Talking about and tracking weight gain with regards to psychiatric medication isn’t fun. My guess is that talking about and tracking weight gain isn’t fun even for psychiatrists. Nevertheless, it seems to me like it’s part of their job. There are lots of “not fun” parts of their job that they seem to manage just fine, but this isn’t one of them. So why is it that psychiatrists don’t talk about or even track weight gain on psych meds?
Weight Gain on Psych Meds
Most people who have been on psych meds know: weight gain is a reality. Weight gain is especially a brutal reality on antipsychotic meds, which are being prescribed more and more for more and more reasons (sleep, depression, bipolar disorder, schizophrenia, etc.). And, of course, you can also experience weight gain on anticonvulsants and antidepressants too.
And, honestly, there is a paucity of data on real-world experiences with weight gain and psychiatric meds. The research I’ve seen almost always underestimates the risk of weight gain when compared to what people tell me and what I’ve experienced. Now, I’m a research girl. I like research. I believe research. But in the case of specific risks and specific pounds gained, it’s hard to find good data because no one really has an interest in getting it. After all, it’s not like drug manufacturers want to shine a light on that.
However, incidence of weight gain and weight gain-related adverse effects are generally available when you look at a specific medication.
One of the biggest offenders when it comes to weight gain in psych drugs is olanzapine (Zyprexa; an antipsychotic). Between 5 and 40% of people experienced weight gain on this psychiatric medication (it was dose dependent). Additionally, the following were also commonly experienced (and are related to weight gain):
- Hypertriglyceridemia (high levels of fat in the blood; ≤39% )
- Hypercholesterolemia (high cholesterol; ≤39%)
- Hyperglycemia (high blood sugar; 12.8%)
Absolutely every psychiatrist knows about the risks of weight gain in psychiatric medication. (Hopefully every patient does too.)
Talking About, Tracking Weight Gain on Psych Meds
And I have gained lots of weight on psychiatric medication. Over the course of 2.5 years when auditioning antipsychotics, I went from a size 10 to a size 18. That is not a small jump. That is noticeable to the eye and everything else. And not one psychiatrist ever talked about or tracked my weight gain.
And here’s the thing about being unbelievably ill: you might not notice yourself. You might even not care because you’re too sick to care about anything. That’s what a doctor is there for. A psychiatrist should be caring for your health when you can’t. That’s the whole freaking point.
A psychiatrist should at least be talking about weight gain on psychiatric medication even if they aren’t tracking it pound by pound. And they should be ordering blood tests to check things like blood sugar and cholesterol levels that can also be negatively impacted by these medications.
But so often they don’t. They are silent. The scale in their office remains unused.
Why Aren’t Psychiatrists Talking About, Tracking Weight Gain on Psych Meds?
It’s a complicated thing, I’m sure.
First, women especially are sensitive about their weight. This means that many people don’t want to bring up weight gain no matter what. I don’t know if this enters a psychiatrist’s mind or not. But maybe.
But what I think it really comes down to is this: psychiatrists only care that you’re not dead. If you’re working, you’re eating, you’re breathing — their job is done.
This is incredibly pathetic as a psychiatrist should be concerned about your quality of life and your quality of life is definitely impacted if you gain too much weight or end up with high blood sugar or cholesterol.
Now, I don’t believe that gaining five pounds is a big deal and I think that some people overreact to small amounts of weight gain. That said, when you start gaining more and more dress sizes, it needs to be discussed and tracked.
Don’t get me wrong — major weight gain might be worth it for you if it’s the only medication that works and it’s giving you a life. That’s totally possible.
It’s also totally possible that the negative impacts on your weight and aspects of your health will actually negatively impact your mental health too. This puts is squarely in a psychiatrist’s purview.
But psychiatrists don’t seem to be taking responsibility for that. They seem very uncaring and hands-off about weight gain on psych meds.
What to Do About Psychiatrists Not Talking About, Tracking Weight Gain on Psych Meds
Unfortunately, this is yet another area where we have to advocate for ourselves. Even though we’re the sick ones. Even though we’re the ones with brain disorders. We still have to be the ones to track our weight gain and ask for blood panels to check our health there too. I hate this. I hate that we have to take responsibility in this way. But we do.
