Depression Learning

Celexa may bring same weight increase as other SSRI's

Question:

Oy. Thanks for the articles, James. No big surprise for me. Since my early 20s I have tended to fight weight gain a bit, but since going on SSRIs 2 years ago the battle has been depressingly one-sided.  :-(    Carbo cravings are really quite acute. – Anne —

Response:

Hi James I had completely the opposite experience with Celexa.  I lost weight and am looking like a skinny rake (under 8 stone).  I also get lots of nausea and stomach discomfort with the med.  I am now going back on Paxil!! Cleo – Hide quoted text — Show quoted text – I am not trying to be negative, but just wanted to share my as well as = some general experience with SSRI’s. I thought Celexa would be different = (from anecdotal stories) in terms of weight gain. Well, reports on it’s = use, where it has been used for sometime, show it to have the *possible* = same weight-gain effect as other SSRI’s. Here are a couple of abstracts, = and related ones: — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, = LinkOut =20 Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, = Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and = ancedotally been associated with nausea and weight loss as a side effect = of their action. The tricyclic antidepressants have been linked to = carbohydrate (CHO) craving and weight gain in patients with major = depressive disorders. This side effect has been attributed to the strong = anti-histaminergic actions of these agents and is recognized as a causal = factor of non-compliance in a substantial percentage of patients. CHO = craving is an important feature and complication of the treatment of = depression and is often ignored. A total of 18 patients were treated = with the SSRI citalopram in our mood disorder clinic. In eight cases = there was a significant increase in CHO craving together with weight = gain shortly after initiation of treatment. The craving for CHO took on = a phasic presentation. These cases are presented, together with data on = the change in mood and anxiety symptom rating scales. Our observations = appear paradoxical, given that serotonin (5-HT) typically mediates a = reduction in CHO intake and that citalopram displays potent and select = 5-HT-enchancing actions. However, the receptor binding profile of = citalopram may predict a risk for inducing this adverse event. These, = together with serotonergic, dopaminergic, histaminergic and other = possible mechanisms are discussed. A profound influence on patient = acceptability was observed, suggesting that the impact on compliance = needs to be considered. Publication Types:=20 Clinical trial=20 PMID: 9031994, UI: 97184034=20 — Clin Neuropharmacol 2000 Mar-Apr;23(2):90-7 Related Articles, Books =20 Neuropharmacology of paradoxic weight gain with selective serotonin = reuptake inhibitors. Harvey BH, Bouwer CD Department of Pharmacology, Potchefstroom University for Christian = Higher Education, South Africa. It has been suggested that weight gain associated with tricyclic = antidepressants (TCA) reflect actions on dopamine (DA) and histamine = receptors. However, a definitive cause is purely assumptive given the = nonselective pharmacology of these agents. The selective serotonin = reuptake inhibitors (SSRIs), as well as agents like dexfenfluramine = (DFF), have emphasized the pivotal role of serotonin (5HT) in reducing = carbohydrate (CHO) intake, and have provided a more selective tool with = which to study appetite regulation. It would be expected that all SSRIs = should exert a similar anorectic action. However, recent reports provide = evidence to the contrary. Despite their claimed selectivity, SSRIs still = interact, either directly or indirectly, with various critical = neurotransmitter systems. In addition, although the anorectic action of = fluoxetine (FLX) is well recognized, long-term follow-up studies in = depressed patients and in obese nondepressed patients reveal that its = weight-reducing effects are transient, even leading to a gain in body = weight. Similarly, paroxetine (PRX) and citalopram (CTP) have also been = associated with weight gain. These latter observations are unexpected = because PRX and CTP are highly potent and selective SSRIs. A = neuropharmacologic rationale for the apparent paradoxic effects of SSRIs = on appetite not a review of neuronal regulation of appetite is presented = in this article. As with the regulation of feeding, paradoxic weight = gain observed with SSRIs appears to rest on the interaction of 5HT with = multiple mechanisms, with the extent of weight gain observed being = dependent on subtle, yet important pharmacologic differences within the = group. Finally, the neurobiology of depressive illness itself, and of = recovery from it, is a major contributing factor to individual response = to these drugs. Publication Types:=20 Review=20 Review, tutorial=20 PMID: 10803799, UI: 20260944=20 — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, = LinkOut =20 Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, = Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and = ancedotally been associated with nausea and weight loss as a side effect = of their action. The tricyclic antidepressants have been linked to = carbohydrate (CHO) craving and weight gain in patients with major = depressive disorders. This side effect has been attributed to the strong = anti-histaminergic actions of these agents and is recognized as a causal = factor of non-compliance in a substantial percentage of patients. CHO = craving is an important feature and complication of the treatment of = depression and is often ignored. A total of 18 patients were treated = with the SSRI citalopram in our mood disorder clinic. In eight cases = there was a significant increase in CHO craving together with weight = gain shortly after initiation of treatment. The craving for CHO took on = a phasic presentation. These cases are presented, together with data on = the change in mood and anxiety symptom rating scales. Our observations = appear paradoxical, given that serotonin (5-HT) typically mediates a = reduction in CHO intake and that citalopram displays potent and select = 5-HT-enchancing actions. However, the receptor binding profile of = citalopram may predict a risk for inducing this adverse event. These, = together with serotonergic, dopaminergic, histaminergic and other = possible mechanisms are discussed. A profound influence on patient = acceptability was observed, suggesting that the impact on compliance = needs to be considered. Publication Types:=20 Clinical trial=20 PMID: 9031994, UI: 97184034=20 —

Response:

– Hide quoted text — Show quoted text – I am not trying to be negative, but just wanted to share my as well as some general experience with SSRI’s. I thought Celexa would be different (from anecdotal stories) in terms of weight gain. Well, reports on it’s use, where it has been used for sometime, show it to have the *possible* same weight-gain effect as other SSRI’s. Here are a couple of abstracts, and related ones: I haven’t really noticed this, but I certainly appreciate your perspective. Darren.

