How does Prozac influence weight. What are the mechanisms behind potential weight changes. Can Prozac cause significant weight gain. How to manage weight while taking Prozac. When to consult a doctor about Prozac-related weight changes.

Understanding Fluoxetine (Prozac) and Its Primary Functions

Fluoxetine, commonly known by its brand name Prozac, is an antidepressant medication that belongs to the class of selective serotonin reuptake inhibitors (SSRIs). The Food and Drug Administration (FDA) has approved it for treating depression and various mood disorders. But how exactly does Prozac work?

Prozac’s primary mechanism of action involves slowing down the reuptake of serotonin in the brain. Serotonin, a crucial neurotransmitter, plays a vital role in regulating mood, emotions, and overall well-being. By increasing the availability of serotonin in the brain, Prozac helps to promote feelings of balance, calmness, and positivity.

The Role of Serotonin in Mental Health

Why is serotonin so important for mental health? Individuals who metabolize serotonin too quickly may experience symptoms of depression. Prozac, along with other SSRIs, helps to balance this out by ensuring that serotonin remains available in the brain for longer periods. This prolonged presence of serotonin can lead to improved mood and a greater sense of well-being.

Prozac and Weight Gain: Examining the Connection

Does Prozac cause weight gain? This is a common concern among patients prescribed this medication. While Prozac is generally associated with modest weight gain, it’s important to understand that the relationship between the drug and body weight is complex and not fully understood.

Potential Mechanisms Behind Prozac-Related Weight Gain

Why might Prozac lead to weight gain in some individuals? Several theories exist:

• Leptin response: Research suggests that Prozac may influence how the body responds to leptin, a hormone produced by fat cells that helps control appetite.
• Mood improvement: As Prozac balances brain neurotransmitters and improves mood, it may restore appetite in individuals who had lost interest in food due to depression.
• Metabolic changes: Some studies indicate that Prozac might affect metabolism, potentially leading to weight gain over time.

It’s crucial to note that weight gain with Prozac is typically moderate and not experienced by all patients. Many individuals may maintain their weight or even lose weight while taking the medication.

Side Effects of Prozac: Beyond Weight Changes

While weight gain is a concern for many, Prozac can cause various other side effects. What are the most common side effects associated with Prozac use?

• Blood sugar fluctuations
• Mood changes, including increased anxiety during initial adjustment
• Sleep disturbances
• Gastrointestinal issues
• Sexual dysfunction
• Headaches

It’s important to discuss any persistent or concerning side effects with your healthcare provider.

Managing Weight While Taking Prozac

How can individuals maintain a healthy weight while taking Prozac? While the medication may influence weight, there are several strategies that can help manage potential weight gain:

1. Regular exercise: Engaging in physical activity can help offset potential weight gain and improve overall mood.
2. Balanced diet: Focus on nutrient-dense foods and practice portion control.
3. Mindful eating: Pay attention to hunger cues and avoid emotional eating.
4. Regular monitoring: Keep track of your weight and discuss significant changes with your doctor.
5. Adequate sleep: Ensure you’re getting enough quality sleep, as poor sleep can contribute to weight gain.

Prozac’s Impact on Appetite and Eating Behaviors

How does Prozac affect appetite? The medication’s impact on eating behaviors can vary among individuals. Some may experience:

• Increased appetite, particularly for carbohydrates
• Decreased appetite, especially during the initial weeks of treatment
• Changes in taste perception
• Alterations in eating patterns or food preferences

These changes are not universal and may evolve over the course of treatment. It’s essential to be aware of any significant shifts in your eating habits and discuss them with your healthcare provider.

Long-Term Effects of Prozac on Body Weight

What are the long-term implications of Prozac use on body weight? Studies suggest that while some individuals may experience weight gain over time, others may not see significant changes. Factors influencing long-term weight outcomes can include:

• Individual metabolism
• Lifestyle habits
• Duration of treatment
• Dosage
• Concurrent medications

It’s important to remember that the potential benefits of Prozac in managing depression and other mood disorders often outweigh the risk of modest weight gain for many patients.

