Weight Gain and Psychotropic Medications By Peter Denton

Firstly I should tell you a little bit about myself; but I will keep it brief! I am 46 years old and have been on the pharma- train i.e. taking psychiatric medications for the past 26 years. Diagnosed with Schizophrenia at the age of 20 and ‘promoted’ to Paranoid Schizophrenia a few years later, I have tried many powerful medications to ‘cure’ my condition, but to no avail. I am a happy husband and father and am currently studying for a degree in Nutrition and Health at a London University. On the completion of my degree I hope to work with people like myself with the aim of improving the physical health of our stigmatized community.

The life expectancy of people with enduring mental health problems is between 13-30 years shorter than the general population. Obesity, Osteoporosis, Cardio-vascular disease, Type 2 Diabetes, and Hypertension, all have increased prevalence amongst this population. All of these conditions have proven causal links to lifestyle choices, i.e. Smoking, poor diet, lack of physical activity, etc, but this is not the whole picture. The treatment for Psychiatric problems is almost exclusively the ingestion of Psychotropic medications. These medications are designed to effect neuro-receptors; part of the central nervous system; which is a highly complex and delicate system controlling central and peripheral bodily functions, including metabolism. Atypical antipsychotic medications have an effect on a number of these receptors by binding to specific sites and thereby blocking any other chemical messengers’ ability to bind to that same site and elicit an effect. The chemical messengers I refer to above come in the form of Hormones, and they are numerous and highly effective in maintaining our body’s homeostasis (balance). Two of these which are vital in regards to our metabolism are Ghrelin and Leptin.

A little bit of science!

Leptin is mainly produced by adipocytes (adipo-fat, cytes-cells) and is a strong long term mediator of energy balance i.e. increased levels reduce hunger and food intake, whilst Ghrelin, is mainly produce by cells of the stomach lining and increased levels increase appetite. Ghrelin levels are increased if the stomach is empty, or by the smell and appearance of food. Leptin levels are proportional to the amount of fat within the body; the higher the amount of fat within the body, the higher the Leptin levels. Both of these messengers/ hormones have been shown to relay signals/impulses between our central and peripheral nervous systems either signalling satiety; or hunger and the need to consume more food. As I am sure you have noticed; some medications elicit a greater weight gain than others, people taking Clozapine or Olanzapine, for instance, may suffer a greater increase in bodyweight than those taking Abilify. What becomes clear, if we look at the Pharmacology of Psychotropic medications is that those with a higher affinity (attraction) to bind to both/either of the H1 or 5-HT2 receptors induce iatrogenic(condition caused by medical treatment) weight gain and obesity. Both Clozapine and Olanzapine have a high affinity for these receptors whereas Abilify amongst others have a very weak affinity.

So to put it more plainly; blockage of these receptors interferes with the normal satiety signals from the stomach (Ghrelin) and adipose tissue (Leptin) resulting in us overeating and becoming overweight and possibly obese. This blockage has other affects such as sedation; creating an additional problem when it comes to our health/bodyweight; we are eating more and moving less!

“OK that’s quite interesting” I hear you say “but what can we do about it”? Well one option that does not involve any changes in medication is to look at the energy density of your diet. Energy density is the amount of calories foods contain per gram. So if you have 100 grams of a food in front of you and it is purely fat, then it will contain 900 calories, but if this food is purely carbohydrate or protein then it will contain only half the amount of calories. So even though the calorie content is halved, you are still eating the same amount of food in weight, Cool eh! Eating foods with a lower energy density means that you can consume fewer calories per gram whilst consuming a larger amount in both weight and size, helping you feel full and so reducing any feelings of hunger and reducing your chances of over-eating. Foods with a low energy density include; those with a high water content (water contains zero calories) , foods that contain fibre (fibre adds bulk and also takes longer to digest) helping you feel fuller for longer , and also foods that are high in protein but low in fat.

Foods with a high energy density; and so are to be avoided/reduced are ; fried foods, full-fat dairy products, biscuits, cakes, pies and also butter, burgers, crisps and chocolate. As I stated earlier, sedation is another problem that we often encounter if taking many of the psychotropic medications. This obviously reduces the amount of energy (calories) we burn off each day, but there is a way to somewhat reduce this feeling and so regain our vitality and burn off the sneaky burger we had on the way home last night! Activity is the only way; although I worked as a fitness instructor for 6 years I’m not suggesting that you join the gym or start a rigorous training programme. What I am suggesting is; trying to incorporate physical activity into your daily life. Start gradually and build up to 30 minutes of moderate activity on 5-7 days per week. I know you have probably heard it before, but give it try and I assure you that you will feel the benefit. Moderate activity means that you should feel your breathing get quicker, your heart rate increase and your body temperature increase slightly it does not mean you need to put on your trainers and head out the door for a 5 mile jog. One tip for achieving this is to aim to walk instead of driving or using public transport, if your destination is only a mile or less away; walk! It will take you about 15-20minutes and you won’t have the frustration of waiting what seems like hours for the bus.

Bibliography

Journal of Obesity
Volume 2011, Article ID 893629, 9 pages.
Weight Gain, Obesity, and Psychotropic Prescribing.
Nikhil Nihalani, Thomas L Schwartz, Umar A Siddiqui, and James L Megna.

Trends in Molecular Medicine 2011
Volume 17(2): 97-107
Antipsychotic drugs and obesity.
Christoph U Correll, Todd Lencz, and Anil K Malhotra.

Cleveland Clinical Journal of Medicine 2007.
Volume 74 (8):597-606
Atypical antipsychotics: New drugs, new challenges.
Manu Matthews MD and David J Muzina MD

You can follow Peter on Twitter via @DentonF15

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