Weight Gain on Medication

Ten million Canadians will face the threat of mental illness this year. For the past fifty years major mental illnesses such as schizophrenia and more recently bipolar disorder have been treated with a class of drugs known as antipsychotics. After some research into this field one must ask the question, does the medical profession unfairly treat patients who are prescribed atypical antipsychotics?

Today, the medication being used to treat various disorders is being more critically looked at in the lives of the patients’ families.

The patients circumstances may be this: “The doctor tells him/her that he/she has a psychiatric condition that needs to be corrected. However, to do so will put he/she at increased risk for heart attack, stroke and diabetes, as well as conditions including high blood pressure, excess body fat around the waist, abnormal levels of cholesterol and triglycerides, as well as becoming insulin resistant.” Would you take the cure?

A year ago, when first beginning to write this magazine article I was convinced I would find the medical profession unfairly treating patients who were prescribed (atypical) antipsychotics, especially since they were assuredly going to gain weight. Researching, rewriting, and redrafting a year later, I now know that this medication while necessary, places both the patient and the doctor in a catch 22 position.

A Brief History of Antipsychotics

In 1951 Doctors Laborit and Huguenard were the first to clinically use an antipsychotic in Paris, France, by administering the chemical combination Chlorpromazine to a patient for its anesthetic effects during surgery. Soon afterward, Doctors Hamon and Delay in New York City stumbled across the Psychiatric use of this chemical combination and serendipitously uncovered its antipsychotic effects. Between 1954 and 1975, 15 other antipsychotic drugs were introduced in North America. These older antipsychotics had unpleasant side effects such as restlessness, muscle spasms, tremors, dry mouth and constipation; however most of these could be corrected by adjusting the dosage.

In 1991 a new drug compound, brand named Clozapine, ushered in the era of the (atypical or second generation) antipsychotic in North America – heralded as a remarkable improvement for patients with schizophrenia.

Press releases trumpeted the news. “Gone would be the awful side effects.” And yes there were some improvements. However, it became apparent that weight gain was a major side effect and it has remained a health hazard. In response to this side effect, the medical profession blamed the patients, pointing to a perceived life style choice such as supposed inactivity and supposed overeating.

The long term effects of antipsychotics aside, weight gain among them, we should be aware that other prescription drugs and over the counter medications can be equally damaging. There are medicines for conditions such as diabetes high blood pressure, heart disorders, and other illnesses that put weight gain among the side effects on their packaging.

Among the medicines that add weight are top-sellers like the serotonin reuptake inhibitors such as Prozac, Zoloft and Paxil, as well as the better known atypical antipsychotics such as Clozaril and Zyprexa. Then there are the antihistamines found in dozens of popular cold, allergy and motion sickness remedies.

These pills are small and weigh almost nothing, but stacked up against a super-sized restaurant meal or a bucket of butter-laced popcorn, or a jumbo cola, any of these pills can pack on the pounds – usually one pound or more a week.

The recent introduction of new “thin” or “obesity pills,” does not answer the problem of drugs that put on weight. Thus far, medical experts who look for the cause and effect of the supposed national obesity epidemic seem to overlook the fact that many times the origin of obesity may originate in the medicine chest.

At first, doctors prescribed the Prozac family of popular (SSRIs) or antidepressants for obese people trying to lose weight. However, it was soon realized that any weight loss was short lived and that these drugs really caused long-term weight gain. As a result, these medications actually create their own repeat dollar revenue by keeping patients depressed and overweight.

Sociologist D.G. Robinson (PhD) proclaimed. “This type of (drug induced) weight gain is enough to make anyone depressed.” He did his Postdoctoral work in Human Biochemistry and Societal Obesity at Stanford University in 1972.

Robinson said that, “Scientists are attempting to pinpoint the biochemical mechanism by which these medicinal agents cause weight gain – an average of 22 pounds in the first year.” Many doctors seem to disbelieve this fact.