So if you’re on psych meds and experiencing weight gain, you need to:
- Track your weight gain either on the scale (probably best) or by how your clothes fit. (Don’t obsess over it. Weight yourself every week, not every day.)
- Decide how much weight gain is reasonable for you. (Remember, we all experience side effects and some weight gain is worth it if it’s keeping you sane, stable and functional. You may have to accept some weight gain.)
- Discuss this with your psychiatrist; learn if your expectations are reasonable; listen to what he or she has to say about it.
- Make a plan as to how to protect your health — for example, by ordering blood panels every six months.
- Consider changing your medication dose or type depending on your test results or weight gain.
And finally, just because your psychiatrist isn’t talking about weight gain on psych meds doesn’t mean that you shouldn’t. We are our own best advocates and we know what we need and want. Communicate this. Be proactive. Because losing weight is so much harder than not gaining it in the first place.
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Before all this mess took place, of my own volition I’d gone to see a counsellor which I did no find the least bit helpful, so then I called a local mental health clinic, again on my own, for a psych assessment. The pdoc there believed a might have bipolar 2 but was not willing to take me on as a patient at that point. I was clearly looking for help but to no avail
What I’ve come to learn is that unless you are lucky enough to find good quality help, you are pretty much on your own
For about a year I went to my GP’s office and saw locum after locum looking for help for my severe anxiety & depression. Never was I ever referred to a psychologist or psychiatrist. Eventually I voluntarily took myself to the ER looking for help but was only given a very low dose of lamictal, a few sleeping pills and a couple of ativan and told to go back to my GP! My regular GP was on sick leave, the result of car accident. Eventually she had to retire early because of her injuries.
She then sold her practice to another GP who after only 2 visits had me involuntarily committed mistakenly believing I was suffering from mania and psychotic depression. Looking back there is no doubt in my mind that my extremely toxic control freak of mother had a hand in all this! My GP’s permanent replacement called the police to her office to take me away. NO, I was not physically or verbally abusive at any point. NO I was not handcuffed. I walked calmly with an officer to his car, feeling utterly humiliated betrayed, defeated and severely tramatized by the so called help I had received
At the hospital I was rediculously overmedicated. At that point I didn’t have the energy to care whether I lived or died. Because of my extremely dysfunctional family upbring I had previously developed what Martin Seligmam calls “learned helplessness” long before this incidence!
When I got out of hospital I was immediately got hooked up with a psychiatrist for aftercare . The pdoc put me on a number of different meds that did absolutely nothing to help with my depression. All they did was suck the life out of me and cause me to balloon up to 303 God damned pounds!!! The pdoc’s solution to all this was to sign me up for $250 worth of free passes at a local recreation centre. The pdoc led me to believe I was responsible for the massive weight gain and that I could somehow fucking exercise the bloody weight off even though I had though I had bitterly complained over and over again of being too tired to move after a full days work. I would literally fell into bed at 6:30 PM every night. I’d later learn that I had also developed “metabolic syndrome” as a result of all the medication I’d beeing put on, namely antipsychotic meds which made it near impossible to loose any weight.
Eventually I weaned myself off everything except the lamical (while still under a pdocs care, although I didn’t tell him until much later). I’d also put myself on a crash diet. I lived off of one powered protein drink and salad every day – less than 500 calories a day – and did water aerobics a few times a week. I lost nearly 90 pounds in 9 months, felt dizzy all the time, had leg cramps all the time, especially after thecwater aerobics, and lost massive amounts of hair. It was only after I was praised for the results that I came clean about what I’d done at which point I was surpringly booted back to my GP instead of the pdoc dealing with my eating disorder! How irresponsible knowinf full well that eating disorders have the highest mortality rate of any mental illness!
They don’t care about your weight because they cannot be sued for it. If you gain 100 pounds “that’s on you.” But if you do not take meds and you harm yourself or someone else, that’s on them. There’s little incentive to warn you of massive weight gain because you may be someone who does not gain any weight (or not much weight) and then they’d be warning you for nothing. Their objective is to get you to take the drugs, so warnings don’t accomplish that objective. Why would they make their own lives harder? They’re looking out for number One, and number one is not you!!