Alternatives to Prozac: Exploring Other Antidepressants

Are there alternatives to Prozac that may have different effects on weight? Indeed, various other antidepressants exist, each with its own potential impact on body weight:

• Bupropion (Wellbutrin): Often associated with weight loss or weight neutrality
• Sertraline (Zoloft): Generally considered weight-neutral
• Escitalopram (Lexapro): May cause slight weight gain in some individuals
• Venlafaxine (Effexor): Typically associated with minimal weight changes

The choice of antidepressant should be made in consultation with a healthcare provider, taking into account individual health factors, potential side effects, and treatment goals.

When to Consult a Doctor About Prozac and Weight Changes

When should you seek medical advice regarding Prozac-related weight changes? It’s advisable to consult your doctor if you experience:

• Rapid or significant weight gain or loss
• Severe changes in appetite
• Concerns about the impact of weight changes on your overall health
• Difficulty managing weight despite lifestyle modifications
• Worsening of depressive symptoms or mood changes

Your healthcare provider can assess your individual situation and may consider adjusting your treatment plan if necessary.

Monitoring Mental Health While Taking Prozac

Beyond weight changes, it’s crucial to monitor your overall mental health while taking Prozac. Pay attention to any changes in mood, energy levels, or thought patterns. If you experience worsening depression, anxiety, or thoughts of self-harm, seek immediate medical attention.

Prozac’s Interaction with Other Medications and Conditions

How does Prozac interact with other medications and health conditions? Prozac can interact with various substances and may affect certain health conditions:

• NSAIDs and blood thinners: Increased risk of bleeding
• MAOIs: Potentially dangerous interactions
• Certain antipsychotics: May increase the risk of serotonin syndrome
• Diabetes medications: Potential impact on blood sugar control
• Seizure threshold: May lower seizure threshold in susceptible individuals

Always inform your healthcare provider about all medications, supplements, and health conditions before starting Prozac.

The Importance of Proper Prozac Dosage and Administration

Why is proper dosage and administration of Prozac crucial? Adhering to prescribed dosages and following proper administration guidelines is essential for several reasons:

• Efficacy: Ensures the medication can work as intended
• Side effect management: Helps minimize potential adverse effects
• Safety: Reduces the risk of complications or interactions
• Consistency: Maintains steady levels of the medication in your system

Never adjust your Prozac dosage without consulting your healthcare provider. The medication has a long half-life, meaning it takes several weeks for plasma levels to adjust when doses are changed.

Discontinuing Prozac: A Gradual Process

Why is it important to taper off Prozac gradually? Abruptly stopping Prozac can lead to discontinuation syndrome, which may cause various uncomfortable symptoms. Your doctor will typically recommend a gradual tapering schedule to minimize these effects and ensure a smooth transition off the medication.

Lifestyle Factors That Can Influence Prozac’s Effectiveness and Side Effects

How do lifestyle factors impact Prozac’s effectiveness and potential side effects? Various aspects of your daily life can interact with Prozac treatment:

• Diet: Certain foods may affect how Prozac is absorbed and metabolized
• Exercise: Regular physical activity can enhance mood and potentially mitigate some side effects
• Sleep habits: Good sleep hygiene can complement Prozac’s mood-stabilizing effects
• Stress management: Effective stress reduction techniques can support overall mental health
• Alcohol consumption: Alcohol can interact with Prozac and potentially increase side effects

Adopting a healthy lifestyle can support your treatment goals and potentially help manage any side effects, including weight changes.

The Role of Genetics in Prozac Response and Side Effects

How do genetic factors influence an individual’s response to Prozac? Emerging research in pharmacogenomics suggests that genetic variations can affect how a person responds to Prozac and other antidepressants. These genetic differences may influence:

• Drug metabolism: How quickly the body processes and eliminates the medication
• Therapeutic response: The likelihood of experiencing positive effects from the medication
• Side effect profile: The types and severity of side effects an individual may experience
• Dosage requirements: The optimal dose for achieving therapeutic effects

While genetic testing is not routinely performed before prescribing antidepressants, it may be considered in cases where individuals have not responded well to multiple medications.

Personalizing Prozac Treatment

How can Prozac treatment be personalized? Your healthcare provider may consider various factors to tailor your treatment plan, including:

• Your specific symptoms and severity of depression
• Your medical history and current health status
• Potential drug interactions with other medications you’re taking
• Your lifestyle and personal preferences
• Your response to previous antidepressant treatments, if any

This personalized approach aims to maximize the benefits of Prozac while minimizing potential side effects, including weight changes.

