Summary And Conclusions

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Weight gain associated with tricyclic antidepress-ant and certain antipsychotic medications is problematic for many treated patients, and often a reason for non-compliance. Such weight gain is associated, at least in part, with reductions in resting metabolic rate and diet-induced thermogenesis. Changes in food preference towards calorically dense ('fattening') sweet-tasting foods do not appear to affect a majority of patients treated with tricyclic medications, but can occur. When such preference changes do occur, though, they are not associated with the development or maintenance of obesity. Another class of antidepressants, specific serotonin reuptake inhibitors (SSRIs), have been used in the past few years as effective antidepressants, but do not promote weight gain during treatment, although this is occasionally seen. The antipsychotic medications often promote weight gain, particularly the conventional medications, but also some of the novel antipsychotics seem to have weight promoting effects. Although the mechanism(s) for anti-psychotic-induced medications is poorly understood, increased caloric intake, a change in leptin response, and reduction in physical activity have all been proposed. Medication-induced weight gain is a significant problem for many treated patients, and the weight promoting effects of different psychiatric drugs should be considered in drug selection. A selection of the least weight promoting medication may promote drug compliance for many treated individuals, as well as avoid the comorbidities associated with increasing weight and obesity.

With respect to other drugs, the weight increases are often more modest, but can be a very serious problem with compounds used for chronic medication or long periods as with antiepileptic drugs such as valproate. The weight increases due to insulin or sulfonylurea agents not only might worsen the metabolic control in diabetic patients, but are also a major factor in non-compliance. So far only very few studies have been performed elucidating specific treatment possibilities in these groups of patients. Unfortunately, none of the current available anorectic agents have so far been studied in these groups of patients. Dietary advice, including avoidance of high calorie beverages, and lifestyle and exercise programs are still the fundamentals for the treatment of medication-induced weight gain. However, the recent advance in obesity research and especially the increased understanding of brain function may provide new possibilities for further treatment.

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