Hi Natasha,
Every psychiatrist I have ever had has tracked my weight gain. They have been concerned with it, worried about it, and yes, checked it in every appointment. They also tracked blood sugar and cholesterol levels. This doesn’t mean such side effects were prevented – I gained 100 lbs on Seroquel and ended up with diabetes. Tracking isn’t the cure-all. I can see how it would be frustrating for these concerns to be ignored, but you can bring these up yourself, and good psychiatrists would know to check.
I was diagnosed BPII 15 years ago have been battling with my VA doc for awhile now regarding anti-psychotic/mania meds. I’ve refused to take any of them because of the side effects. I tried Depakote and Lithium years ago but couldn’t stand them. A friend told me about lithium orotate (OTC lithium) and so far it’s worked really well with basically no side effects. I don’t typically have hypomanic episodes until spring/summer roll around so I’m not sure if this will work for mania but I’m praying it will. I have also been taking an Omega 3 high in DHA which is also helping. I’ve become a lot more stable and better over the years but my mania last summer really hit me hard. I got a new job, celebrated a year sober from alcohol and had my 40th bday all in a span of about a month. Turned out to be the worst episode I’ve ever had since I’ve been diagnosed. The thought of having to live with this illness the rest of my life is devastating and I’m not sure I can do it for another 30 years, especially if I’m alone.
In my experience Dr., psychiatrists especially, don’t mention ALOT OF THINGS! Just the act of admitting the weight gain aspect will open the door to having to admit the multitude of the other problems with medications. It’s not only weight gain, it’s tardive dyskinesia,increased anxiety, headache, dizziness/fainting, facial paralysis, uncontrolled movement of the body, increased heart rate, feeling even more socially awkward, dry mouth,increase of suicidal thoughts, and so on. And yes I’ve had to experience ALL of these symptoms on the laundry list of meds I’ve been on the last 20 years. I’ve ended up in the ER 5x due to certain antipsychotics and meds for bipolar. I gained 56 pounds and felt even worse, developed high blood pressure(which of course I had to take a pill for)and became suicidal! Finally I had enough and quit taking 5 of the meds and weaned myself off the Prozac, and began yoga, exercise, and meditation. Took me a year to lose the weight and that was with me exercising every day. I was luckier than most who never lose the weight. They don’t want people, women especially, to come into it with a negative mindset, nor do they want folks questioning the efficiency of said medication. They do not want to lose the kickbacks they receive from the pharmaceutical companies for prescribing meds they have very little experience with or knowledge of for the most part. It’s becoming more and more common for doctors to use their patients as guinea pigs and the ages get younger and younger. Hell my 6 yr olds pediatrician has tried several times to put him on Zoloft and Prozac!!( and he’s not depressed just a normal happy kid) INSANITY! They hide behind this “it’s FDA approved so it’s safe” mentality, when it’s anything but. Meds I was RX as a teenager like depakote, risperdal, I’m now seeing on tv “call 1800 bad drug” bc they’ve caused things like men growing female breasts and other serious health issues. Not to mention gaining a ton of weight in the process and feeling quite lethargic which in turn gives an excuse to add on another one to cover the effects produced by the previous medication. It’s a never ending vicious cycle. I’m not implying medications are ALL bad by any means, many people benefit greatly, but I feel doctors need to be more aware and cautious of interactions, pre-existing conditions, and serious effects of these drugs and fully inform their patients before prescribing them.
I am always skeptical when a parent, grandparent, or other relative rails against a doctor who wants to medicate a child by saying “they are a normal happy/active/whatever child!” because of how many times I’ve seen this being said about kids who were not acting like a “normal [fill in the blank] child!” by ANY stretch of the imagination. Children whose mental health needs were both clear and obvious to EVERYONE around them EXCEPT for the person insisting the kid is JUST FINE. I find it totally baffling, terribly sad, and more than a little horrifying, and it happens SO often.