The Doctors Say

I have recently logged a personal account from one MD who placed a patient on a very low dose of an (atypical) antipsychotic, hoping it would do very little damage. Nonetheless, the patient gained a lot of weight in a short space of time even though the MDs’ drug of choice was of real benefit to the patient.

Nonetheless, pharmaceutical companies and doctors persisted in prescribing this medication for persons with diagnosis other than for which the drug was developed.

We know that the medical profession says that weight gain is dangerous to the human body and places a person at risk for a host of health predicaments such as type 2 diabetes, cancer and heart disease. Why then – some ask – does the medical profession prescribe such dangerous medications to such a vulnerable group of patients for such an extended time?

In February 2002, Doctor R.S. McIntyre, Assistant Professor at the Department of Psychiatry, University of Toronto, conducted searches of peer-review articles, abstracts presented at professional meetings, Medline and print publications. In addition, he collected industry information from all major pharmaceutical manufacturers about psychotropic or antipsychotic -induced weight gain.

In that same year, Dr. McIntyre began to review published and non-published literature which described changes in weight and glucose numbers when patients’ were prescribed antipsychotics. As the writer of this article, I have completed similar research this year (2007).

Doctor McIntyre concluded that significant weight gain was highly probable and equally distressing, and a real concern with novel antipsychotics, (as he called them). He offered that reduced compliance with medication was a present possibility. Along side all of that, the increased risk of diabetes was a genuine fear and advised his colleagues prescribing these agents to routinely monitor weight and body chemistry profiles.

What is Bipolar?

Bipolar disorder is often mistaken for other disorders. It’s a wonder that it even gets treated. Many people only notice the low mood swings, never mind those unbelievable highs that seem to send patients to the moon. Bipolar disorder affects some 2 to 5 percent of Canadians, but how do you combat an illness when someone does not know that they have that illness?

A recent study showed that half the patients initially diagnosed with depression were actually suffering from bipolar disorder. Differentiating the two can be tricky because symptoms look pretty much identical. The thing to remember is that bipolar disorder instigates bouts of depression and mania. In fact, patients may assume the mania is part of their personality rather than signs of illness. Besides, who can remember “up” episodes when the depressive ones are so low?

Bipolar disorder patients are now prescribed atypical antipsycotics even though these patients may not be psychotic. However, the pharmaceutical companies encouraged the physicians to engage in this kind of off-label prescribing. It appeared that a study by the Calabrese Organization of Wheaton, Illinois, found that the second-generation antipsychotic medication had a salutary effect on individuals diagnosed with Bipolar I or II.

Able to stay on the job thanks to modern chemistry, these patients now remain in the job market and as a result, they are a newer group, presenting before medical practitioners for treatment. These patients are increasingly adept at bringing their condition under control and, unlike other longer term patients, are less likely to fall through the socio-economic cracks. Able to maintain their social status, the only problem they will face after their psychiatric issues, is uncontrolled weight gain.

Societal stigmas abound regarding any number of psychiatric conditions. Whether psychotic or depressive, the addition of obesity makes it harder to deal with a poor self-esteem. It can cause a person to avoid the healthcare system for fear of embarrassment and even criticism from healthcare workers.

The Journal of New England Medicine published an article in highlighting some facts about obesity. It said that no matter how obese the person is, it has a serious effect on the entire body and that the rate of obesity seems higher in patients with chronic psychiatric problems.

Twenty-five percent of Canadians and more than 200 million people worldwide are considered obese, an increase from 10 years ago. A small number of these are psychiatric patients. Obesity is usually associated with but not limited to developed nations. What causes obesity? The traditional view is that overeating and/or lack of exercise are responsible for obesity.

Weight Loss & Weight Gain

The health care profession would tell us that it is the result of poor self-care, is a sedentary lifestyle, and a lower socioeconomic status. In other words – in some cases it is hopeless!

