonin. And there are plenty of plain protein options that can be part of a healthy breakfast and lunch like eggs, fat free dairy products, chicken and turkey breast meat, and all sorts of fish.

    If you can keep your awareness on how certain foods make you feel (mood, energy level, appetite, ability to sleep, etc.) then you can guide your eating in such a way that it will make you feel your best - and, in the end, achieve and maintain a healthy weight.

    Nina T Frusztajer, MD replied to Jayne4694's response:
    HI Jayne,

    weight gain is such an unwanted side effect of medications that otherwise are of such benefit! But great you've stopped gaining.

    If controlling your appetite is what it will take for you to lose weight, you might want to try the following dinners:
    - pasta with grilled vegetables
    - a baked potato with a salad, burrito with rice, beans, fat free cheese, and diced tomatoes
    - rice with stir-fry vegetables

    All of the above can be made without spices.

    and an afternoon or after-dinner snack of breakfast cereal, crackers, or fat-free or low-fat cookies (like graham crackers).

    You may find that boosting brain serotonin late in the day makes you feel good and controls your appetite so that you will naturally eat even less than you are now. Make sure you're getting your daily requirements of protein and lots of fruits and vegetables for overall health.

    The more awareness you have of how food makes you feel (appetite, mental energy, mood, quality of sleep, etc.), the more you'll be able to choose the right foods for you at the right times, and ultimately if you eat just what your body needs, you will achieve and maintain a healthy weight.

    Some of the responses above may speak to you and give you more ideas - I hope that helps!

    - Nina
    Janna56 responded:
    Welcome Dr. Nina: I usually write books when I start typing, but I promise I will make this short tonight (or should I say this morning - 2:00a.m.).

    I have struggled with weight all my life and I am 56. I have three siblings who have the same issue.

    I work in a Group Home with special needs individuals and I work the 2nd shift. There is only one Staff at a shift, as we only have two Consumers. I am having a terrible time sleeping. It was 4:00am this morning, before I could get to sleep. My mind just races when my head hits the pillow. When most people are getting up, that is when I really start to feel tired and want to sleep. I'm not proud to say this, but there are days when I'm not working, that I just can't get out of bed.

    My eating habits are not good right now. I will eat a bowl of oatmeal with Splenda before work, then I don't eat much at work, as I am busy fixing two separate meals,and tending to the Consumers. We have one who will sit at the table and just watch me eat and it makes me very uncomfortable, so I don't even enjoy it. I get home around midnight and that is when I want to go for my comfort food. I am alone, so I know no one is around to judge or watch me. I've been on many anti-depressants and the last one was zoloft and I put on 50 pounds. I've been on Bupropion XL 300 mg. for about 6 weeks now and have actually lost. I'm finding some of the cravings I did have, have gone away. I love my sweets and wish I could find a low-fat,carb,calorie or whatever it takes to satisfy that.

    I had talked to my daughter last night who moved 20 hours away and I was upset when we ended our conversation. The first thing I did was eat and it wasn't a healthy choice. I felt good while eating it , but then beat myself up later for doing it and felt lousy.

    Well, enough said for tonight. I appreciate and thank you for being here. Hope your week-end is being good to you!!! Janna
    And This Too, Shall Pass - - -
    lb707 replied to Janna56's response:
    Dr. Nina,

    Good reading. It sounds much like the diet Suzanne Sommers or the fit for life diet. When ever I tried them I was in less pain. I have been playing around with eating similar to what you were talking about just to help digestion. I have just not given up the protein at night. I guess I will be trying it.

    One question, would rice protein with no carbs be considered a protein? I often have that mixed into a smoothie with parsley, bluberries and carrot juice. By taking out the bluberries I think it would be better if I read right.

    Nina T Frusztajer, MD replied to Janna56's response:
    Hi Janna,

    I'm sorry to hear about your daughter moving away - my kids and I visited my new 5-day old nephew today and they live 2.5 hours away - even that seems like a long way away (but I love going to visit and it's so worth it) so I can only imagine 20 hours away is so hard!

    You sound so dedicated to the people you care for, it must be rewarding but certainly requires you to give a lot of yourself.

    Sleep challenges are tough on many levels. And the causes of sleep disturbances are many. We have definitely found in our weight loss practice that eating carbs in the evening with vegetables and perhaps a bit of fruit can help with relaxation and winding down before bed by elevating serotonin levels (but serotonin is not directly involved in making you fall asleep). So you might want to try a carbohydrate dinner that includes pasta, potatoes, rice, tortillas, whole wheat bread, or corn on the cob.

    Don't beat yourself up for reaching for comfort foods when you're exhausted, stressed, or upset! In fact, you're doing exactly the right thing - and how great there is a way to soothe yourself at those times. But reaching for the right comfort foods that will make you feel better, and in the right portions, is essential both the achieve the desired result as well as to avoid weight gain - or lose weight. Better yet: eat carbs "preventatively". How about keeping a mini bag of pretzels on hand for the drive home so you don't feel like consuming the entire contents of your fridge when you get home? And choose low-fat or fat free carbs like air-popped popcorn, a whole wheat english muffin with jam, or rice crackers when you feel really stressed?

    As for not eating much during the day except for oatmeal in the morning, I would definitely recommend a change! You won't have mental energy without protein on board, so how about boiling an egg or two the night before and, if you're pressed for time in the morning on the way to work, eat them on your way to work. Can you bring in some sliced deli turkey meat, canned tuna, fat free yogurt or fat free cottage cheese to work, leave it in a fridge or your own mini cooler with ice packs? Then find a quiet corner (or walk outside of the building) to eat it along with some cherry tomatoes, a can or 3 of low-salt V8 juice, or some vegetable soup you can eat from a flip-top can (I'm not suggesting any of this is gourmet, but there are some handy options for those work days!).

    I can't speak to the feeling of not wanting to get out of bed on non-work days - sometimes it's the medication but that would be a topic to discuss with your prescribing physician. Great you've lost weight since taking buproprion and that some of your cravings have gone away.

    The best thing is to experiment with different foods, try to be creative with your eating while at work so that you can be there for your consumers in the best way possible, and notice the effects of what you eat on how you feel on all levels.

    Often taking care of yourself is the best way to be there for others!

    - Nina

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