I also don’t understand why people assume that children cannot have or show symptoms of mental illnesses. I was a kid in the early 70s, and *even then* it was obvious to me that some of the children I was friends with/went to school with had mental health issues, whether they were as “garden variety” as ADHD or something much worse. Children are susceptible to every other disease & illness that adults are, including ones normally associated with aging – such as CANCER- and they can even have disorders that cause their bodies to age rapidly and prematurely. Why would they not ALSO be susceptible to mental illness- especially when researchers are becoming ever more informed about the genetic basis of it? It’s not like kids are born with the propensity for mental illness but it’s like a turkey timer that doesn’t pop up until they reach 18- it will show when it shows, late or early.
Someday, the science of mental health will be at a level that blood/genetic tests and/or brains scans will be much more effective at diagnosis as well as determining the exact type/s of medication/s that will be most effective for a particular persons illness, but SCIENCE ITSELF is still not advanced enough to do so, as of yet…though they are making headway. Until then, trial & error is the ONLY way to determine which med/s are most beneficial, but that is NOT the same thing as using patients as “guinea pigs”. They are using the best of their knowledge with drugs that have already shown efficacy in certain types of illnesses. It is not much different than when a physician uses their knowledge to use THIS antibiotic for an infection instead of THAT one, or THIS type of surgery rather than THAT, or THIS therapy or THIS treatment or whatever. You are not being used as a ‘guinea pig’ if a doctor uses their knowledge & best practices to treat a physical disorder, but that treatment just happens to not work FOR YOU, nor are you if a doctor treats your mental illness in the exact same way. That’s just STANDARD MEDICAL TREATMENT.
I have LIFELONG experience with chronic physical illness, issues that require me to take medication every single day of my life so that I do not die. I love living, so I do that, despite hating the fact that the only way I can have any quality of life, let alone life itself, is to be a walking bag of pharmaceuticals. I’d MUCH rather be healthy! But I was born this way and don’t have any choice in the matter.
I don’t see my choice to take medication for my mental illness to me ANY different than my choice to take meds for my physical illness – they keep me alive, and improve the quality of that life.
Why is this such a difficult concept for people to understand?
There is serious study that states that depression is highly effected by inflammation.
What do you think?
I have taken Zyprexa for the last 8 years, and I’ve gained about 20-25 pounds. I also am an emotional eater, which exacerbates the problem. I went from a size 12 to a size 16. It is frustrating for sure. I once had a breakdown after going off my anti-psychotic (with my then-psychiatrist’s permission), mainly because I wanted to lose weight. It’s a delicate balance, and yes, I wish more psychiatrists talked about this.
Hi Lisa,
I tried to get off my antipsychotic for weight loss too, but it just caused so much instability it wasn’t viable.
You’re not alone.
– Natasha Tracy
“But what I think it really comes down to is this: psychiatrists only care that you’re not dead. If you’re working, you’re eating, you’re breathing — their job is done.”
You forgot the word “shitty” in front of psychiatrists.
Tracking weight is something they should be doing as part of the standard of care, as is regular monitoring of lipid profiles, glucose, etc. Some do this. Shitty ones don’t. There’s no accountability though, so unless they’re really interested in their patients’ wellbeing…. ditto for not caring the (non-metabolic) effects that weight gain has on their patients’ lives.
You’re bang on that you’re your best advocate. It’s just screwed up that you need to advocate to reach even the minimum standard of care some places.
p.s. the reward for psychiatrists to do the right thing and treat their patients seems to be getting paid less, since the ones who skimp on everything slam more patients through. have found that with other doctors too, e.g. the family doctors who have the best reputation and spend time with their patients bill a lot less than the crappy ones. great incentives built into the system, right?
From latest Canmat bipolar guidelines (which is what pdocs should do…)
Patients on atypical antipsychotics should have their weight monitored monthly in the first 3 months and every 3 months thereafter. Blood pressure, fasting glucose and lipid profile should be assessed at 3 and 6 months, and yearly thereafter.