I have been taking Celexa for 14 days 20mg (switched directly from Paxil 20mg)  I have had a decrease in appetite and my weight has been managable- I actually lost some.  Maybe it’s early yet and things may change – but at least I can have an orgasm now!!!!!  But I had some break through anxiety / panic(yesterday)  I just can’t win! I’m really looking forward to the next generation SSRI’s. Bonnie

Response:

- Hide quoted text — Show quoted text – I am not trying to be negative, but just wanted to share my as well as some general experience with SSRI’s. I thought Celexa would be different (from anecdotal stories) in terms of weight gain. Well, reports on it’s use, where it has been used for sometime, show it to have the *possible* same weight-gain effect as other SSRI’s. Here are a couple of abstracts, and related ones: I haven’t really noticed this, but I certainly appreciate your perspective. Darren. I have been taking Celexa for 14 days 20mg (switched directly from Paxil 20mg)  I have had a decrease in appetite and my weight has been managable- I actually lost some.  Maybe it’s early yet and things may change – but at least I can have an orgasm now!!!!!  But I had some break through anxiety / panic(yesterday)  I just can’t win! I’m really looking forward to the next generation SSRI’s. Bonnie

Bonnie, it may be that you’ll need more than 20mg Celexa to give you the same control of anxiety as 20mg Paxil. As for the next generation SSRI, I’ve been waiting for about 12 years for Glaxo to release Ondansetron, also a SSRI. All the reports of this at the time suggested it was a superior anti anx med. But it also proved a superb anti nausea drug, so Glaxo packaged it for use in alleviating the effects of chemo therapy where they were able to charge a fortune for it (brand name Zofran) .  However, I’ve heard that its patent for this is about to expire and it may soon be available for use by us. There shouldn’t be a sexual dysfunction problem with it. Its been used as an "antidote" to this affect of standard SSRIs. It may also prove to be an effective treatment for alcoholism and may even reduce/prevent benzo withdrawal. But don’t tell the anti benzo idiots, it’ll ruin their day – those that come here seem to like inducing suffering! Ian

Response:

I am not trying to be negative, but just wanted to share my as well as some general experience with SSRI’s. I thought Celexa would be different (from anecdotal stories) in terms of weight gain. Well, reports on it’s use, where it has been used for sometime, show it to have the *possible* same weight-gain effect as other SSRI’s. Here are a couple of abstracts, and related ones: — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients. CHO craving is an important feature and complication of the treatment of depression and is often ignored. A total of 18 patients were treated with the SSRI citalopram in our mood disorder clinic. In eight cases there was a significant increase in CHO craving together with weight gain shortly after initiation of treatment. The craving for CHO took on a phasic presentation. These cases are presented, together with data on the change in mood and anxiety symptom rating scales. Our observations appear paradoxical, given that serotonin (5-HT) typically mediates a reduction in CHO intake and that citalopram displays potent and select 5-HT-enchancing actions. However, the receptor binding profile of citalopram may predict a risk for inducing this adverse event. These, together with serotonergic, dopaminergic, histaminergic and other possible mechanisms are discussed. A profound influence on patient acceptability was observed, suggesting that the impact on compliance needs to be considered. Publication Types: Clinical trial PMID: 9031994, UI: 97184034 — Clin Neuropharmacol 2000 Mar-Apr;23(2):90-7 Related Articles, Books   Neuropharmacology of paradoxic weight gain with selective serotonin reuptake inhibitors. Harvey BH, Bouwer CD Department of Pharmacology, Potchefstroom University for Christian Higher Education, South Africa. It has been suggested that weight gain associated with tricyclic antidepressants (TCA) reflect actions on dopamine (DA) and histamine receptors. However, a definitive cause is purely assumptive given the nonselective pharmacology of these agents. The selective serotonin reuptake inhibitors (SSRIs), as well as agents like dexfenfluramine (DFF), have emphasized the pivotal role of serotonin (5HT) in reducing carbohydrate (CHO) intake, and have provided a more selective tool with which to study appetite regulation. It would be expected that all SSRIs should exert a similar anorectic action. However, recent reports provide evidence to the contrary. Despite their claimed selectivity, SSRIs still interact, either directly or indirectly, with various critical neurotransmitter systems. In addition, although the anorectic action of fluoxetine (FLX) is well recognized, long-term follow-up studies in depressed patients and in obese nondepressed patients reveal that its weight-reducing effects are transient, even leading to a gain in body weight. Similarly, paroxetine (PRX) and citalopram (CTP) have also been associated with weight gain. These latter observations are unexpected because PRX and CTP are highly potent and selective SSRIs. A neuropharmacologic rationale for the apparent paradoxic effects of SSRIs on appetite not a review of neuronal regulation of appetite is presented in this article. As with the regulation of feeding, paradoxic weight gain observed with SSRIs appears to rest on the interaction of 5HT with multiple mechanisms, with the extent of weight gain observed being dependent on subtle, yet important pharmacologic differences within the group. Finally, the neurobiology of depressive illness itself, and of recovery from it, is a major contributing factor to individual response to these drugs. Publication Types: Review Review, tutorial PMID: 10803799, UI: 20260944 — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients. CHO craving is an important feature and complication of the treatment of depression and is often ignored. A total of 18 patients were treated with the SSRI citalopram in our mood disorder clinic. In eight cases there was a significant increase in CHO craving together with weight gain shortly after initiation of treatment. The craving for CHO took on a phasic presentation. These cases are presented, together with data on the change in mood and anxiety symptom rating scales. Our observations appear paradoxical, given that serotonin (5-HT) typically mediates a reduction in CHO intake and that citalopram displays potent and select 5-HT-enchancing actions. However, the receptor binding profile of citalopram may predict a risk for inducing this adverse event. These, together with serotonergic, dopaminergic, histaminergic and other possible mechanisms are discussed. A profound influence on patient acceptability was observed, suggesting that the impact on compliance needs to be considered. Publication Types: Clinical trial PMID: 9031994, UI: 97184034 —