The Future of Antidepressant Research: Beyond Prozac

What does the future hold for antidepressant treatments? Ongoing research in the field of psychiatry and neuroscience is exploring new avenues for treating depression and related disorders:

• Novel drug targets: Researchers are investigating medications that act on different neurotransmitter systems
• Personalized medicine: Advancements in genetic testing may lead to more tailored treatment approaches
• Combination therapies: Exploring the potential benefits of combining medications with psychotherapy or other interventions
• Alternative treatments: Investigating non-pharmacological approaches, such as transcranial magnetic stimulation or ketamine therapy

While Prozac remains a widely prescribed and effective treatment for many, ongoing research aims to expand the options available and improve outcomes for individuals with depression and related disorders.

Prozac in the Context of Overall Mental Health Treatment

How does Prozac fit into a comprehensive mental health treatment plan? While Prozac can be an effective tool in managing depression and other mood disorders, it’s often most beneficial when used as part of a holistic approach to mental health care. This may include:

• Psychotherapy: Cognitive-behavioral therapy, interpersonal therapy, or other evidence-based approaches
• Lifestyle modifications: Regular exercise, balanced nutrition, and stress management techniques
• Social support: Engaging with support groups or strengthening personal relationships
• Mindfulness practices: Meditation, yoga, or other mindfulness-based interventions
• Regular medical check-ups: Monitoring overall health and addressing any co-occurring conditions

By combining medication with other therapeutic approaches, individuals may achieve more comprehensive and sustainable improvements in their mental health.

The Importance of Patient Education and Empowerment

Why is patient education crucial in Prozac treatment? Empowering patients with knowledge about their medication, potential side effects, and overall treatment plan can lead to better outcomes. Informed patients are more likely to:

• Adhere to their prescribed treatment regimen
• Recognize and report significant side effects promptly
• Make informed decisions about their healthcare
• Actively participate in their treatment process
• Have realistic expectations about the medication’s effects and timeline

Healthcare providers play a crucial role in educating patients about Prozac, addressing concerns, and fostering a collaborative approach to treatment.

Does Prozac Cause Weight Gain? Know This

Fluoxetine (Prozac) is an antidepressant approved by the Food and Drug Administration (FDA) for the treatment of depression and certain other mood disorders.

It is a selective serotonin reuptake inhibitor (SSRI) similar to Paxil, Celexa, and others.

Prozac slows the reuptake of serotonin, helping to increase what is available to the brain.

Serotonin is a neurotransmitter that promotes feelings of balance and calm, leading to a better mood, feelings of well-being, and positivity.

People who clear serotonin too quickly can experience symptoms of depression, and SSRIs like Prozac can help to balance this out.

If you are taking Prozac, or it has been prescribed by your doctor, you may be wondering if one of the associated side effects may be weight gain.

There are certain precautions that are important when it comes to Prozac.

• Suicidal thoughts and behaviors: Anyone taking Prozac or other antidepressants should be monitored closely for changes in behavior, worsening symptoms, or thoughts of self-harm. If you’re having a mental health emergency, call 911 or go to the nearest emergency room. You can also get free 24/7 support from a suicide and crisis expert by calling or texting 988. If you’d prefer to chat online, you can chat with a suicide and crisis expert by visiting the Lifeline Chat.

• Serotonin Syndrome: This life-threatening side effect can include symptoms like agitation, hallucinations, coma, or changes to mental status. It may also lead to muscular coordination problems, twitching, racing heartbeat, sudden changes in blood pressure, fever, nausea, vomiting, or diarrhea. If any of these symptoms occur together, seek emergency medical help. 

• Allergic reaction: If you experience a rash, hives, swelling, or other signs of an allergic reaction, stop taking Prozac and seek medical care.

• Seizures: In people who have a lower seizure threshold, Prozac may increase the risk.

• Altered appetite: In some cases, Prozac may reduce appetite and lead to significant weight loss. However, this is not a positive side effect of this medication. Sudden changes in weight or lack of appetite need to be reported to health care providers.