Reality Check: You’d rarely find me defending Psychiatrists OR the voodoo pseudoscience they call Psychiatry. I don’t even refer to The APA for what it stands for…I prefer “Consortium of Clowns” (COC) as a more apt name for them. Not to mention that little “book” that a subset of APA members have published every decade or so, called The DSM. It doesn’t remotely meet the criteria for a medical text in any way. It is far closer to a dictionary then anything else. Yet, here I am…
Does anyone else realize that circa 20-25 years ago, Psychiatrists were demoted to nothing more than diagnosticians and medication managers? The Psychotherapy that most of the older PDocs were trained for has gone the way of VHS tapes. That transition was dictated by Insurance Co’s, and not fought against – at all – by The APA…much to the dismay & frustration of legions of PDocs.
With the sole exception of your initial intake visit, PDocs are only reimbursed for “about 15 minutes” of their time for med management. Most PDoc’s will schedule no more then 3 patients/clients/customers (pick your euphemism here) per hour. Reimbursements range from c. $22 (Medicaid ) to a whopping c. $70-75 (BC/BS) for those precious 15 minutes. PDocs are LITERALLY earning less then they earned 30 & 40 years ago (in actual dollars – *not* wages adjusted for inflation.)
Although no PDocs went into that field to be the businessmen they have been forced to become, somewhere in there…they need to pay their very significant overhead, AND earn a living somewhat commensurate with their levels of education and experience. It isn’t like the doctors who sit on The APA , (or The COC, as I call them) is *any* kind of an advocacy group for *anyone* other then themselves and their immediate cronies on The APA Boards – NOT for their fellow Psychiatrists, and CERTAINLY NOT for their patients either.
I don’t expect my Oncologist to care about my ingrown toenails any more then I expect my Podiatrist to care about my breast cancer. A Nephrologist will assess your stage of renal failure caused by a s/e from the Lithium you took for 20 years – not a Psychiatrist. An Endocrinologist will see you about the Hypothyroidism you developed as another s/e from the same, AND will see you about the Diabetes you developed from the weight gain associated with the antipsychotic meds you’ve been on. Your PCP will care for the hypertension (high B/P) you’ve developed and your high cholesterol too. I see a Dermatologist for the Psoriasis I’m prone to develop from the severe stress of having to deal with so many Cluster B’s in my FOO, WHILE dealing with my own B/P d/o that none of the Narcissists in my family will even acknowledge exists.
Both the PCP’s and Specialists (*other than Psychiatrists*) actually get paid for longer visits, depending upon the complexity and/or acuteness of the problem and follow-up care needed. Not so for PDocs – not only are their patients considered bottom feeders…so are the PDocs. The attitude of Insurers?… If a person needs extra care for Psychiatry…they should be admitted for in-patient services. “PAYMENT DENIED!” You will NOT find that in any other specialty…I challenge you to do so.
Do not expect PDocs to do more than a bi-annual CBC/Chem Panel (if even,) some KFT’s and a Thyroid panel. Any problems that arise from med s/e’s (including weight gain) should be referred to the needed Specialist or right back to your PCP – you need them all, folks. We have a complicated illness that stigma has adversely impacted to the point of absent care.
We are at the very bottom of the barrel, fellow sufferers. Sometimes, acceptance is the wisest course of action (not always though), then move forward from there. Not a pretty picture I’ve painted, but I consider myself to be a Realist. if I sound cynical, that’s because Cynicism and Realism go hand & hand when you’ve been afflicted with this illness for a long time. Seek the care you need from the Specialists or PCP’s you need to. Fight on people…fight on!
When Clozaril came out, it was causing massive weight gain that the manufacturer refused to address. It was brought to NAMI’s attention over and over again, but they simply refused to criticize a funder.
Dear Mr. Jaffe, I had just posted above, before realizing my post was written above someone I admire so much. Ah, the Pharmas…the Insurers, and the traitorous bedfellows they have purchased. (You know which Orgs. I’m talking about.)
There are so few true advocates for Serious Mental Illnesses (SMI’s) on ANY blogs at all. I know that other than you (and Mr. Pete Early,), very few here will comprehend my disdain for the “Big Tent” concept…that if anyone has a mere scintilla of BP d/o or the mildest transient GAD… we are all the same boat …we are most certainly not. There are leaky canoes and solid battleships. I’d rather cross an ocean in the later – not too many people even get that, nor can imagine it in those terms.
