Psychiatry, Psychiatry Medicine and Weight Gain

Jennifer Morris, MD, MBA

ABPN, ABOM, ABPM-add

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 Personal insite: I pursued a board certification in weight management after hearing  patients relate that they would present to weight-loss clinics, and be told that they would not be able to lose weight while taking psychiatry medicines. The blanket statement "you must stop your psych meds" seemed to be a mantra that was pushed AT patients to push them out of weight management, or out of psychiatric treatment (frequently with catastrophic results.) 

This was frustrating on several fronts: 

1. Psychiatric medicines tend not to be optional. 

2. not all psychiatry medicines cause weight gain, nor cause weight gain to a similar extent. This table aids in  stratifying medicines by risk of weight gain and includes many commonly used psychiatric medicines. Medicines may also cause varying amounts of weight gain based on their duration of use (Anekwe, 2022) 

Additionally, interventional options such as Edmond Psychiatric's rTMS (repetitive transcranial magnetic stimulation) and Spravato/ketamine (administered supervised, in office) may offer treatment options without weight gain. 

3. the weight gain from most medicines can be moderated, if they cannot be changed to less weight-noxious medicines. This can be done by monitoring nutrition and exercise, by pairing weight-gain oriented medicines with weight-loss oriented medicines, or by utilizing weight-loss medicines (metformin, GLP-type medicines) with psychiatric medicines. 

4.  Psychiatric diagnoses themselves (depression, bipolar, psychosis, anxiety, even ADD) are associated with weight gain, independent of medication treatment. Weight gain is listed as a potential core symptom of major depression. This may be due to changes in brain satiety signals, challenges in executive function, or challenges in adhering to lifestyle recommendations, among other causes. Anxiety is associated with obesity, potentially through the mechanisms of disinhibition and hunger. Hunger may be moderated through mechanisms similar to depression. (Hussenoeder, 2021.) Weight gain may be associated with bipolar disorder and psychosis through genetic vulnerability and  unhealthy food habits (Dayabandara, 2017.) Insulin resistance, in particular, plagues this group of patients even outside of medicines that also increase this risk. ADD can be associated with weight gain through disinhibition and poor impulse control. 

Because psychiatric diagnoses themselves are associated with weight gain, stopping medicines not only may create devastating psychiatric consequences; it may also not be enough to allow an individual the opportunity to achieve a healthy weight.

By partnering with a treatment team familiar with weight concerns, there is an opportunity to create the healthiest options possible...with positive physical and mental health outcomes. 

Anekwe, Chica, MD MPH. Managing weight gain from psychiatric medications. Harvard Health Publishing, July 18, 2022 .https://www.health.harvard.edu/blog/managing-weight-gain-from-psychiatric-medications-202207182781  Accessed 8/25/24. 

Dayabandara, Madhubhashinee; Raveen Hanwella; Suhashini Ratnatunga; Sudarshi Seneviratne; Chathuri Suraweera; Varuni A De Silva. Antipsychotic-associated weight gain: management strategies and impact on treatment adherence. Neuropsychiatric Disorder Treatment 2017; 13:2231-2241. Published online 2017 Aug 22. doi: 10.2147/NDT.S113099. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574691/#:~:text=Many%20factors%20contribute%20to%20weight%20gain%20in%20patients,in%20the%20management%20of%20patients%20treated%20for%20psychosis.Accessed 8/25/24. 

Hussenoeder, Felix; Ines Conrad; Chritoph Engel; Silke Zachariae; Samira Zeynalova; Heide Glaesmer; Andreas Hinz; Veronika Witte; Anke Tonjes; Markus Loffler; Michael Stumvoll; Arno Villringer; and Steffi G. Riedel-Heller. Analyzing the link between anxiety and eating behavior as a potential pathway to eating-related health outcomes. Scientific reports; 19 July 2021. https://www.nature.com/articles/s41598-021-94279-1. Accessed 8/25/24.