Weight gain on suddenly stopping citalopram
Medicines to make you fat
"You have to look very carefully in underweight patients to see whether the depression is not an eating disorder," says Lautenschlager. As a result of long-term severe depression, secondary anorexic structures could also develop. The patients then lose the feeling of hunger.
In younger depressed patients, however, malnutrition is the exception. More often they develop overweight in mild or moderate forms. Depressed adolescents have a 2.5 times higher risk of weight gain than healthy peers (2). One cause may be that those affected try to lighten their depressed mood by eating and drinking, especially sweet foods. Periodic cravings can occur in which control over eating behavior fails (binge eating). In addition, depression is often associated with lethargy and a sedentary lifestyle - energy consumption drops and excess calories are stored in fat deposits.
Bipolar affective disorders, characterized by an episodic course of depressive, manic or mixed phases, are often associated with overweight or obesity. This also applies to anxiety disorders (3, 4).
Fat and sad: cortisol as a link
There is a complex correlation between depression and obesity. Obesity can be the consequence and cause of depression: On the one hand, depressed people often become overweight in the course of the disease, on the other hand, many obese people also struggle with depression. Frustration after repeated unsuccessful diet attempts, dissatisfaction with one's own body and social stigmatization play an important role here. In addition, there is a combination of both diseases at the physiological level.
A permanently elevated cortisol blood level has been observed in both depressed and obese people. The cause is obviously a dysregulation of the hypothalamus-pituitary-adrenal cortex axis. The feedback loops of the control loop are disturbed. Corticotropin-releasing hormone is released even though the cortisol level is already elevated (5, 6). With antidepressant therapy, the cortisol level normalizes again, which underlines the importance of the control loop in the development of depression (7). Such dysregulation has also been demonstrated in other psychiatric diseases (8).
From a physiological point of view, depressed patients are therefore under constant stress. Therefore, learning stress management techniques is a logical approach to therapy. This has a positive effect on the control of eating behavior and mood (5). Exercise and sport also help reduce stress.
As a result of hypercortisolism, a diabetic metabolic situation and trunk-accentuated adipose tissue deposits can occur. Apparently there is also a connection in the opposite direction: Type 2 diabetics are twice as likely to develop depression as healthy people (9, 10).
Dementia wears off
Dementia diseases also affect body weight. Most people with dementia unintentionally lose weight as the disease progresses - for a variety of reasons. In the beginning, due to the onset of cognitive deficits, it becomes more and more difficult for those affected to plan shopping or to prepare a meal, for example. Later, the patient can often no longer interpret feelings such as hunger and thirst, no longer understands the situation at the table or he does not recognize the food. The sense of taste is often severely impaired.
In the full clinical picture of dementia, there is often strong psychomotor restlessness. Stereotypical movements such as wiping, moving the furniture, standing up, sitting down or walking around consume a lot of energy. For these reasons, the daily energy requirement of an Alzheimer's patient can be 3000 to 4000 kcal - almost twice as high as that of a healthy elderly person. Without targeted countermeasures, people with dementia easily develop a state of malnutrition (11).
Psychotropic drugs weigh on the scales
Neuroleptics and antidepressants can effectively improve the symptoms of schizophrenia or depressive illnesses. In many cases, this also eliminates the causes of the overweight or underweight that has arisen.
However, some drugs also have a direct influence on body weight without this being the intention. There are substances such as bupropion or fluoxetine that inhibit appetite so much that old patients in particular can become underweight. Those affected often do not even perceive this as a problem, even though it significantly reduces their well-being and resistance. The pharmacy team should carefully approach older customers about the weight loss and recommend that they seek a solution with the doctor.
Much more often, however, undesirable weight gain occurs, which puts a considerable strain on patient compliance. Irregular consumption of psychotropic drugs or even unauthorized discontinuation of therapy carry a high risk of the disease flaring up again. It is not uncommon for this to result in inpatient admission. But even if the patient tolerates the weight gain, it is problematic because of the associated health risk. The patient often has to take psychotropic drugs for years or decades. In addition, it is difficult for many patients to lose weight after completing therapy (12).
An increase in body weight has been described for neuroleptics, antidepressants and phase prophylactics. There are big differences in the substance groups (table). The following substances in particular increase the weight of many patients:
the sedating tricyclic antidepressants,
the tetracyclic mirtazapine,
the phase prophylactic drugs lithium and valproate
as well as the neuroleptics clozapine and olanzapine (12).
In the case of hypnotics, there are isolated indications of an increase in weight with prolonged use, but this hardly plays a role in practice.
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