You “get” anosognosia (as few do,) & how dangerous & lethal psychosis actually is. I admire your efforts and successes in advocating/helping implement AOT programs. The thing is – people who suffer so severely (those 4% you speak of) are not even capable of posting cognizant thoughts on blogs like this – or even knowing such blogs exist. Thus…they have no voices at all and are *never* heard from – just the way our society wants it to be – out of sight…out of mind. I am so pleased with the B4Stage4 movement as well.
Were it not for the dedication of people like you & Mr Early… speaking for those who cannot, progress would be even more elusive than it already is. Thank you for having the backs of the neediest, most maligned and *The Most Marginalized* members of our society with SMI’s. Your book, “Insane Consequences” was an outstanding (albeit painful and disheartening) read on the reality of the society we live in and all its copious failures.
Sad that we’ve lost all of our passionate advocates in Congress during the last decade (i.e., The Kennedy’s x 2 and T. Murphy.) As for NAMI? What a pathetic organization that has completely lost its way, as proven to me by last years elections. I recommend NAMI to no one these days. I’m a big DBSA fan – but that can be touch & go, depending upon the luck of one’s locale & peer leadership there.
Stay well, and please keep up the good fight – you live among my Hero’s…and they are so few…and waning still. Kudos to you – you’re an amazing citizen & advocate! The best to you & yours.
I’m on Zyprexa. Yeah, I gained almost 30 pounds before I knew it.
But, for about a year now my psychiatrist makes all his patients fill out a small form when they check in. We have to report our height, weight and waist at the navel. He also orders a CBC along with Depakote levels for me every 3 months. Oddly, we don’t talk about my weight unless I bring it up. Although to be fair, I think he warned me about the weight gain.
Hi Robert,
Well, the tracking is promising, I guess, even if the tracking doesn’t seem to do much for _him_ although it can do something for you.
– Natasha Tracy
I wasn’t expecting weight gain. Of course, the depression cycle of lethargy and no desire to exercise didn’t help. Then, a routine blood test showed up diabetes. Look at the side effects of some of this stuff and diabetes is often there. Damned proc wanted me to take an anti-psychotic which can cause diabetes, which I had already developed by then! “Is that *really* a good idea for me to take it?” The pDoc said, “Ah, perhaps not. ” We are safe in their hands? Perhaps not!
Hi Harry,
I’m so sorry to hear you had that experience — on all sides. I said it — we are our best advocates. It’s just too bad we have to work so hard at it.
– Natasha Tracy
Hi Natasha,
This is an area that has always baffled me. There sems to be as though an ignorance by Pdocs to this reality. Yet it plays a pivotal role in medication compliance and depression, which we are almost certainly on .Having a daily battle with the scales myself for decades, its as though this correlation of weight gain and depression, is just a side effect to be ignored until it in itself becomes a health issue brought up by our GP with furtherinv issues such as diabetes. One’s own body image causes depression, which is made worse my meds, which leads go an increase and around the vicious circle we go. Many Pdocs in my experience will acknowledge your concerns when brought up, though near always dismissed as an unfortunate side effect. It’s a ” I’ve done job, you’re still alive what else do you want” complacency which irritates me and leaves me feeling very much undupported and undignified. Of course we all start to play with our food intake, which again just adds another layer to our mental health stability. My dog eats more than I do, I’ve a large boned body so to speak, yet I’m diagnosed with anorexia tendencies, and they wonder why?
I feel for all who battles this issue, which affects 100% of the people i know on AP, MS or AD
Hi Blitter,
I’m so sorry, that’s so hard. I know that feeling entirely. I have been through periods where I’ve eaten next to nothing to try and fight back. It’s horrible.
– Natasha Tracy
Hi Natasha. This is a very good article. I started taking psych meds many years ago, and I also started gaining a bunch of weight – around 100 pounds. I also take Zyprexa (olanzapine). I’m going to ask my doctor if I can cut the Zyprexa in half just to see if I lose weight and also have a clearer head. I think it also has affected my triglycerides. Thanks for the article!
Hi D,
Good luck. You’re welcome :)
– Natasha Tracy