antidpressants/weight gain/diagnosticians

[pooks]

So I've gained thirty pounds since last November and my husband thinks it's my antidepressants and good lord, I hope he's right. Problem is, I just can't bring myself to care enough to stop eating. (Also, I honestly am not eating any different than I was eating before I gained weight. What this means is, I was eating too much and was too heavy, but not gaining like this before.)

Anyway, I began thinking that maybe having my internist hand me samples to find the right med wasn't the best way to do it, and decided to get an appointment with a psychiatrist under the assumption that they deal with these kinds of meds all the time and might have a better handle on what to give me. But then a friend told me that her HMO sent her to a diagnostician first to get diagnosed, and only after that did they send her to a psychiatrist.

I'm now confused, thinking I would like to go to a diagnostician, but don't know how to find one. Does anybody have any advice on this stuff, any of it?

Thanks.

[KnottedYet]

I was on antidepressants briefly after my dad died. They were prescribed by my regular doctor, and really messed with me. They didn't make me feel better, just made me "duller". As I recall, I gained weight on them, too.

I've never heard of a diagnostician, other than in the TV show "House."

I would think a psychiatrist or diagnostician would be a better choice than an internist handing you free samples. (I thought it took a few weeks of being on the meds before you could really see any effects anyway?)

[pooks]

Yeah, she gave me a month or so of samples and at the end of that month I went in to see her again and was just beginning to feel better so she gave me more, and when I REALLY started feeling good, and knew they were helping, she wrote me the prescription. But after a few months they stopped being effective, and so she gave me some different ones to try. (I weaned off the first ones, tried the second ones for a few days but my blood pressure went up.) That's when I thought, you know, I need to go to somebody who does this all the time. So I'm back on the original ones and feel better than I did w/o them, but it's not great. I have been going along like this for a few weeks and finally realized that they make me feel just enough better to not feel pressure to do the work required to find a doc to go to.

So, that's what I'm trying to do now. (The shrink whose name I was given didn't have any appts. until July and I figured I should try and find somebody else.)

[salsabike]

Don't know what the heck a "diagnostician" is. See a good psychiatrist for a consultation. I took tricyclic antidepressants many years ago for severe muscle pain from fibromyalgia, and gained an absolutely amazing amount of weight which I am still trying to get rid of. To test that the weight gain was from the antidepressant, I spent a month dieting quite seriously at 900 calories a day and taking four ballet classes a week, and at the end of the month had still gained a pound. Those drugs can definitely cause dramatic weight gain all by themselves.

[pooks]

Thanks, Salsa. I appreciate it.

[silver]

OK, I don't know what a diagnostician is.....but what a lot of insurance companies require is a sort of screening process to "determine" whether you need a psychiatrist. In my experience, it's been a phone call with someone who asks you questions and then they approve or disapprove you for treatment.

You need to call your insurance company requires.

IMO, the psychiatrist will know best what specific AD you need. But still it will be a trial and error process. I've been on at least 5 different ones.

on the gaining weight thing......hummm.....it certainly is harder to get control of your overeating and exercise when you are depressed, i think that once you find a med that works that things will work out.

but the way that I look at it is....my treatment for depression Includes my medicine, my therapy (talking with a counselor), good nutrition, and exercise. I do not believe that I can fight depression using any one of these tools by itself.

[rapid cycler]

Hey, pooks, I'm new here but have some experience with psychiatry and meds to share. In fact, I got into cycling as a way to cope with mental health issues.

Almost all the available psychotropic meds slow down metabolism—an engraved invitation to weight gain! The only effective antidepressant I've found that doesn't "help" me gain weight is Wellbutrin. In fact, I've lost a few pounds on it. It's currently being studied in clinical trials as a weight-loss aid (it's already also prescribed as a smoking-cessation aid); anecdotally, it seems that about 25% of psychiatry patients lose weight on it because, as I understand, it works differently than SSRIs (your standard Prozac-type ADs) by boosting "satisfaction" chemicals in the brain. I've always tended toward eating emotionally, and I just don't anymore. I eat (the right things) when I'm hungry, and I actually have to remind myself to eat sometimes. (I've never been one to miss a meal!) Maybe you can nudge providers in this direction?

Have you obtained a referral to a psychiatrist? I wouldn't want to accept psych med prescriptions from anyone else. It takes weeks for most folks to gauge a difference after reaching a therapeutic dose, and it can take weeks to titer up to that dose, so being under the care of a doctor who knows what she (OK, maybe even he) is doing is crucial.

I hope something here is helpful to you, and I hope those moods even out for you soon. Depression's a real wheelsuck.

