Best AD for obsessions that causes less weight gain? (Thinking on Zoloft)

[OliverB]

I will be prescribed an AD for obessions and anxiety but I am worried about the weight gain. The ER doctor said Zoloft and Paxil are the first line AD for this, but as far as I read it can cause weight gain. What I don't know is how common it is or if it tends to cause less or more weight gain than others AD. I gained 80 pounds while taking Seroquel and Paxil when I was 15.

 

What do you take for anxiety and obsessions? Does it cause you weight gain? Can you lose the weight or have it under control?

 

[iaawal]

I just started paxil so I can give an update in the future. Do you mean OCD obsessions? Fluoxetine worked pretty good for my anxiety the first time I took it. I went up to 80mg and it helped a lot with OCD and anxiety. Unfortunately, the second time I took it it didn't help as much hence the paxil. Fluoxetine was really weight neutral. 

[OliverB]

Just now, iaawal said:

I just started paxil so I can give an update in the future. Do you mean OCD obsessions? Fluoxetine worked pretty good for my anxiety the first time I took it. I went up to 80mg and it helped a lot with OCD and anxiety. Unfortunately, the second time I took it it didn't help as much hence the paxil. Fluoxetine was really weight neutral. 

I have obsessions about what if... and over-perfectionism (to the point I miss examns because I have study 90% of it instead of 100%)  and a really high anxiety related to this, and a urge to have everything under control. I think it's more similar to OCpersonality disorder traits. This end up causing me some degree of anxiety.

I tried paxil but it caused me hypomania, and prozac.

[mellifluous]

unsure if it's similar, but i have graphically violent intrusive thoughts from OCD. the antidepressants alone would make me have an episode and were ineffective. lowest dosage zoloft with 10 mg abiify works for me. they're almost entirely gone.

 

good luck to you xx

[mikl_pls]

Try either fluoxetine (Prozac) or fluvoxamine (Luvox). Prozac is used off-label for weight loss, and I read a study that Luvox causes the least amount of weight gain of all the SSRIs long-term, and it's indicated specifically for OCD (and SAD).

Although sertraline (Zoloft) isn't a bad option, either. It's generally pretty weight-neutral for most people.

Edited January 2, 2017 by mikrw33

[AnxietyGirl74]

For me, it's been Prozac or Luvox CR without a doubt. I was on the highest dosage of both of them and am back on the highest dose of Prozac and never gained weight from either of them.

[OliverB]

The only problem is Luvox increases antipsychotics potency and I am already taken the lowest dosage of amisulpride....

[thunder]

I didn't gain weight on Zoloft. It helped my anxiety some, but I think therapy made a bigger dent. I also didn't gain significant weight on Celexa, but it didn't help my anxiety as much as Zoloft. Oddly, Lexapro sucked more for me (hypomania/mixed episodes that were not diagnosed at the time as such). I eventually ended up cycling on Zoloft, although I did have probably a year or so of good results on it before that. 

[mikl_pls]

1 hour ago, OliverB said:

The only problem is Luvox increases antipsychotics potency and I am already taken the lowest dosage of amisulpride....

How does Luvox increase amisulpride's potency and other antidepressants not? Is it a certain CYP protein that Luvox is metabolized by that others aren't (like CYP1A2)? If so, sertraline, citalopram, fluoxetine, and paroxetine are all substrates and/or inhibitors of CYP1A2. I wasn't able to find anything much about amisulpride's CYP metabolism profile to check for drug-drug interactions, except that it is minimally hepatically metabolized and mostly excreted unchanged. But admittedly, I don't know much about amisulpride since it's not a drug available in the States. I wish it were, though... It would be very useful for depression (low dose).

[notloki]

Prozac.

[OliverB]

13 hours ago, mikrw33 said:

How does Luvox increase amisulpride's potency and other antidepressants not? Is it a certain CYP protein that Luvox is metabolized by that others aren't (like CYP1A2)? If so, sertraline, citalopram, fluoxetine, and paroxetine are all substrates and/or inhibitors of CYP1A2. I wasn't able to find anything much about amisulpride's CYP metabolism profile to check for drug-drug interactions, except that it is minimally hepatically metabolized and mostly excreted unchanged. But admittedly, I don't know much about amisulpride since it's not a drug available in the States. I wish it were, though... It would be very useful for depression (low dose).

It's not that easy.

I don't have my psychopharmacology book here, but Luvox is metabolized by many isoenzymes or may inhibit or occupy it/them to the point of inhibition as well as others antidepressant (but regarding different isoenzimes or not to the point of inhibition). Maybe Luvox occupys certain isoenzimes more than others antidepressant (or at least, more than sertraline since it's the one I checked) so in general it increases AP potency, that's what the book said on the interactions part. As an example, fluoxetine, as far as I remember, increases aripiprazol potency , but sertraline doesn't. About sertraline interactions there was nothing related to increasing AP potency, the same regarding to escitalopram (I am talking about the book).

[mikl_pls]

5 hours ago, OliverB said:

It's not that easy.

I don't have my psychopharmacology book here, but Luvox is metabolized by many isoenzymes or may inhibit or occupy it/them to the point of inhibition as well as others antidepressant (but regarding different isoenzimes or not to the point of inhibition). Maybe Luvox occupys certain isoenzimes more than others antidepressant (or at least, more than sertraline since it's the one I checked) so in general it increases AP potency, that's what the book said on the interactions part. As an example, fluoxetine, as far as I remember, increases aripiprazol potency , but sertraline doesn't. About sertraline interactions there was nothing related to increasing AP potency, the same regarding to escitalopram (I am talking about the book).