Perhaps some of these middleclass healthcare professionals should exist for thirty days fully in a consumer/survivors shoes. Existing solely on their income of approximately $450.00 per month as if they where living in their accommodations, while eating according to what they can afford to buy. In other words, they should put the mini-van in the garage for those thirty days.

In past years, others have claimed to live on this budget and failed. To my knowledge, a female reporter with the Globe and Mail has been the only one who almost succeeded at this masquerade in February 2007. Moreover, by all accounts, she nearly did nutritional harm to her children at the end of the thirty days.

Approaching 1995, as doctors began to more routinely prescribe atypical antipsychotics, consumer/survivors began to turn up the volume about the amount of weight the wonder pills were adding to their waist line. At first the argument seemed to be between the patient and the doctor, but as the screaming grew throughout society much was made of the apparent obesity factor and the clamour invaded everyone’s life via the print and electronic media.

The problem was exacerbated by the fact that nobody at that time, not even today, has separated the fact that obesity from over eating, and obesity from being over medicated are two very different things. Patient internet discussion sites carry accounts complaining that they got fat after starting to take their medication.

Even when the consumer/survivors do go to extraordinary lengths to loose weight, because they cannot stop taking the medication, the weight all comes back a short time later – pound for pound. This was shown in an Alabama general hospital study published in June 2007.

The medical profession and the pharmaceutical industry is going to have to answer the weight gain question candidly. Perhaps it is simple. The drug adds weight – all by itself!

Aside from a healthy diet and exercise, it could be that the medication has nothing more to do with the patients’ lifestyle. Then again, it may have to do with a genetic substance highlighted by the Toronto Globe and Mail (2006), feature columnist Margaret Wente, when she wrote of Jeffrey Friedman (PhD) and his ground breaking research into genetics and a chemical called leptin, at Rockefeller University in New York City.

She noted that Dr Friedman published the fact that leptin is an adipose tissue hormone which regulates body weight. It interacts with various brain receptors and regulates food intake, energy expenditure and other neuroendocrine systems. Ms Wente also observed that Friedman is also famous for enraging the “food Nazis” to the point where they want to toss their tofu at him.

“The obese population whether from perceived over eating or from being medicated, has a self-regulating system. This is the case with all people. It is not really a lack of willpower – as everyone seems to think” indicates Dr. Friedman.

Friedman holds the prestigious Gairdner, Passano ward for research into the Molecular Genetics Sciences. He goes on to clarify that this explains our shortcoming in our feedback loop and why we’re doomed to keep losing and gaining the same 35 pounds over and over. People think that all they have to do is eat less and exercise more. “But the system that regulates their weight is unconscious.” Said Dr. Friedman.

Genetic scientists around the globe have discovered an anomaly that may be responsible for some types of obesity. The anomaly may be a type of chemical/gene reaction believed to disrupt the body’s metabolic control center. That’s the mechanism that tells the brain when one has sufficient fat stores to meet its demands.

“When it comes to weight,” Friedman continued, “We still continue to blame the victim.” He explained, “Some guy gets lucky and manages to loose 100 pounds and miraculously keeps .the weight off, and we expect everyone to do the same, but in general, trying to turn a fat person into a thin one, is as futile as trying to turn a short person into a tall one.”

Society has decided that mental illness has biochemical origins and is treatable. Yet society views obesity very differently. We still blame the victim.

Dr. Friedman would say, “It seems that there is a brand new religion – it’s called weight control. The public has an odd attitude about the root causes of what weight is.”

He continued, “In reality there are any number of obese people who eat very little. They are obese due to enumerable reasons including medical circumstances.”

For the record, Dr. Friedman does not endorse couch-potatoism. Exercise and healthy eating are excellent. He states that obesity is a serious problem with serious consequences. Nevertheless, the Doctor feels the most promising treatments will come from the research lab, not from class action suits against McDonald’s and Burger King.

