Depression Drugs

Hi Folks

I am heading back to the doctor's this week.  I am very depressed and am finally giving in and getting a prescription for depression.  My homework before seeing her was to find out what depression drugs we can take.  I am a RNY patient.  My doctor does not know much about the surgery, so is basing her prescription on my help.

So please help me and also I really don't want to gain any more weight back than I have so if there is a prescription that increases appetite I don't need it.

Thanks for your help.

We don't absorb extended release meds well but can take any other depression meds.

Your doctor should be aware of common side effects of antidepressants, including which ones often cause weight gain.  If she isn't aware of basic stuff like that, then I would find a psychiatrist that is aware of at least the basics.

My psychiatrist is off right now, so I had to go see a GP.  She is very willing to help but is concerned about the WLS info.

Do you know if Prozac is good for you or Celexa or Effexor.  I really don't want the weight gain.  Thanks poet-kelly

I know that Effexor comes in a non-extended release version but I also know it causes weight gain in some people.  Not in everyone, though.

Your GP should have a book called a Physician's Desk Reference in which she can look up all the potential side effects of meds before prescribing them.  You can ask her to check her PDR for info.  Whether or not a drug causes weight gain has nothing to do with WLS, though.  It can have that effect on anyone, even if they have never had WLS.

It's up to you, of course, but I would feel uncomfortable having a doc prescribe powerful drugs with potentially serious side effects for me if the doctor was not even familiar with basic side effects of the drugs.  Again, the side effects are the same whether you've had WLS or not, so the fact that she doesn't know a lot about WLS doesn't mean she should not be familiar with the basic side effects.  I think it's kind of irresponsible for a doctor to prescribe drugs they are not familiar with, but even if doctors are willing to prescribe meds they know little or nothing about, I don't want them prescribing those drugs to me.  I would find another doctor that is at least familiar with the basics regarding antidepressants.

I've had no trouble at all with my Cymbalta. 

I take Zoloft, have for many years, and did not have the weight gain side effect. 

You will definitely want to avoid any extended or controlled release medications.  Some people use them after RNY without any problem, but Tjose are usually people who were on them prior to surgery.  Since there is no way to know how much of the dose you are absorbing, finding a dosage that works for you is even more difficult than it can be for people who have NOT had RNY.

My PhD program required a course on psycho-pharmaceuticals.  The bottom line is that there are a couple of drugs which physically increase appetite (e.g., as oral steroids do), but MOST antidepressants do not do that.  Some do slow the metabolism a bit, however.  Many people who experience weight gain on antidepressants do so simply because when they start to feel better they eat more.  

Remeron is by far the worst when it comes to weight gain (but it has the advantages of also aiding with sleep and NOT having the sexual side effects that the SSRIs have).  It is unlikely that your PCP has even heard of it, but if (s)he suggests it, say NO.  

Of the SSRIs, Paxil is the most likely to cause weight gain; Prozac and Lexapro are the least likely (Prozac actually sometimes results in weight loss) and are often categorized as weight-neutral. Celexa and Zoloft are in the middle of the pack.  

Of the newer SNRIs, Celexa and Effexor (the two most widely prescribed) are both considered weight-neutral.  

Keep in mind, though, that the incidence of significant weight gain even with Paxil is relatively low.  In one study, 14% of participants gained more than 7%  of their body weight and in another study it was just under 20%.  Usually, however, the amount of weight gained is relatively low (3.5% of body weight increase in one study and 4% in another for Paxil, but only 1-2% with Zoloft).  So if you weigh 150 pounds, the average weight gain with Zoloft (and, similarly, Celexa) would be less than 5 pounds and under 10 pounds even with Paxil.   

I hope that helps!  

Lora

You might be interested in an article about psychobiotics that I saw on popsci.com. They posted it on Facebook the other day so it's probably still featured on the website. 

thanks Lora, let's put it this way...If someone's metabolism is going to slow down it would be mine.  That is just the way it is with me. Poet Kelly  My GP does know alot about the SNRI's but she is concerned about the WLS aspect.  She wants to be sure she is prescribing me the right one.  I really respect her for being concerned and wanting what is best for me.

I wonder if I am being just lazy and am I thinking taking a drug will help.  I don't know. 

Often, people who are experiencing clinical depression need the medication to help them get to a level of functioning that enables them to think more clearly (outside the fog of depression that makes everything seem so hopeless and futile) and reach a point where they can reach it for help and then address the root of the depression.  Some depression is organic, but most of the time there are underlying issues that therapy/counseling can help with.

I have serious concerns about doctors (whether they be PCPs or Psychiatrists) who will prescribe anti-depressants for patients for years and years and years without requiring them to also see someone for counseling (very few Psychiatrists do actual counseling; they only want to know enough about what is going on so that they can determine what medication might be most useful).

Finding the right medication, even with a Psychiatrist, is trial and error because people react so very differently to this class of drugs, and since most medications take several weeks to fully "kick in", it can be a long process.  Personally, unless you can get in to see another Psychiatrist right away, I would let your PCP start you on something, and then when you can get in to see the Psych, (s)he can determine how much it is helping you and whether something else might be more appropriate. Doing nothing is just delaying getting some relief, and the depression may worsen.

Lora