Depression Treatments - Zoloft and Celexa

Written by HealthyPlace.com Staff Writer

shan10: Please try to shed some light why some people gain weight with medications such as Zoloft and Celexa?

Dr. Cady: Shan10, the issue of weight gain is a vexing one for certain antidepressants. The biggest offenders used to be the tricyclics; the most serious offender now is Remeron. The atypical antipsychotics are the champion "weight-gainers", however. Some antidepressants are thought to be weight neutral. Actually, Celexa is one of them, as is Serzone and Wellbutrin. But, like I mentioned above, anybody can have any kind of reaction to any medication and what stimulates somebody to eat more and gain weight may not do it to the next person. The safest thing to do is to ask your doc to switch you to another antidepressant if you're gaining too much weight.

Kaprikel: In the same light as Shan10's question. I am dieting, and taking Wellbutrin and Neurontin, and I cannot seem to lose weight. Can these medications contribute to that?

Dr. Cady: Great question, Kaprikel. Neurontin can tend to put on weight. Wellbutrin typically does not. The best "diet" by the way, that I've found and that's physiologically and biologically sound and rational really isn't a diet, it's the Bill Phillips Body for Life program. Check it out on his web site, www.bodyforlife.com. It's safe, healthy, and rational. Beats the heck out of dieting!

David: Here are a few audience comments on what's being said tonight. Then we'll get to more questions.

amaranth: In my case, I've been depressed since I was 6 and I've been working to get better since I was 13. No antidepressant medications have worked on me yet. I'm on Remeron and its not doing a thing for me.

lisarp: It's very discouraging and I go deeper with each episode. I have been for a second opinion consult and still am struggling. I become angry when I hear that no one has to be depressed in this day and age.

mazey: I just got out of the psych unit on Monday with a relapse of depression. What they thought would work, didn't, and now the doctors want to make another med change. Last time, I ended up in a medication induced psychosis. I'm afraid of medications.

David: Here's a good question from a young person, Dr. Cady:

Bzuleika: Is there any way to seek professional help without letting my parents know?

Dr. Cady: Bzuleika, it depends. If you're under 18, legally, a physician must have your parents' consent to treat you. Particularly if medicine is prescribed, it's considered "battery" if legal consent isn't obtained. I can't see that a physician would take you on as a patient in this context. On the other hand, you could begin treatment by exploring, with a school counselor, the nature of your feelings, and reasons why you might be feeling depressed. I hope that gives you a general framework to work in.

David: How can one tell if their depression is situational vs. chemical...or that what may have started as situational but has become a chemical imbalance?

Dr. Cady: First part of the question: if it starts "situationally" - and one's autobiographical memory is intact, one can frequently trace back to something like, "It all started when....." and then usually relate it to an event, a trauma, a reversal of fortune, etc. Then, if it worsens into clinical depression, or "major depression" as it's diagnosed, essentially the psychological problem has broadened into one which is now both psychological and biological. Basically, if it's a major depression, or "severe clinical depression" - it's biological - however it started. As noted some 45 minutes or so back in our conference, however, the strategy for dealing with it, should embrace both a psychotherapeutic one and a biologically based one.

David: Some people with depression turn to drinking alcohol to ease their pain, even while they are taking antidepressants. Can you address the effects of that please?

Dr. Cady: Alcohol can definitely anesthetize the pain and agony of depression temporarily. The problem is that it is a symptomatic, bandaid approach to things, such as the pain, and in some cases, the insomnia, brought on by depression. If used to treat insomnia, one can achieve tolerance (e.g., "get used to the stuff") requiring more and more, until one wakes up not only depressed but an alcoholic on top of it. Additionally, the use of alcohol WITH PROZAC OR PAXIL should be carefully considered. Both of these two medications ("the two P's") cause an inhibition in the liver enzyme system responsible for breaking down alcohol (as well as cough syrup and a host of other compounds). So you not only have to be aware of the dangers of alcohol but the dramatically greater dangers of mixing it with specific drugs.

EKeller103: Doctor, could you please discuss depression related to/ caused by Obsessive Compulsive Disorder (OCD)?

Dr. Cady: Good question, EKeller 103. The way I would conceptualize this would be probably two-fold:

First, OCD is classically thought to be a Serotonin deficit. Serotonin deficits are rampant in depression. Hence, what causes the OCD - lack of serotonin - is probably one of the difficulties in your depression.

Secondly, I have my patients learn the mantra "stress causes depression...stress causes depression..." so that they will realize that when they get (or got) depressed, it wasn't due to some moral laxity, etc, but related to (typically) overwhelming stress. People that have OCD and find themselves behaving in irrational, obsessive and compulsive ways are STRESSED. Obsessive Compulsive Disorder is considered "ego dystonic" - which means that you know that you are not acting right... you just can't help it. This is stressful. So, there could be both an underlying biological relationship between the two, as well as an underlying psychological, causally exacerbating link between the two.