Response:

Hi James, You are probably right about the weight gain, but I would rather be fat and calm than thin and anxious.  Life is not perfect, meds are not perfect.  I am phobic about meds, but see their need.  Thanks for sharing, but would like to see the other side of your thoughts too, if you have any, about ways they can help us. Take care, Liz – Hide quoted text — Show quoted text – I am not trying to be negative, but just wanted to share my as well as some general experience with SSRI’s. I thought Celexa would be different (from anecdotal stories) in terms of weight gain. Well, reports on it’s use, where it has been used for sometime, show it to have the *possible* same weight-gain effect as other SSRI’s. Here are a couple of abstracts, and related ones: — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients. CHO craving is an important feature and complication of the treatment of depression and is often ignored. A total of 18 patients were treated with the SSRI citalopram in our mood disorder clinic. In eight cases there was a significant increase in CHO craving together with weight gain shortly after initiation of treatment. The craving for CHO took on a phasic presentation. These cases are presented, together with data on the change in mood and anxiety symptom rating scales. Our observations appear paradoxical, given that serotonin (5-HT) typically mediates a reduction in CHO intake and that citalopram displays potent and select 5-HT-enchancing actions. However, the receptor binding profile of citalopram may predict a risk for inducing this adverse event. These, together with serotonergic, dopaminergic, histaminergic and other possible mechanisms are discussed. A profound influence on patient acceptability was observed, suggesting that the impact on compliance needs to be considered. Publication Types: Clinical trial PMID: 9031994, UI: 97184034 — Clin Neuropharmacol 2000 Mar-Apr;23(2):90-7 Related Articles, Books   Neuropharmacology of paradoxic weight gain with selective serotonin reuptake inhibitors. Harvey BH, Bouwer CD Department of Pharmacology, Potchefstroom University for Christian Higher Education, South Africa. It has been suggested that weight gain associated with tricyclic antidepressants (TCA) reflect actions on dopamine (DA) and histamine receptors. However, a definitive cause is purely assumptive given the nonselective pharmacology of these agents. The selective serotonin reuptake inhibitors (SSRIs), as well as agents like dexfenfluramine (DFF), have emphasized the pivotal role of serotonin (5HT) in reducing carbohydrate (CHO) intake, and have provided a more selective tool with which to study appetite regulation. It would be expected that all SSRIs should exert a similar anorectic action. However, recent reports provide evidence to the contrary. Despite their claimed selectivity, SSRIs still interact, either directly or indirectly, with various critical neurotransmitter systems. In addition, although the anorectic action of fluoxetine (FLX) is well recognized, long-term follow-up studies in depressed patients and in obese nondepressed patients reveal that its weight-reducing effects are transient, even leading to a gain in body weight. Similarly, paroxetine (PRX) and citalopram (CTP) have also been associated with weight gain. These latter observations are unexpected because PRX and CTP are highly potent and selective SSRIs. A neuropharmacologic rationale for the apparent paradoxic effects of SSRIs on appetite not a review of neuronal regulation of appetite is presented in this article. As with the regulation of feeding, paradoxic weight gain observed with SSRIs appears to rest on the interaction of 5HT with multiple mechanisms, with the extent of weight gain observed being dependent on subtle, yet important pharmacologic differences within the group. Finally, the neurobiology of depressive illness itself, and of recovery from it, is a major contributing factor to individual response to these drugs. Publication Types: Review Review, tutorial PMID: 10803799, UI: 20260944 — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients. CHO craving is an important feature and complication of the treatment of depression and is often ignored. A total of 18 patients were treated with the SSRI citalopram in our mood disorder clinic. In eight cases there was a significant increase in CHO craving together with weight gain shortly after initiation of treatment. The craving for CHO took on a phasic presentation. These cases are presented, together with data on the change in mood and anxiety symptom rating scales. Our observations appear paradoxical, given that serotonin (5-HT) typically mediates a reduction in CHO intake and that citalopram displays potent and select 5-HT-enchancing actions. However, the receptor binding profile of citalopram may predict a risk for inducing this adverse event. These, together with serotonergic, dopaminergic, histaminergic and other possible mechanisms are discussed. A profound influence on patient acceptability was observed, suggesting that the impact on compliance needs to be considered. Publication Types: Clinical trial PMID: 9031994, UI: 97184034 —

– There is always music amongst the trees in the garden but our minds must be very still to hear it.

Response:

