Psychiatic medications and Psychiatic medications and obesityobesity

Nasr EsfahaniNasr EsfahaniAssociate Professor of PsychiatryAssociate Professor of Psychiatry

Iran University of Medical Science Iran University of Medical Science Rasool Akram HospitalRasool Akram Hospital

20092009

Introduction Introduction

Social and psychological consequences Social and psychological consequences

Appetite Appetite

Regulating eating behaviorRegulating eating behavior

Social and psychological consequencesSocial and psychological consequences

PsychologicaPsychologica BlameBlame

Subject of teasingSubject of teasing discriminationdiscrimination

OccupationalOccupational Income powerIncome power

SocialSocial Absence of romantic relationshipsAbsence of romantic relationships

Appetite Appetite

Appetite, defined as the desire for food.Appetite, defined as the desire for food.

Hungry person may eat to full satisfaction when Hungry person may eat to full satisfaction when food is available, but appetite can also induce food is available, but appetite can also induce a person to overeat past the point of satiety.a person to overeat past the point of satiety.

Regulating eating behaviorRegulating eating behavior(neurotransmetters)(neurotransmetters)

SerotoninSerotonin

HistamineHistamine

DopamineDopamine

NorepinephrineNorepinephrine

Regulating eating behaviorRegulating eating behavior(Hormones) (Hormones)

Corticotrophin releasing factor (CRF)Corticotrophin releasing factor (CRF)

Neuropeptide YNeuropeptide Y

Gonadotropin-releasing hormoneGonadotropin-releasing hormone

Thyroid-stimulating hormoneThyroid-stimulating hormone

A new subtance obestatin, made in the stomach, A new subtance obestatin, made in the stomach, is a homone that in animal experiments is a homone that in animal experiments produce satiety and may have potential use as produce satiety and may have potential use as a weight loss agent in humans. a weight loss agent in humans.

Cannabinoid receptorsCannabinoid receptors

Cannabinoid receptors are related to Cannabinoid receptors are related to appetiteappetite and and stmulated withstmulated with cannbis cannbis (marijuana). (marijuana).

A cannabinoid antagonist has been developed that block A cannabinoid antagonist has been developed that block appetite.appetite.

Rimonabant is an inverse agonist to the cannabidiol Rimonabant is an inverse agonist to the cannabidiol receptor,meanig that blocks appetite.receptor,meanig that blocks appetite.

Olfactory systemOlfactory system

The olfactory system may play a role in satiety.The olfactory system may play a role in satiety.

Experiments have shown that stong stimulation Experiments have shown that stong stimulation of the olfactory bulbs in the nose with food by of the olfactory bulbs in the nose with food by use of an inhaler saturated with a particular use of an inhaler saturated with a particular smell produce satiety for that food. This may smell produce satiety for that food. This may have implication for therapy of obesity.have implication for therapy of obesity.

Psychiatric Medications and Psychiatric Medications and Changes in Body WeightChanges in Body Weight

MechanismMechanism

No specific mechanism have been idetified as No specific mechanism have been idetified as causing weight gain, and it appears that the causing weight gain, and it appears that the histamin and serotonin systems mediate histamin and serotonin systems mediate changes in weight associated with many drugs changes in weight associated with many drugs used to treat depression and psychosis.used to treat depression and psychosis.

Serotonin receptorsSerotonin receptors

5-HT5-HT1A1A 5-HT5-HT2A2A 5-HT5-HT55αα

5-HT5-HT1B1B 5-HT5-HT2B2B 5-HT5-HT55ββ

5-HT5-HT1D1D 5-HT5-HT2C2C 5-HT5-HT66

5-HT5-HT1E1E 5-HT5-HT33 5-HT5-HT77

5-HT5-HT1F1F 5-HT5-HT44

5HT5HT2c 2c receptorsreceptors

Stimulation of 5HT2c receptors has been proposed to produced anxiogenic effects as well as anorectic effects (LSD)

Inhibition of 5HT2c receptors may play a role in the weight gain and development type II diabetes associated with atypical antipsychotics

Histamine receptorsHistamine receptorsH1, H2, H3, H4H1, H2, H3, H4

Antagonist of H1 : sedation and weight gainAntagonist of H1 : sedation and weight gain

Antagonist of H2 : treatment of peptic ulcer diseaseAntagonist of H2 : treatment of peptic ulcer disease

Antagonist ofAntagonist of H3 : propsed to treat sleep disorders, obesity, dementia H3 : propsed to treat sleep disorders, obesity, dementia

Antagonist of H4 : possible role as anti-inflemmatory agentsAntagonist of H4 : possible role as anti-inflemmatory agents