[surgtech1956]

Wellbutrin - killed my appetitide for sweets, I too loss weight. Nancy

[pooks]

Cymbalta knocked out my appetite when I was first on it, but then I must have gotten used to it because that wore off after a couple of months and the weight came back -- and then a lot more.

That's when the internist told me to try the Wellbutrin (also because I have ADD and it sometimes helps that) but ooops -- it raised my blood pressure. That's when I decided I needed to go to a psychiatrist, and I haven't gotten that referral yet. My bad, but I guess the urgency wore off because when I started spark people and started riding more regularly plus watching what I eat, I've been feeling so much better and am losing very nicely right now.

I'm still taking the Cymbalta, so will stay with this until we get back from our camping trip in a few weeks and by then I should have an appt with the shrink lined up.

Thanks for the info, rapid cycler!

[ShubieGA]

Hey Pooks,

I know that since I have been on Lexapro I have re-gained 30 lb I had lost. It does not make things dull, but it had gotten rid of the low points. I can't equate the weight gain to the meds, as I also slowed down on my exercise, and was traveling for work, at which point I blow up the calorie intake. Since my traveling slowed, I have been riding 3x's per week, and yoga 1x, and I am finally starting to lose a few. I would love to get off the Lexapro, but I can't deal with the perimenopause roller coaster yet! Good luck on your end!

[anneimall]

I've been on and off different antidepressents for about 10 years now to treat pmdd (bad pms). Wellbutrin has been the best for me for weight control but it makes me speedy and inteferes with in my sleep. All the others I tried (mostly SSRIs) made me flat and intefered with sexual function. One, serzone, gave me panic attacks and made it much worse. My preference is to deal with the speediness and sleep problems with the Wellbutrin. It really helps with the rollercoaster each month ... and does seem to help control my appetite.

When I first sought help I went to see a psychiatrist. Since then I've consulted with my gynocologist and my internest for different prescriptions, etc. I prefer to have my internist or gynocologist oversee my treatment. Over the years I've come to realize that my depression is more physical than mental. And, both my internist and my gynocolgist are great and very familiar with the different options. I felt like going to a psychiatrist was overkill, and she only had me go for medicine checks, no therapy. I think that therapy would have helped early on to understand how the antidepressants would affect me. Now, I don't feel like therapy would help that much with the PMDD (although I'm sure it would help with all sorts of other issues I may have!) That said, I've come to these conslusions after consulting with different doctors and trying different treatments. I would recommend speaking to as many professionals as you can and deciding for yourself what makes you most comfortable. And, this may change over time ...

All and all though, exercise has been the very best treatment. The more the better. And, the more the exercise involves mental focus the more effective. It is hard to get out and exercise though when you can't even get out of bed!!

[rapid cycler]

Yeah, it was kinda irresponsible of me to not mention the whole body/mind therapy-exercise-meds triangle. I guess even on a board like this one we can forget to move our bodies, eh?

Pooks, I don't know whether you've tried therapy or whether you feel your mental health would benefit from it, but I keep a weekly appointment myself—and my talk doc always asks after my cycling when I'm feeling low. (I just emerged from a patch of several months during which I didn't even want to think about my bike, then my girlfriend dragged my *** to the Tour de Georgia and I rebooted.) Even when I feel like I've talked about myself more than anyone should be allowed to, therapy serves as a weekly reality check for me, affirming the behaviors that help, and reminding me of behaviors that are toxic—like banishing my bike to the garage.

Because I started meds, therapy, and cycling all at the same time, it's difficult to say which has helped the most, but I can certainly gauge a difference when any one of the three is lacking.

anneimall, I know what you mean; Wellbutrin makes me fly if I don't split the dose. Have you messed with your dosing schedule at all?

[Dogmama]

Cymbalta is an SNRI meaning that it hits serotonin and norephinephrine. That's is why it can make you feel spacy and speedy. Effexor is the same thing.
I second the recommendation to see a psychiatrist. They usually know what's new, what can be successfully combined, etc.

[Tuckervill]

I started Zoloft again in February, and my weight loss accelerated. Weight loss is stated as a possible side effect.

Karen

[hirakukibou]

Hi Pooks,
I gained a lot of weight nortriptaline (sp?). A lot meaning 70 pounds in three months! I kept it on for a while trying different anti-depressants and other psychotropic meds. Now I am taking a med for ADHD Strattera which helps my depression and my attention. I lost the weight on that med and with the biking. I too think that therapy has helped in addition to the meds and more exercise. I would definitely see a psychiatrist, although find one with whom you are comfortable. My experience has been mixed with some of them being as warm as an arctic freeze. Good luck with all of this. Depression is the pits, but there is help out there.
--Pata