The Doctors on Dr. Bob’s Psychopharmacology Tips were not impressed by Celexa’s efficacy in depression.  None of them said it was any better than the older SSRIs. – Hide quoted text — Show quoted text – I am not trying to be negative, but just wanted to share my as well as = some general experience with SSRI’s. I thought Celexa would be different = (from anecdotal stories) in terms of weight gain. Well, reports on it’s = use, where it has been used for sometime, show it to have the *possible* = same weight-gain effect as other SSRI’s. Here are a couple of abstracts, = and related ones: — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, = LinkOut =20 Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, = Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and = ancedotally been associated with nausea and weight loss as a side effect = of their action. The tricyclic antidepressants have been linked to = carbohydrate (CHO) craving and weight gain in patients with major = depressive disorders. This side effect has been attributed to the strong = anti-histaminergic actions of these agents and is recognized as a causal = factor of non-compliance in a substantial percentage of patients. CHO = craving is an important feature and complication of the treatment of = depression and is often ignored. A total of 18 patients were treated = with the SSRI citalopram in our mood disorder clinic. In eight cases = there was a significant increase in CHO craving together with weight = gain shortly after initiation of treatment. The craving for CHO took on = a phasic presentation. These cases are presented, together with data on = the change in mood and anxiety symptom rating scales. Our observations = appear paradoxical, given that serotonin (5-HT) typically mediates a = reduction in CHO intake and that citalopram displays potent and select = 5-HT-enchancing actions. However, the receptor binding profile of = citalopram may predict a risk for inducing this adverse event. These, = together with serotonergic, dopaminergic, histaminergic and other = possible mechanisms are discussed. A profound influence on patient = acceptability was observed, suggesting that the impact on compliance = needs to be considered. Publication Types:=20 Clinical trial=20 PMID: 9031994, UI: 97184034=20 — Clin Neuropharmacol 2000 Mar-Apr;23(2):90-7 Related Articles, Books =20 Neuropharmacology of paradoxic weight gain with selective serotonin = reuptake inhibitors. Harvey BH, Bouwer CD Department of Pharmacology, Potchefstroom University for Christian = Higher Education, South Africa. It has been suggested that weight gain associated with tricyclic = antidepressants (TCA) reflect actions on dopamine (DA) and histamine = receptors. However, a definitive cause is purely assumptive given the = nonselective pharmacology of these agents. The selective serotonin = reuptake inhibitors (SSRIs), as well as agents like dexfenfluramine = (DFF), have emphasized the pivotal role of serotonin (5HT) in reducing = carbohydrate (CHO) intake, and have provided a more selective tool with = which to study appetite regulation. It would be expected that all SSRIs = should exert a similar anorectic action. However, recent reports provide = evidence to the contrary. Despite their claimed selectivity, SSRIs still = interact, either directly or indirectly, with various critical = neurotransmitter systems. In addition, although the anorectic action of = fluoxetine (FLX) is well recognized, long-term follow-up studies in = depressed patients and in obese nondepressed patients reveal that its = weight-reducing effects are transient, even leading to a gain in body = weight. Similarly, paroxetine (PRX) and citalopram (CTP) have also been = associated with weight gain. These latter observations are unexpected = because PRX and CTP are highly potent and selective SSRIs. A = neuropharmacologic rationale for the apparent paradoxic effects of SSRIs = on appetite not a review of neuronal regulation of appetite is presented = in this article. As with the regulation of feeding, paradoxic weight = gain observed with SSRIs appears to rest on the interaction of 5HT with = multiple mechanisms, with the extent of weight gain observed being = dependent on subtle, yet important pharmacologic differences within the = group. Finally, the neurobiology of depressive illness itself, and of = recovery from it, is a major contributing factor to individual response = to these drugs. Publication Types:=20 Review=20 Review, tutorial=20 PMID: 10803799, UI: 20260944=20 — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, = LinkOut =20 Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, = Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and = ancedotally been associated with nausea and weight loss as a side effect = of their action. The tricyclic antidepressants have been linked to = carbohydrate (CHO) craving and weight gain in patients with major = depressive disorders. This side effect has been attributed to the strong = anti-histaminergic actions of these agents and is recognized as a causal = factor of non-compliance in a substantial percentage of patients. CHO = craving is an important feature and complication of the treatment of = depression and is often ignored. A total of 18 patients were treated = with the SSRI citalopram in our mood disorder clinic. In eight cases = there was a significant increase in CHO craving together with weight = gain shortly after initiation of treatment. The craving for CHO took on = a phasic presentation. These cases are presented, together with data on = the change in mood and anxiety symptom rating scales. Our observations = appear paradoxical, given that serotonin (5-HT) typically mediates a = reduction in CHO intake and that citalopram displays potent and select = 5-HT-enchancing actions. However, the receptor binding profile of = citalopram may predict a risk for inducing this adverse event. These, = together with serotonergic, dopaminergic, histaminergic and other = possible mechanisms are discussed. A profound influence on patient = acceptability was observed, suggesting that the impact on compliance = needs to be considered. Publication Types:=20 Clinical trial=20 PMID: 9031994, UI: 97184034=20 —

Response:

The Doctors on Dr. Bob’s Psychopharmacology Tips were not impressed by Celexa’s efficacy in depression.  None of them said it was any better than the older SSRIs.

IMO/E, no antidepressant is intrinsically any better than another. But one may be for an individual. Ian

Response:

Hi James, I have been on Paxil with an Ativan at night, if needed.  I am now switching to Zoloft, and am halfway between Paxil and Zoloft…taking a half dose of each.  So far, things have been fine with the switch, so I am hoping for really good things.  I am finding I am less sleepy in the day now that there is less Paxil in my body.  Time will tell how the Zoloft works, once I am just taking that.  Thanks for asking. Take care, Liz – Hide quoted text — Show quoted text – Hi Liz: No problem, as I understand where you are coming from. I am certainley not med free, though. I use a couple of meds, both benzodiazepines, for my anxiety and panic. I am in no position to ever think I will be "med free"…I’ve had to ’start/stop’ many times. I also still use either Doxepin or even Elavil once in awhile for sleep, as well as the occasional pain med. I have NIL problem going back to any med if/when  I do find myself in a really deep, dark situation. My anxiety has been the main element in my depression, though, and even just calming that brings such and *intense* amount of relief. I also still deeply need support, and have always gotten it from here. You will never here any anti-med crud from me, as I know meds are almost priceless at times, especially when you have hit *rock bottom*. Ask Philip about some of my *experiments* with meds…hehe..call me "The Mad Chemist"..lol! Anyhow, thanks, and how about yourself…do you mind if I ask what meds you are on, and how are you finding them? Take care.. James:-) Hi James, I am feeling a lot better about your post, now that you have explained both sides.  I am very sure there are many people who are on an SSRI who don’t need it, and there are a lot of people who are not on SSRIs who DO really need it.  We try really hard to not frighten the new people who are just starting on a med and posting on ASAP for support.  You are right…each person’s biology is different.  I did not respond well to Celexa at all, but many people do well using it. You are also right about the mental illness stigma that needs to change even more in our society than it has.  Things are much better than they used to be, but there is a long way to go. How are you doing now without the meds? Take care, Liz Liz, thanks for responding. I honestly was not trying to turn anybody *off* about Celexa, and you are quite correct, that the MOST important thing is is your good mental health:-) From some of the other stories, and some of the other research, each SSRI does have a fairly different profile, even though they all are classified as "SSRI"s. Celexa *seems* to be good for those who find Paxil TOO sedating, and Prozac and Zoloft too stimulating and anxiety provoking. Again, though, thats a generalization. I must admit, I tolerated the med very well, but it didn’t seem to address both my anxiety and depression also. Mind you, I haven’t really tolerated ANY a.d. very well. But, *that’s me*, so YMMV, etc. I would never discourage anybody from trying it! Our biology is so unique, that’s why I think that even the most *scientific* of psychiatric med studies often go against many peoples experiences. IMHO, though, one of the key factors that NEEDS to change to really take the weight off of mental illness is a change in the larger society’s attitudes and views. But, I know, I am dreaming..heh. James:-) —  "I do not know how to teach philosophy without becoming a disturber  of  the peace." -Baruch Spinoza http://216.32.166.89:11488/ – New World Vibe: 80’s 90’s, Today Post-Modern Pop, Rock, Alternative. Hi James, You are probably right about the weight gain, but I would rather be fat and calm than thin and anxious.  Life is not perfect, meds are not perfect.  I am phobic about meds, but see their need.  Thanks for sharing, but would like to see the other side of your thoughts too, if you have any, about ways they can help us. Take care, Liz I am not trying to be negative, but just wanted to share my as well as some general experience with SSRI’s. I thought Celexa would be different (from anecdotal stories) in terms of weight gain. Well, reports on it’s use, where it has been used for sometime, show it to have the *possible* same weight-gain effect as other SSRI’s. Here are a couple of abstracts, and related ones: — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients. CHO craving is an important feature and complication of the treatment of depression and is often ignored. A total of 18 patients were treated with the SSRI citalopram in our mood disorder clinic. In eight cases there was a significant increase in CHO craving together with weight gain shortly after initiation of treatment. The craving for CHO took on a phasic presentation. These cases are presented, together with data on the change in mood and anxiety symptom rating scales. Our observations appear paradoxical, given that serotonin (5-HT) typically mediates a reduction in CHO intake and that citalopram displays potent and select 5-HT-enchancing actions. However, the receptor binding profile of citalopram may predict a risk for inducing this adverse event. These, together with serotonergic, dopaminergic, histaminergic and other possible mechanisms are discussed. A profound influence on patient acceptability was observed, suggesting that the impact on compliance needs to be considered. Publication Types: Clinical trial PMID: 9031994, UI: 97184034 — Clin Neuropharmacol 2000 Mar-Apr;23(2):90-7 Related Articles, Books   Neuropharmacology of paradoxic weight gain with selective serotonin reuptake inhibitors. Harvey BH, Bouwer CD Department of Pharmacology, Potchefstroom University for Christian Higher Education, South Africa. It has been suggested that weight gain associated with tricyclic antidepressants (TCA) reflect actions on dopamine (DA) and histamine receptors. However, a definitive cause is purely assumptive given the nonselective pharmacology of these agents. The selective serotonin reuptake inhibitors (SSRIs), as well as agents like dexfenfluramine (DFF), have emphasized the pivotal role of serotonin (5HT) in reducing carbohydrate (CHO) intake, and have provided a more selective tool with which to study appetite regulation. It would be expected that all SSRIs should exert a similar anorectic action. However, recent reports provide evidence to the contrary. Despite their claimed selectivity, SSRIs still interact, either directly or indirectly, with various critical neurotransmitter systems. In addition, although the anorectic action of fluoxetine (FLX) is well recognized, long-term follow-up studies in depressed patients and in obese nondepressed patients reveal that its weight-reducing effects are transient, even leading to a gain in body weight. Similarly,

… read more »

Response:

Hi Liz: No problem, as I understand where you are coming from. I am certainley not med free, though. I use a couple of meds, both benzodiazepines, for my anxiety and panic. I am in no position to ever think I will be "med free"…I’ve had to ’start/stop’ many times. I also still use either Doxepin or even Elavil once in awhile for sleep, as well as the occasional pain med. I have NIL problem going back to any med if/when  I do find myself in a really deep, dark situation. My anxiety has been the main element in my depression, though, and even just calming that brings such and *intense* amount of relief. I also still deeply need support, and have always gotten it from here. You will never here any anti-med crud from me, as I know meds are almost priceless at times, especially when you have hit *rock bottom*. Ask Philip about some of my *experiments* with meds…hehe..call me "The Mad Chemist"..lol! Anyhow, thanks, and how about yourself…do you mind if I ask what meds you are on, and how are you finding them? Take care.. James:-) – Hide quoted text — Show quoted text – Hi James, I am feeling a lot better about your post, now that you have explained both sides.  I am very sure there are many people who are on an SSRI who don’t need it, and there are a lot of people who are not on SSRIs who DO really need it.  We try really hard to not frighten the new people who are just starting on a med and posting on ASAP for support.  You are right…each person’s biology is different.  I did not respond well to Celexa at all, but many people do well using it. You are also right about the mental illness stigma that needs to change even more in our society than it has.  Things are much better than they   used to be, but there is a long way to go. How are you doing now without the meds? Take care, Liz Liz, thanks for responding. I honestly was not trying to turn anybody *off* about Celexa, and you are quite correct, that the MOST important thing is is your good mental health:-) From some of the other stories, and some of the other research, each SSRI does have a fairly different profile, even though they all are classified as "SSRI"s. Celexa *seems* to be good for those who find Paxil TOO sedating, and Prozac and Zoloft too stimulating and anxiety provoking. Again, though, thats a generalization. I must admit, I tolerated the med very well, but it didn’t seem to address both my anxiety and depression also. Mind you, I haven’t really tolerated ANY a.d. very well. But, *that’s me*, so YMMV, etc. I would never discourage anybody from trying it! Our biology is so unique, that’s why I think that even the most *scientific* of psychiatric med studies often go against many peoples experiences. IMHO, though, one of the key factors that NEEDS to change to really take the weight off of mental illness is a change in the larger society’s attitudes and views. But, I know, I am dreaming..heh. James:-) —  "I do not know how to teach philosophy without becoming a disturber of  the peace." -Baruch Spinoza http://216.32.166.89:11488/ – New World Vibe: 80’s 90’s, Today Post-Modern Pop, Rock, Alternative. Hi James, You are probably right about the weight gain, but I would rather be fat and calm than thin and anxious.  Life is not perfect, meds are not perfect.  I am phobic about meds, but see their need.  Thanks for sharing, but would like to see the other side of your thoughts too, if you have any, about ways they can help us. Take care, Liz I am not trying to be negative, but just wanted to share my as well as some general experience with SSRI’s. I thought Celexa would be different (from anecdotal stories) in terms of weight gain. Well, reports on it’s use, where it has been used for sometime, show it to have the *possible* same weight-gain effect as other SSRI’s. Here are a couple of abstracts, and related ones: — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients. CHO craving is an important feature and complication of the treatment of depression and is often ignored. A total of 18 patients were treated with the SSRI citalopram in our mood disorder clinic. In eight cases there was a significant increase in CHO craving together with weight gain shortly after initiation of treatment. The craving for CHO took on a phasic presentation. These cases are presented, together with data on the change in mood and anxiety symptom rating scales. Our observations appear paradoxical, given that serotonin (5-HT) typically mediates a reduction in CHO intake and that citalopram displays potent and select 5-HT-enchancing actions. However, the receptor binding profile of citalopram may predict a risk for inducing this adverse event. These, together with serotonergic, dopaminergic, histaminergic and other possible mechanisms are discussed. A profound influence on patient acceptability was observed, suggesting that the impact on compliance needs to be considered. Publication Types: Clinical trial PMID: 9031994, UI: 97184034 — Clin Neuropharmacol 2000 Mar-Apr;23(2):90-7 Related Articles, Books   Neuropharmacology of paradoxic weight gain with selective serotonin reuptake inhibitors. Harvey BH, Bouwer CD Department of Pharmacology, Potchefstroom University for Christian Higher Education, South Africa. It has been suggested that weight gain associated with tricyclic antidepressants (TCA) reflect actions on dopamine (DA) and histamine receptors. However, a definitive cause is purely assumptive given the nonselective pharmacology of these agents. The selective serotonin reuptake inhibitors (SSRIs), as well as agents like dexfenfluramine (DFF), have emphasized the pivotal role of serotonin (5HT) in reducing carbohydrate (CHO) intake, and have provided a more selective tool with which to study appetite regulation. It would be expected that all SSRIs should exert a similar anorectic action. However, recent reports provide evidence to the contrary. Despite their claimed selectivity, SSRIs still interact, either directly or indirectly, with various critical neurotransmitter systems. In addition, although the anorectic action of fluoxetine (FLX) is well recognized, long-term follow-up studies in depressed patients and in obese nondepressed patients reveal that its weight-reducing effects are transient, even leading to a gain in body weight. Similarly, paroxetine (PRX) and citalopram (CTP) have also been associated with weight gain. These latter observations are unexpected because PRX and CTP are highly potent and selective SSRIs. A neuropharmacologic rationale for the apparent paradoxic effects of SSRIs on appetite not a review of neuronal regulation of appetite is presented in this article. As with the regulation of feeding, paradoxic weight gain observed with SSRIs appears to rest on the interaction of 5HT with multiple mechanisms, with the extent of weight gain observed being dependent on subtle, yet important pharmacologic differences within the group. Finally, the neurobiology of depressive illness itself, and of recovery from it, is a major contributing factor to individual response to these drugs. Publication Types: Review Review, tutorial PMID: 10803799, UI: 20260944 — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School,

… read more »

Response:

