Anti anxiety meds

[BetterGolfNow 4]

Just curious if I'm alone here. I started taking citalopram for anxiety a few years ago. I knew a potential side effect was weight gain. I'm guessing some gain weight because it mellows you out and takes away some of that energy that may keep one from exercising. Sure enough, I gained weight. . . Because of the citalopram or because I turned 40, not sure the cause. Anyway, I am 10 weeks post op and down from 280 to 215, and feeling great! I kind of assumed that my anxiety would go away with the extra weight, but I am finding that my stress and anxiety are still present and I am thinking about going back on citalopram because it really helped me with anxiety. But I don't want to slow down my weight loss as I am a consistent 3-4 pounds a week and don't want to slow down until I hit my 185 target. Any and all thoughts, experiences, and opinions, are welcome. Thanks!

[Daisee68 2,493]

Well not exactly the same thing, but I can tell you that I had to up my depression med (Brintellix) and my Synthroid after surgery because it just wasn't absorbing correctly (though I did have bypass). Any chance of trying a different anxiety med maybe that is more weight neutral? If not, you could always give it a try and just see how it goes.

Great job on the loss by the way! Keep up the great work!

[BetterGolfNow 4]

Thanks Daisee, good idea to look at a different med. Congrats right back atcha on your progress too!

[able2cope 193]

I'm on escitalopram, and I don't think I've experienced any adverse effects... I know that weight loss is a priority, but to me, the anxiety is a higher one... so worth it if there were any effects.

[LetItGo 73]

Brintellix is not known for weight gain. It is one of the newer medications out there. I was on Cymbalta for 10 years and gained over 40 pounds. It took me over 6 months to withdraw from it and the process was hell. I won't ever take it again!!

[RuralNurse 48]

I am a psychiatric nurse practitioner and prescribe these meds to people daily. Although some people do gain weight on citalopram most do not. Escitalopram (Lexapro) is the newer "cleaner" version of citalopram (Celexa) and I see even fewer people gain weight on it. When they do research on these meds they have to document EVERY possible side effect. I believe that much of this is people that are very depressed lose weight and when they begin to take these meds they "gain" weight but really are just getting back to a normal weight.

Brintellix is a good medication but is a newer one and much more expensive (and less well covered by insurances than citalopram). Also it work on serotonin, norepinephrine and dopamine, where citalopram works only on serotonin that is more implicated in anxiety (where the others are more implicated in depression and anxiety combined).

The psych meds that are really bad for weight gain are the atypical anti-psychotics like Zyprexa, Seroquel, Risperidal, etc. These can be used for psychotic conditions and, more commonly, bipolar disorder. But not everyone gains weight on them. Anxiety meds that are worse for weight gain - paxil, remeron, sometimes prozac.

In my opinion if you have uncontrolled anxiety you are more likely to "self -medicate" to feel better. That may be with food, alcohol, marijuana, other drugs (prescription or illicit), gambling, etc.

Good luck!

Edited December 20, 2015 by RuralNurse

[able2cope 193]

I am a psychiatric nurse practitioner and prescribe these meds to people daily. Although some people do gain weight on citalopram most do not. Escitalopram (Lexapro) is the newer "cleaner" version of citalopram (Celexa) and I see even fewer people gain weight on it. When they do research on these meds they have to document EVERY possible side effect. I believe that much of this is people that are very depressed lose weight and when they begin to take these meds they "gain" weight but really are just getting back to a normal weight.

Brintellix is a good medication but is a newer one and much more expensive (and less well covered by insurances than citalopram). Also it work on serotonin, norepinephrine and dopamine, where citalopram works only on serotonin that is more implicated in anxiety (where the others are more implicated in depression and anxiety combined).

The psych meds that are really bad for weight gain are the atypical anti-psychotics like Zyprexa, Seroquel, Risperidal, etc. These can be used for psychotic conditions and, more commonly, bipolar disorder. But not everyone gains weight on them. Anxiety meds that are worse for weight gain - paxil, remeron, sometimes prozac.

In my opinion if you have uncontrolled anxiety you are more likely to "self -medicate" to feel better. That may be with food, alcohol, marijuana, other drugs (prescription or illicit), gambling, etc.

Good luck!

A great response, and very interesting - thanks for sharing your knowledge. Much appreciated.

[Daisee68 2,493]

Yes @RuralNurse. Thank you so much for that! I am going to have to change med or dose or something on my Brintellix as I am being laid off on the 31st and am currently paying $600 per month for the Brintellix. (Well I had already met my out of pocket so I wasn't paying that myself but as the deductible starts over 1/1, I just cannot justify the cost.) My dr put me on 15 mg which isn't an option, so I am getting 10mg pill and 5 mg pill each day which is why I am having to pay so much. UGH! It has really helped me but surely my dr can find something that will work as well (though I don't know how wise it is to change this drug as such a stressful time in life. Oh well!) Anyway, really appreciate your sharing your knowledge!

[RuralNurse 48]

am currently paying $600 per month for the Brintellix.

You may want to call your doctor's office and ask to speak with his/her nurse (I say that because it can be really hard to get the doc on the phone). Tell her you are struggling with the double cost because there is a charge for both dosages and ask if they have samples. Let her know that you may want to change at some point due to poor insurance coverage but want to stay on it for now. Doc's are more likely to give samples if they feel it is not being used as a long term solution.

Also many of the drug companies have "Co-pay" cards that help with the cost above what insurance covers.