Studies have demonstrated that a biological factor in weight regulation is real. Researchers have found the factor that plays a role in weight regulation is the hypothalamus that regulates eating patterns, body temperature and controls the metabolic system. The hypothalamus is one of the glands that manufactures leptin.

It has been shown that the rate of leptin production in fat cells depends on cell size. Leptin receptors have also been found in the pancreatic system which produces insulin. It has been shown that it enhances the effects of insulin and it is possible that insulin may stimulate the release of leptin in return.

Leptin also plays a role in the reproductive function. It regulates the onset of puberty in women. Individuals deficient in leptin tend to mature sexually at a later stage. This could be related to the amount of fat that is stored. For example, many female athletes (are women with a low percentage of body fat), do not have their periods. Leptin has also been implicated in the immune system and the development of bones.

The study was a randomized, controlled, dose-escalation trial conducted between April 1997 to October 1998 at (Harvard Medical School – Beth Israel), four university nutrition and obesity clinics, New York, NY, Boston, Mass, University of Wisconsin and Chicago Illinois including two other contract clinical research sites, in a research study that explored the relationship between increasing doses of exogenous leptin administration and weight loss in both lean and obese adults.

There were 127 participants in a study that lasted two years. There were 54 average weight male and female participants. In addition there were 73 other obese male and female participants. The entire group was predominantly Caucasian with an average age of 39 years old.

This study established the relationship between increasing doses of injected leptin and the resulting weight loss in both lean and obese adults. This controlled study has recently been duplicated in several locations at several universities worldwide.

Additional research into the potential role for leptin and related hormones in the treatment of human obesity is definitely warranted.

Conclusion

The effectiveness of antipsychotic medication is evident in acute and maintenance treatment of these disorders, and most mental health professionals recognize these drugs as a cornerstone in treating affected people.

It is hoped that soon there will be an adequate medication that will balance out the side effects of weight gain among others, caused by the tyranny of the necessary daily medication needed to be consumed by these vulnerable patients.

On Monday, March 19, 2007 The Right Honorable Jim Flaherty, Finance Minister recently announced the establishment of a Canadian Mental Health Commission, and called for “respect and dignity” for people with mental illness.

“Health care goes beyond physical well-being,” he said as he addressed the House of Commons in Ottawa.

“We must reach out in practical and compassionate ways to those struggling with mental illness.”

Retired Senator Michael Kirby said that $10 million in funding is available now, and there is $17 million a year for the duration of the commission’s existence – a minimum of 10 years headquarters in Calgary

Thirty-seven per cent of Canadians experience a mental illness in the course of their lifetime, he added.

The most vulnerable are those in their teens and early to mid-20s.

“Depression today is the fastest growing source of disability in the Canadian labor force, representing 75 per cent of long-term disability and about 40 per cent of short-term disability,” he said.

Like the VON I echo the sentiment that this is a good start, but will this mental health initiative end like so many others? Could one of its mandates be used to look at the caused of medication induced weight gain along with ways of improving the health and “life style” of consumer survivors everywhere.

Then, today the psychiatric medications being used to treat various disorders are being more critically looked at in the lives of the patients’ by their friends and families. Ten million Canadians are likely to have contact with mental illness and it may well by either bipolar depression or schizophrenia. As always society will spend relatively little money or time on the plight of drug induced weight gain and will simply blame the patient – who never asked to be on the drug in the first place.

One may ask why it is that as a society we look at a health care budget and see that our government has spent billions of dollars in the area of heart care or cancer therapy, yet psychiatric care usually receives between 3% – 5% of the over all government health budget.

Perhaps this is one reason why I have asked the question: Does the medical profession unfairly treat patients who are prescribed atypical antipsychotics?

A full two months before the story was finished and published the writer had contacted all major pharmaceutical companies that manufactured drugs related to this story. To date, the companies have not contacted the writer either by telephone or by e-mail.