Hi James, I am feeling a lot better about your post, now that you have explained both sides.  I am very sure there are many people who are on an SSRI who don’t need it, and there are a lot of people who are not on SSRIs who DO really need it.  We try really hard to not frighten the new people who are just starting on a med and posting on ASAP for support.  You are right…each person’s biology is different.  I did not respond well to Celexa at all, but many people do well using it. You are also right about the mental illness stigma that needs to change even more in our society than it has.  Things are much better than they   used to be, but there is a long way to go. How are you doing now without the meds? Take care, Liz – Hide quoted text — Show quoted text – Liz, thanks for responding. I honestly was not trying to turn anybody *off* about Celexa, and you are quite correct, that the MOST important thing is is your good mental health:-) From some of the other stories, and some of the other research, each SSRI does have a fairly different profile, even though they all are classified as "SSRI"s. Celexa *seems* to be good for those who find Paxil TOO sedating, and Prozac and Zoloft too stimulating and anxiety provoking. Again, though, thats a generalization. I must admit, I tolerated the med very well, but it didn’t seem to address both my anxiety and depression also. Mind you, I haven’t really tolerated ANY a.d. very well. But, *that’s me*, so YMMV, etc. I would never discourage anybody from trying it! Our biology is so unique, that’s why I think that even the most *scientific* of psychiatric med studies often go against many peoples experiences. IMHO, though, one of the key factors that NEEDS to change to really take the weight off of mental illness is a change in the larger society’s attitudes and views. But, I know, I am dreaming..heh. James:-) —  "I do not know how to teach philosophy without becoming a disturber of  the peace." -Baruch Spinoza http://216.32.166.89:11488/ – New World Vibe: 80’s 90’s, Today Post-Modern Pop, Rock, Alternative. Hi James, You are probably right about the weight gain, but I would rather be fat and calm than thin and anxious.  Life is not perfect, meds are not perfect.  I am phobic about meds, but see their need.  Thanks for sharing, but would like to see the other side of your thoughts too, if you have any, about ways they can help us. Take care, Liz I am not trying to be negative, but just wanted to share my as well as some general experience with SSRI’s. I thought Celexa would be different (from anecdotal stories) in terms of weight gain. Well, reports on it’s use, where it has been used for sometime, show it to have the *possible* same weight-gain effect as other SSRI’s. Here are a couple of abstracts, and related ones: — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients. CHO craving is an important feature and complication of the treatment of depression and is often ignored. A total of 18 patients were treated with the SSRI citalopram in our mood disorder clinic. In eight cases there was a significant increase in CHO craving together with weight gain shortly after initiation of treatment. The craving for CHO took on a phasic presentation. These cases are presented, together with data on the change in mood and anxiety symptom rating scales. Our observations appear paradoxical, given that serotonin (5-HT) typically mediates a reduction in CHO intake and that citalopram displays potent and select 5-HT-enchancing actions. However, the receptor binding profile of citalopram may predict a risk for inducing this adverse event. These, together with serotonergic, dopaminergic, histaminergic and other possible mechanisms are discussed. A profound influence on patient acceptability was observed, suggesting that the impact on compliance needs to be considered. Publication Types: Clinical trial PMID: 9031994, UI: 97184034 — Clin Neuropharmacol 2000 Mar-Apr;23(2):90-7 Related Articles, Books   Neuropharmacology of paradoxic weight gain with selective serotonin reuptake inhibitors. Harvey BH, Bouwer CD Department of Pharmacology, Potchefstroom University for Christian Higher Education, South Africa. It has been suggested that weight gain associated with tricyclic antidepressants (TCA) reflect actions on dopamine (DA) and histamine receptors. However, a definitive cause is purely assumptive given the nonselective pharmacology of these agents. The selective serotonin reuptake inhibitors (SSRIs), as well as agents like dexfenfluramine (DFF), have emphasized the pivotal role of serotonin (5HT) in reducing carbohydrate (CHO) intake, and have provided a more selective tool with which to study appetite regulation. It would be expected that all SSRIs should exert a similar anorectic action. However, recent reports provide evidence to the contrary. Despite their claimed selectivity, SSRIs still interact, either directly or indirectly, with various critical neurotransmitter systems. In addition, although the anorectic action of fluoxetine (FLX) is well recognized, long-term follow-up studies in depressed patients and in obese nondepressed patients reveal that its weight-reducing effects are transient, even leading to a gain in body weight. Similarly, paroxetine (PRX) and citalopram (CTP) have also been associated with weight gain. These latter observations are unexpected because PRX and CTP are highly potent and selective SSRIs. A neuropharmacologic rationale for the apparent paradoxic effects of SSRIs on appetite not a review of neuronal regulation of appetite is presented in this article. As with the regulation of feeding, paradoxic weight gain observed with SSRIs appears to rest on the interaction of 5HT with multiple mechanisms, with the extent of weight gain observed being dependent on subtle, yet important pharmacologic differences within the group. Finally, the neurobiology of depressive illness itself, and of recovery from it, is a major contributing factor to individual response to these drugs. Publication Types: Review Review, tutorial PMID: 10803799, UI: 20260944 — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients. CHO craving is an important feature and complication of the treatment of depression and is often ignored. A total of 18 patients were treated with the SSRI citalopram in our mood disorder clinic. In eight cases there was a significant increase in CHO craving together with weight gain shortly after initiation of treatment. The craving for CHO took on a phasic presentation. These cases are presented, together with data on the change in mood and anxiety symptom rating scales. Our observations appear paradoxical, given that serotonin (5-HT) typically mediates a reduction in CHO intake and that citalopram displays potent and select 5-HT-enchancing actions. However, the receptor binding profile of citalopram may predict a risk for inducing this adverse event. These, together with serotonergic, dopaminergic, histaminergic and other

… read more »

Response:

I am not trying to be negative, but just wanted to share my as well as some general experience with SSRI’s. I thought Celexa would be different (from anecdotal stories) in terms of weight gain. Well, reports on it’s use, where it has been used for sometime, show it to have the *possible* same weight-gain effect as other SSRI’s. Here are a couple of abstracts, and related ones: I haven’t really noticed this, but I certainly appreciate your perspective. Darren.

