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Body Weight Changes: The Use of Antidepressants and Diet Pills

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Body weight changes: The use of antidepressants and diet pills.

Change in the body weight is a common effect of antidepressants substances use. Some studies based on antidepressant drugs have been done and they demonstrate that these medications can act as potential factors to increase or decrease weight. The tricycle antidepressant types such as amitriptyline are more likely to intensify and promote weight gain. On the other hand, substances like fluoxetine, paroxetine and sibutramine might lead to weight loss. There are many contrasts when it comes to the mechanism responsible for these variations in body mass. However, it is known that the weight rise can be the cause of different unwelcome future consequences such as type 2 diabetes mellitus, hypertension and other chronicle diseases. When it comes to weight decrease, the antidepressant drug problems are related to nervous system stimulation and it is at this point that the use of diet pills comes from. Most diet pills contain antidepressant constituents that have the power to act in the metabolism as thermogenic and in the activity of neurotransmitters increasing weight loss very quickly. This literature review will discuss the association between weight changes, antidepressant and diet pill intake and their consequences to users. In particular, it will relate the evidences and show the literature contrasts about the usage of antidepressants either as a medication or as a diet pill component.

Keywords: Tricycle antidepressants, Weight gain, Weight loss, Diet aids, Sibutramine

Antidepressants are some of the most prescribed/used medication all over the world (Batty, Geddes et al. 2010). These drugs can be used in many different situations such as depressive episodes, bipolar syndrome, eating disorders and others psychological and/or psychiatric conditions. Many side effects are associated with the use of antidepressants but changes on body weight are very common (Russ and Ackerman 1988). It has been studied and hypothesized as one of the causes of major depression episodes when combined with major changes on weight specially on cases of obesity or anorexia (Sutin and Zonderman 2012).

There are different groups of antidepressants and they can lead into a diverse range of consequences in body metabolism and weight maintenance. The first generation of tricycle antidepressants is known to produce an increase in weight and the group of amitriptyline has it as permanent characteristic. (Joubert, Gagiano et al. 1995). On the other hand, there are other classes that usually have weight loss as an observed outcome such as Fluoxetine, Paroxetine and sibutramine that apparently have a small potential to reduce weight (Joubert, Gagiano et al. 1995). Due to this propriety, some antidepressant substances are included in diet pills (Cohen, McCormick et al. 2009). This can be very dangerous and end up increasing the contact with antidepressant among non-depressive patients (Cohen, McCormick et al. 2009). Especially women are affected by the use of diet pills because the concern about weight changes is more frequent in this group due to media pressure, pregnancy and the physiological characteristic to carry more fat mass on their body instead of the lean mass present on muscles (Sutin and Zonderman 2012).

Weight gain effect

One of the main concerns about prescribing an antidepressant drug is the potential side effect found in it. In particular, weight gaining as one of psychotropic drugs effects has been discussed and studied through the years and new researches have aimed to minimize and control this adversity. The main antidepressant group that causes body weight gaining is the tricycle and amitriptyline. A study conducted by Aberg in 1975 and cited by Gottifries in 1981, 204 patients were tested in three different kinds of psychotropic drugs, an increase of 83% in weight was noticed when compared to the placebo group. Also cited by Gottifries, in 1978 Coopen et al. guided a research, which the subjects were treated with amitriptyline for one year after recovering from depressive disorder. They used a double blind method and they found a significant difference on weight gaining. The placebo group did not gain any weight, but the amitriptyline-treated one did and continued to increase it after the progress of the depression. In a randomized double-blind study comparing amitriptyline, trazodone and placebo for 6 weeks, which the depressive patients had their amitriptyline intake increased for 4 days until reach the amount of 200mg/day, this drug was the only one that had significant difference when compared to the placebo group (Orzack, Cole et al. 1986). Most studies that compared amitriptyline with another antidepressant have found this remarkable characteristic of providing weight gain. The treatment with this drug was tested and it increased weight on the first week and it went even further during the following 5 weeks (Joubert, Gagiano et al. 1995).

The action mechanism of these antidepressants on weight gaining is still unsure. One of the hypotheses is that tricycle antidepressants increase the soluble TNF receptor plasma levels, which is involved in weight regulation (Hinze-Selch, Schuld et al. 2000). In this study, the growth on the body mass index after 6 weeks taking amitriptyline was followed by a statistically significant increase in TNF receptor p57. Although paroxetine was also tested, this drug did not demonstrate any significance. It is very important to understand how these antidepressants can act in the weight metabolism and it becomes even more relevant because alterations on body mass can be one of the factors that promotes the development of some chronic diseases such as type 2 diabetes and cardiovascular malfunctions. A series of nested studies headed by Batty et al. (2010) aimed to establish a relationship between antidepressant use and type 2 diabetes incidences. Within a prospective cohort of 157347 men and women subjects under continuing antidepressant drug treatments for 4.8 years, this study showed that the weight gain among non-users was 1.4kg and 2.5kg among users with defined daily doses above 200mg. However, this part of the study was based on surveys and due to the small number of incident diabetes case subjects between the baseline and the follow-up, there was no association between antidepressant use and diabetes. Taking type 2 diabetes into consideration and seeing it as one of the metabolic syndrome symptoms, the differences in weight gets even more importance since metabolic syndrome is very common nowadays. As an attempt to explain the mechanism of these antidepressants, a study commanded by Berilgen et al. (2005) and cited by McIntyre et al. (2010) found that possibly tricycle antidepressants and mirtazapine

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