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Treatment Guidelines

Why Some Medications Cause Weight Gain:

Most of the medications that are used to treat psychiatric disorders have weight gain as a side effect. This is secondary to a couple of things. First, many of them stimulate the appetite a great deal. This generally isn’t something that is temporary, although it can be with some medications and with some people. Another source of the problem is suppression of satiety, the quality of knowing one is ‘full’. When satiation is suppressed, this can be in varying degrees. With mild forms, it can just cause overeating at meals. When it is severe, hunger is present at all times, regardless of how much is eaten, how full the stomach is or what type of foods are eaten. This can produce copious weight gain along with possibility of stressing the diaphragm causing reflux and/or hiatal hernia, with reflux being quite common. As you can imagine, these factors can present a number of problems beyond weight gain. You may be aware that recent studies have linked Type II Diabetes with long term use of some psychiatric medications, particularly in children. This along with the typical stress that is placed on the human body when overweight or obese can be very problematic for the long term health of our children. For this reason, we will look at some of the things we can do to help avoid or reduce weight gain in our children taking medications that are causing these side effects.

 Non Medication

 Some families have had success with requiring the children to do 30 minutes each weekday of aerobic or strength exercise. Some have found they must continually provide new options to keep the children's interest up. Some options could include:

·         Stationary bike in front of the TV

·         Dance Dance Revolution game

·         Tae Bo Videos

·         Jogging

·         Weight Machine 

·         Basketball (a hoop in front of the house)

·         Bike riding

·         Chin ups (bar in the bedroom door)

·         Sit ups

·         Push ups (these 3 we tried to continually "beat the clock" or "do more than before")

·         Tae Kwon Do (for kids who have not had physical aggression issues)

Generally things that are not competitive with other people are better choices than activities that have intense competition with other youth. Developing an active lifestyle can go a long way toward controlling weight problems.

Another tactic is to change shopping habits. Don't buy deserts or cookies any more. Provide high protein snacks because that helps fill them up more than chips and other carbs, and provides a longer lasting source of energy than carbs. Soda and juice are generally high in calories and low in nutrition, so by drinking water you can eliminate many calories without much effort. 
 

It's always good to ask the pediatrician or psychiatrist if they have further ideas that could help in your child's specific case. There are no known risks to healthy diet and increased exercise, unlike some of our other options.  

Medication

Sometimes medications are used to help alleviate, avoid or otherwise inhibit the undesirable weight gain side effects of psychiatric medications. The following medications have been used with mixed results.

Acid Blockers-Zantac, Pepcid AC, Axid

Acid Blocker Abstract

Reducing the acid production can help reduce the appetite for some people. It also reduces the incidence of heartburn associated with gastric reflux. Anecdotal reports, but not double blind randomized studies; indicate starting Axid at the same time as initiating treatment with Zyprexa can prevent the usual suppression of satiety that occurs in most cases with Zyprexa treatment. Caution should be used as there are some reports of these medications interfering with the absorption of other meds.

Glucophage (metformin)    

Glucophage Abstract

Anecdotal reports have shown metformin can help with weight loss in some children. How this works is not certain. It is possible that this happens due to the common side effects of increased GI motility causing chronic diarrhea. For nutrient absorption however, this is not good, especially for growing children. Additionally, there is consideration within the medical community of adding another classification of ‘pre-diabetes’ to address the borderline or at risk population of people. Because metformin’s action doesn’t directly affect glucose levels, rather it reduces insulin intolerance, it is considered safe to dose in those who fit this newly forming and still unclearly defined category of pre-diabetes patients. The idea is to treat proactively. Whether this is something to consider for your child is between you and your child’s doctor and likely requires consult with an endocrinologist, not just a decision by the pediatrician or psychiatrist.    

 Topamax    

Topamax and Weight

This medication has been shown to help with weight gain when used as an adjunct in the medication cocktail. It tends to suppress appetite in many people, thus balancing the increased appetite side effects of other medications. The downside to this medication is that it is very often quite cognitively dulling, a very undesirable side effect.