If I had a pt that was on Brintellix but cost was an issue I would (barring allergies) put him/her on Lexapro (Escitalopram) because it is a good SSRI with few side effects. After being on that for maybe a month I would add Wellbutrin (Bupropion). That medicine is an NDRI which is norepinephrine and dopamine. Brintellix works on all 3 and combining is not exactly the same "recipe" as Brintellix but it is close and much cheaper as both are generic.

Wellbutrin is known for weightloss in many people. It is more activating and helps with focus as well.

Is you doc a psychiatrist or a family practice generalist? Some FP docs get worried about mixing anti-depressants because they don't really understand the way they work and the neurotransmitters they effect.

Good luck!

[BetterGolfNow 4]

Awesome and very helpful info, thanks for taking the time to respond!

[%#LoosingIt?!&- 16]

I'm pre op and on antidepressant and anxiety meds. I am dependent on my meds (hope to one day be able to not be but weight control is my focus now) and don't want to loose their effectiveness. I've been comfortable being fat and less depressed than a little smaller and mega anxious. Hoping to be skinny and non anxious post op!

Is it normal for sleevers to need more of their meds or less?? I didn't even think of this before your post!

[RuralNurse 48]

I'm pre op and on antidepressant and anxiety meds. I am dependent on my meds (hope to one day be able to not be but weight control is my focus now) and don't want to loose their effectiveness. I've been comfortable being fat and less depressed than a little smaller and mega anxious. Hoping to be skinny and non anxious post op!

Is it normal for sleevers to need more of their meds or less?? I didn't even think of this before your post!

I think this can be quite variable...I know we all would like a more specific answer. But the reality is people can have depression or anxiety (both heavily regulated by serotonin) for lots of different reasons and respond in different ways. I am a psychiatric nurse practitioner and have been caring for people with mental illness for over 15 years. I have had pts that were almost identical in age, sex, ht, wt, symptoms, etc and respond completely different to the same prescription. We are not cookie cutter people, we have wondrous variety and I am reminded of this daily. So take this as general info only.

We produce serotonin in our brain but about 90% is found in the gut or GI tract. For simplicity - when you were a bunch of cells, before you were even fetus, the cells that made your brain and the cells that made your gut and intestines were identical. That is why if you have ever had a bad headache or Migraine, you may get nauseated and through up; or why if you have a bad stomach flu you have a headache, why if you feel really anxious (in your brain) you feel like your stomach is tied in knots, or you get a dry mouth, etc. Or if you take meds that effect your brain like pain meds (they may make your broke ankle feel better but really they are effecting your brain) you get GI disturbance in the form of Constipation. This is why so many "psych" meds can upset your stomach, cause diarrhea or appetite change.

So will your medication needs change after surgery? It is hard to say. But as serotonin builds over time and is depleted over time you may not notice it for a few months after surgery.

One thing that I think is important to know however; your anxiety or depression maybe worsened by how you feel, but simply "feeling bad" about yourself is unlikely to cause major depression or an anxiety disorder. So what I mean by this is, if you truly have a chemical imbalance that is causing depression or anxiety, losing weight is not going to suddenly make your world perfect and you will have no more anxiety.

You may have more confidence and may be better able to express yourself; you may have more self esteem and less likely to allow others to take advantage of you; you may take better care of yourself and feel better physically, you may lose weight and get rid of sleep apnea so sleep better; you may be able to get more physical activity and release your own endorphins...

But don't assume that if you really have a deficit of neurotransmitters that losing weight will make your world perfect. You may or may not be able to get off meds.

I will try to put a link to a nice site that helps to explain the brain - gut connection.

http://nutritionwonderland.com/2009/06/understanding-bodies-serotonin-connection-between-food-and-mood/

[3283 8]

I take citalopram, I am about 9 days out after surgery I took my last tablet(30mg) the day before surgery. I have a follow up in 2 days and will ask if I can take them, for the purposes of weaning off,cause doctor advised going cold turkey will eventually have withdrawal symptoms.

[RuralNurse 48]

I take citalopram, I am about 9 days out after surgery I took my last tablet(30mg) the day before surgery. I have a follow up in 2 days and will ask if I can take them, for the purposes of weaning off,cause doctor advised going cold turkey will eventually have withdrawal symptoms.

You have already "gone cold turkey"

If you were going to have what we call "discontinuation syndrome" (which is similar to but much unlike "withdrawal" experienced with other meds/substances) it would have happened by now. Now what you may experience is return of symptoms. Citalopram is an SSRI and as such it helps you to build your own levels of serotonin, and it does this over time. Stopping it will cause a reduction in your own levels of serotonin eventually. Will it reduce enough to cause your symptoms of anxiety or depression to come back? Who knows, it may or may not. If you want to see how you do off the meds it would be reasonable to stay off it as you have already been off for close to 2 weeks by the time you see your doc.

Unfortunately most primary care docs don't really understand how all of these psych meds work (unless they are a psychiatrist). They have basic knowledge and are told that many of them cause "withdrawal" symptoms. Many do, but the pure SSRIs are much less likely to do this compared to the SNRIs like Effexor or Cymbalta.

If you feel good and are not having anxiety or depression now and want to try staying off, ask your doc about that. Going back on just to wean off when you have had no symptoms of coming off is not really needed. What I would add however, is monitor your mood/anxiety closely. Depression and panic can creep up and before you know it you are miserable. Keep an open dialog with your doc in case you need to go back on. Good luck!

Edited December 28, 2015 by RuralNurse