Q. Dear Anna,

My 14 year old is taking Effexor 150mgs, lithobid-1200mgs, risperdal-2.5mgs, and (just recently added)geodon-40mgs. She has gained a significant amount of weight over a period of 3 months. She has cut down on her eating, and although she won't exercise, her energy level is beginning to pick up after a period of meds trials, withdrawals and adjustments. Even though I have read that risperdal and lithium are associated with weight gain, her doctor denies this. I don't know if she doesn't want to admit this because my daughter is finally becoming pretty stable after months of trials. I don't push the issue because she would become non compliant as weight is such a touchy issue with her. I am also very conderned about her weight as there is a family history of diabetes, both type 1 and type 2.What is it about these meds that encourages such weight gain? Do they actually alter metabolism or is it the fact that they increase appetite and are sedating, thus making it difficult to find the energy to exercise? I know there are other mood stabilizers out there and other anti psychotics not associated with weight gain. But I also feel very reluctant to put her on any more med changes right now. Is it possible to take these meds and still lose weight with exercise and diet modification? Is it any more difficult to lose weight than under normal circumstances?

Thanks for the advice.
Jeanne
jeannelupien@yahoo.com

A. Dear Jeanne,

Thanks for your question. A simple answer is YES. YES, the medications your daughter is taking can and often do cause weight gain. YES, weight gain increases the risk of developing diabetes. YES, it is possible to lose weight while taking these medications, although it can be very difficult. YES, a combination of things are responsible for the weight gain.

Some psychiatric medications alter metabolism and increase appetite for the same reasons they alter mood and control psychiatric symptoms. Neurotransmitters regulate appetite as well as mood, energy level, and sleep. The medications you listed change the levels of these neurotransmitters in the brain.

In addition, decreased energy, both a symptom of depression and of many medications, can reduce the amount of exercise an individual gets each day, which in turn lowers metabolism and increases weight gain. Some antipsychotics, especially risperdal, are also believed to cause insulin resistance, which not only further increases the chances of developing diabetes, but increase weight gain.

Some amount of weight gain can be controlled through dietary changes and increased exercise, but too much weight gain can result in damaged health, low self-esteem, and more depression. If the weight gain is out of control you might want to consider a change in medications, or the addition of an appetite suppressant if increased appetite seems to be the main culprit. Keep in mind though, medication side effects usually diminish over time.

One last comment: Any physician prescribing these medications should not only be aware of their tendency to cause weight gain, but should also be sensitive to both the psychological and physical effects of increased weight. Maybe that is something to keep in mind.

Anna