Response:

Liz, thanks for responding. I honestly was not trying to turn anybody *off* about Celexa, and you are quite correct, that the MOST important thing is is your good mental health:-) From some of the other stories, and some of the other research, each SSRI does have a fairly different profile, even though they all are classified as "SSRI"s. Celexa *seems* to be good for those who find Paxil TOO sedating, and Prozac and Zoloft too stimulating and anxiety provoking. Again, though, thats a generalization. I must admit, I tolerated the med very well, but it didn’t seem to address both my anxiety and depression also. Mind you, I haven’t really tolerated ANY a.d. very well. But, *that’s me*, so YMMV, etc. I would never discourage anybody from trying it! Our biology is so unique, that’s why I think that even the most *scientific* of psychiatric med studies often go against many peoples experiences. IMHO, though, one of the key factors that NEEDS to change to really take the weight off of mental illness is a change in the larger society’s attitudes and views. But, I know, I am dreaming..heh. James:-) —  "I do not know how to teach philosophy without becoming a disturber of the peace." -Baruch Spinoza http://216.32.166.89:11488/ – New World Vibe: 80’s 90’s, Today Post-Modern Pop, Rock, Alternative. – Hide quoted text — Show quoted text – Hi James, You are probably right about the weight gain, but I would rather be fat and calm than thin and anxious.  Life is not perfect, meds are not perfect.  I am phobic about meds, but see their need.  Thanks for sharing, but would like to see the other side of your thoughts too, if you have any, about ways they can help us. Take care, Liz I am not trying to be negative, but just wanted to share my as well as some general experience with SSRI’s. I thought Celexa would be different (from anecdotal stories) in terms of weight gain. Well, reports on it’s use, where it has been used for sometime, show it to have the *possible* same weight-gain effect as other SSRI’s. Here are a couple of abstracts, and related ones: — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients. CHO craving is an important feature and complication of the treatment of depression and is often ignored. A total of 18 patients were treated with the SSRI citalopram in our mood disorder clinic. In eight cases there was a significant increase in CHO craving together with weight gain shortly after initiation of treatment. The craving for CHO took on a phasic presentation. These cases are presented, together with data on the change in mood and anxiety symptom rating scales. Our observations appear paradoxical, given that serotonin (5-HT) typically mediates a reduction in CHO intake and that citalopram displays potent and select 5-HT-enchancing actions. However, the receptor binding profile of citalopram may predict a risk for inducing this adverse event. These, together with serotonergic, dopaminergic, histaminergic and other possible mechanisms are discussed. A profound influence on patient acceptability was observed, suggesting that the impact on compliance needs to be considered. Publication Types: Clinical trial PMID: 9031994, UI: 97184034 — Clin Neuropharmacol 2000 Mar-Apr;23(2):90-7 Related Articles, Books   Neuropharmacology of paradoxic weight gain with selective serotonin reuptake inhibitors. Harvey BH, Bouwer CD Department of Pharmacology, Potchefstroom University for Christian Higher Education, South Africa. It has been suggested that weight gain associated with tricyclic antidepressants (TCA) reflect actions on dopamine (DA) and histamine receptors. However, a definitive cause is purely assumptive given the nonselective pharmacology of these agents. The selective serotonin reuptake inhibitors (SSRIs), as well as agents like dexfenfluramine (DFF), have emphasized the pivotal role of serotonin (5HT) in reducing carbohydrate (CHO) intake, and have provided a more selective tool with which to study appetite regulation. It would be expected that all SSRIs should exert a similar anorectic action. However, recent reports provide evidence to the contrary. Despite their claimed selectivity, SSRIs still interact, either directly or indirectly, with various critical neurotransmitter systems. In addition, although the anorectic action of fluoxetine (FLX) is well recognized, long-term follow-up studies in depressed patients and in obese nondepressed patients reveal that its weight-reducing effects are transient, even leading to a gain in body weight. Similarly, paroxetine (PRX) and citalopram (CTP) have also been associated with weight gain. These latter observations are unexpected because PRX and CTP are highly potent and selective SSRIs. A neuropharmacologic rationale for the apparent paradoxic effects of SSRIs on appetite not a review of neuronal regulation of appetite is presented in this article. As with the regulation of feeding, paradoxic weight gain observed with SSRIs appears to rest on the interaction of 5HT with multiple mechanisms, with the extent of weight gain observed being dependent on subtle, yet important pharmacologic differences within the group. Finally, the neurobiology of depressive illness itself, and of recovery from it, is a major contributing factor to individual response to these drugs. Publication Types: Review Review, tutorial PMID: 10803799, UI: 20260944 — Int Clin Psychopharmacol 1996 Dec;11(4):273-8 Related Articles, Books, LinkOut   Phasic craving for carbohydrate observed with citalopram. Bouwer CD, Harvey BH Department of Psychiatry, University of Stellenbosch Medical School, Tygerberg, Republic of South Africa. The serotonin selective reuptake inhibitors (SSRIs) have clinically and ancedotally been associated with nausea and weight loss as a side effect of their action. The tricyclic antidepressants have been linked to carbohydrate (CHO) craving and weight gain in patients with major depressive disorders. This side effect has been attributed to the strong anti-histaminergic actions of these agents and is recognized as a causal factor of non-compliance in a substantial percentage of patients. CHO craving is an important feature and complication of the treatment of depression and is often ignored. A total of 18 patients were treated with the SSRI citalopram in our mood disorder clinic. In eight cases there was a significant increase in CHO craving together with weight gain shortly after initiation of treatment. The craving for CHO took on a phasic presentation. These cases are presented, together with data on the change in mood and anxiety symptom rating scales. Our observations appear paradoxical, given that serotonin (5-HT) typically mediates a reduction in CHO intake and that citalopram displays potent and select 5-HT-enchancing actions. However, the receptor binding profile of citalopram may predict a risk for inducing this adverse event. These, together with serotonergic, dopaminergic, histaminergic and other possible mechanisms are discussed. A profound influence on patient acceptability was observed, suggesting that the impact on compliance needs to be considered. Publication Types: Clinical trial PMID: 9031994, UI: 97184034 — — There is always music amongst the trees in the garden but our minds must be very still to hear it.

Response:

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