Psychotropic drugs and weight gain Psychotropic drugs and weight gain

Retained fluidRetained fluid

Decrease exerciseDecrease exercise

Altered metabolismAltered metabolism

Increased caloric intakeIncreased caloric intake

IncreasedIncreased appetiteappetite Anticholinergic effectsAnticholinergic effects

FoodFood cravingscravings Dry mouthDry mouth

Eating carbohydrats Increased thirst Eating carbohydrats Increased thirst

Tricyclic and Tricyclic and tetracyclic tetracyclic

antidepressantsantidepressants

Tricyclic and Tricyclic and tetracyclic tetracyclic

antidepressantsantidepressants

Selective Serotonin Reuptake InhibitorsSelective Serotonin Reuptake InhibitorsSSRIsSSRIs

Initial anorexia can also occur and is most common with Initial anorexia can also occur and is most common with fluoxetine.fluoxetine.

SSRI- induced appetite and weight loss begin as soon as the SSRI- induced appetite and weight loss begin as soon as the drug is taken and peak at 20 weeks, after which weight drug is taken and peak at 20 weeks, after which weight often returns to baseline.often returns to baseline.

This effect is mediated through a This effect is mediated through a metabolic mechanism, metabolic mechanism, increase in appetite, or both. increase in appetite, or both. it happens gradually and is it happens gradually and is usuallyusually resistant to diet and exersise regimens. resistant to diet and exersise regimens.

Atypical antipsychoticsAtypical antipsychotics

Insulin resistance Insulin resistance

Weight gainWeight gain

Type II diabetesType II diabetes

olanzapine, clozapineolanzapine, clozapine

Tendency to Increase Appetite and Body WeightTendency to Increase Appetite and Body Weight

Antidepressant drugsAntidepressant drugs

GreatestGreatest IntermediateIntermediate Least Least Amitriptyline (Amitriptyline (ElavilElavil)) Doxepin (Sinequan)Doxepin (Sinequan)

Imipramine (Tofranil)Imipramine (Tofranil)Mirtazapine (Remeron)Mirtazapine (Remeron)Nortriptyline (Pamelor)Nortriptyline (Pamelor)

Phenelzine (Nardil)Phenelzine (Nardil)

Trimipramine(Trimipramine(SurmontilSurmontil))

Amoxapine (Asendin)Amoxapine (Asendin)Desipramine Desipramine (Norpramin)(Norpramin)Trazodone (Desyrel)Trazodone (Desyrel)Tranylcypromine Tranylcypromine (Parnate)(Parnate)Fluoxetine (Prozac)Fluoxetine (Prozac)

Sertraline (Zoloft)Sertraline (Zoloft)aa

Bupropion (Wellbutrin)Bupropion (Wellbutrin)

Venlafaxine (Effexor)Venlafaxine (Effexor)

Tendency to Increase Appetite and Body WeightTendency to Increase Appetite and Body Weight

Mood stabilizersMood stabilizers

GreatestGreatest IntermediateIntermediate Least Least

Lithium (Eskalith) Lithium (Eskalith)

Valproic acid Valproic acid (Depakene)(Depakene)

Carbamazepine Carbamazepine (Tegretol)(Tegretol)

Topiramate Topiramate (Topamax)(Topamax)

Tendency to Increase Appetite and Body WeightTendency to Increase Appetite and Body Weight

Antipsychotic drugsAntipsychotic drugs

GreatestGreatest IntermediateIntermediate Least Least

Chlorpromazine Chlorpromazine (Thorazine)(Thorazine)

Thioridazine (Mellaril) Thioridazine (Mellaril)

Mesoridazine (Serentil) Mesoridazine (Serentil)

Olanzapine (Zyprexa)Olanzapine (Zyprexa)

Sertindole (Serdolect)Sertindole (Serdolect)

Risperidone (Risperdal)Risperidone (Risperdal)

Haloperidol (Haldol)Haloperidol (Haldol)

TrifluoperazineTrifluoperazine

PerphenazinePerphenazine

ThiothixeneThiothixene

fluphenazinefluphenazine

Ziprasidone (Geodon)Ziprasidone (Geodon)Aripiprazole (Abilify)Aripiprazole (Abilify)Molindone (Moban)Molindone (Moban)aa

Brain serotonergic pathwayBrain serotonergic pathway

Brain dopaminergic Brain dopaminergic pathwaypathway

Brain noradrenergic Brain noradrenergic pathwaypathway

Histaminergic pathwayHistaminergic pathway

Brain cholinergic pathwayBrain cholinergic pathway