Oh ok. I see. I learned something new.  

What psychopharmacology book is it, if you don't mind me asking? If you don't remember that's okay.

Edited January 3, 2017 by mikrw33

[ByePolarCoordinates]

I found this info:

Quote

Luvox (fluvoxamine) is a potent inhibitor of several cytochrome P450 (CYP) enzymes. These liver enzymes metabolize many different molecules. Luvox is different from other SSRIs in that it inhibits several CYP enzymes:

CYP1A2 - that metabolize caffeine, theophylline, olanzapine, clozapine, haloperidol, polyaromatic hydrocarbons found in tobacco smoke, etc.;

CYP3A4 & CYP2D6 - metabolizes haloperidol, clozapine, & many other newer atypical antipsychotics (2D6 also metabolizes quetiapine).

CYP2C19 - metabolizes diazepam & phenytoin.

Because of the amount of drug interactions caused by Luvox, it is not used much by GPs. It is not an antipsychotic, but as the paper linked by poser938 said Luvox is potent agonist at the sigma-1 receptor. This gives the antidepressant anxiolytic (anti-anxiety) and anti-agression activity. This is why it is used in conjunction with antipsychotics.

http://www.dr-bob.org/babble/20130308/msgs/1040148.html

[OliverB]

16 minutes ago, mikrw33 said:

Oh ok. I see. I learned something new.  

What psychopharmacology book is it, if you don't mind me asking? If you don't remember that's okay.

It is not very specialized, it's a basic one. I haven't found it in English.

 

I found this info:

http://www.dr-bob.org/babble/20130308/msgs/1040148.html

Thank you, that's what I meant. Others antidepressant interact with diazepam or specific antipsychotics, buy Luvox does with almost all if not all.

Edited January 3, 2017 by OliverB

[ByePolarCoordinates]

Also, a nice reference table of substrates and liver enzyme inducers/inhibitors:

http://medicine.iupui.edu/clinpharm/ddis/main-table

They also have a slightly abbreviated clinical version.

[cloudmonger]

On 1/2/2017 at 8:34 AM, OliverB said:

I will be prescribed an AD for obessions and anxiety but I am worried about the weight gain. The ER doctor said Zoloft and Paxil are the first line AD for this, but as far as I read it can cause weight gain. What I don't know is how common it is or if it tends to cause less or more weight gain than others AD. I gained 80 pounds while taking Seroquel and Paxil when I was 15.

What do you take for anxiety and obsessions? Does it cause you weight gain? Can you lose the weight or have it under control?

 

I took Celexa (Citalopram) for a year and it caused no weight gain at all. Side effect profile was very minimal (for me). I remember it really helped a lot with anxiety (most SSRI's especially Zoloft made me feel super wired & awful or more anxious). I've never taken Paxil, probably bc it is known for weight gain and has a reputation for bad withdrawal syndrome. I have heard Prozac is effective for obsessions but it's been awhile since I took it.

[cloudmonger]

On 1/2/2017 at 3:08 PM, mikrw33 said:

Prozac is used off-label for weight loss

I've never heard this - is this something new? I am aware that Topamax (anticonvulsant) and a few other classes of drugs are now also used for weight loss.

I've experienced temporary weight loss from medications only within the first 2 weeks of starting due to loss of appetite. After adjusting to this side effect, weight gain can start and possibly increase the longer you are on the med.

It seems on all of the SSRI drug PI sheets, Weight gain OR weight loss is listed (depending on the individual). I have read however, that the newer classes of SSRI's (and more so, SNRI's) are supposedly formulated so that they are less likely to cause weight gain, but who knows...there are many factors involved. It also it depends on how long you plan to take the medication.

Edited January 7, 2017 by cloudmonger

[browri]

Sertraline more often than not actually induces weight loss in the beginning of treatment. I believe in the long run, the weight normalizes, so the initial loss is negligible.

[mikl_pls]

On 1/7/2017 at 7:06 AM, cloudmonger said:

I've never heard this - is this something new? I am aware that Topamax (anticonvulsant) and a few other classes of drugs are now also used for weight loss.

I've experienced temporary weight loss from medications only within the first 2 weeks of starting due to loss of appetite. After adjusting to this side effect, weight gain can start and possibly increase the longer you are on the med.

It seems on all of the SSRI drug PI sheets, Weight gain OR weight loss is listed (depending on the individual). I have read however, that the newer classes of SSRI's (and more so, SNRI's) are supposedly formulated so that they are less likely to cause weight gain, but who knows...there are many factors involved. It also it depends on how long you plan to take the medication.

2

Yes, I can't find any information about it, but I have read that weight-loss doctors will use fluoxetine along with phentermine to potentiate the phentermine and therefore the weight loss effects. My mom was on phentermine 37.5 mg and her doctor put her on fluoxetine and ramped it up to 80 mg to potentiate it, and she lost a lot of weight on that combo.

Yes, some SNRIs like Effexor, Pristiq, and Cymbalta can cause weight loss. I experienced weight loss on Pristiq and Cymbalta, no weight loss or gain on Fetzima, and actually weight gain on Effexor, strangely enough.

[OliverB]

My pdoc told me to stop taking it since he thinks I can manage my rumination and obssesions by myself, he doesn't like the idea of being on too many medications (and we were adding Concerta) and he thinks the side effects outweight the beneficts.

[mcjimjam]

Cymbalta helps my intrusive thoughts and I have not gained weight from it. I did not gain weight on Prozac, Zoloft, Effexor or Lexapro, either and they all helped my intrusive thoughts.