• Bleeding problems: Prozac may increase the risk of bleeding, especially in people who take NSAIDs, aspirin, or anticoagulants.

• Cognitive and motor impairment: Do not drive or operate heavy machinery until you know how Prozac affects you. It has been shown to alter judgment, thinking, and motor skills.

• Long half-life: It takes several weeks for plasma levels to adjust when doses are adjusted. Weaning off of Prozac takes time, but it is important not to suddenly discontinue Prozac or any other antidepressant unless an allergic reaction occurs.

In this article, we will explore the purposes of Prozac, its side effects, and why it may be associated with weight gain for some.

We will also discuss proactive ways to manage your weight while taking Prozac as well as how to know when you should see a doctor.

Why Does Prozac Cause Weight Gain?

Some antidepressants are associated with weight gain — some more than others — and Prozac tends to be associated with modest weight gain.

The exact mechanism behind its association with weight gain is not fully understood, but researchers are getting closer to answers.

Leptin is a hormone that is produced by fat cells and helps control appetite.

Certain types of stimulation can increase how the body responds to leptin, and research is finding that Prozac’s drug effects may have a similar response in the brain to environmental triggers that may signal the desire to eat.

While the relationship between leptin, Prozac, and body weight is not fully linked, it may offer some insights as to why people on longer-term Prozac treatment may experience weight gain.

Another theory is that Prozac helps to balance brain neurotransmitters, increasing feelings of well-being.

If a patient’s appetite was low because of depression, or they had lost a desire to prepare or enjoy food, Prozac’s mood-balancing effect might lead to weight gain by helping to restore a better appetite and desire for food.

Overall, Prozac does not typically lead to excessive weight gain.

Most patients notice moderate weight gain after long-term treatment, but it is not guaranteed to happen in everyone.

Side Effects of Using Prozac

Common side effects of Prozac may include:

• Blood sugar changes: Prozac may cause problems with blood sugar control, especially in people with diabetes. It may cause higher levels while the body adjusts to the new dosage. If you have diabetes, your doctor may recommend a different medication.

• Mood changes: People who take Prozac may experience a slight increase in anxious feelings while they adjust to the medication.

• Sleep changes: Prozac may lead to trouble falling asleep or staying asleep, or may cause changes to normal sleep patterns. It may also cause unusual dreams.

• Sexual problems: Prozac and other antidepressants sometimes have an effect on sexual function, including ejaculation disorders in people with penises or sexual dysfunction in people with vaginas.

• Appetite and digestion change: The most common side effects of Prozac have to do with gastrointestinal symptoms like loss of appetite, indigestion, nausea, vomiting, or diarrhea.

• Infections: Prozac may trigger flu-like symptoms, sinus infections, or sore throat.

• Energy changes: Common side effects of Prozac may include weakness, fatigue, yawning, tremors, and shaking. These may subside as the body adjusts to the medication. If you notice shaking or tremors that worsen, let your doctor know.

• Body temperature regulation: Prozac may cause sweating or hot flashes.

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Managing Your Weight While Taking Prozac

There is no secret to preventing weight gain while taking Prozac or other antidepressants.

Managing your weight on these medications is the same as any other time:

• Eat a balanced diet
• Get regular physical activity
• Stay hydrated
• Practice portion control
• Engage in mindful eating

If you work to manage your weight while taking Prozac and still gain, talk to your doctor.

If the weight gain bothers you, your doctor may suggest switching to a different antidepressant medication, evaluating you for other causes of weight gain, or providing some alternative ideas.

How to Bring Your Weight Back to Normal

If you have been taking Prozac for more than six months and are noticing consistent weight gain, your doctor may suggest tapering back your dosage and eventually switching you to a different antidepressant.

You and your healthcare provider have to consider the benefits versus the side effects.

While other antidepressants, like Wellbutrin, may not be associated with weight gain and may even be linked to weight loss, not all antidepressants work the same.

If Prozac makes you feel as if your mood is balanced, changing medications for weight-related reasons may cause unwanted mood changes.

Your doctor will help you determine a plan to focus on your mental and physical health.

When to See a Doctor

If you take Prozac and are concerned about weight gain, speak to your doctor.

They will be able to help you understand if it is normal or if it is a side effect that warrants a medication change. Never stop taking Prozac without working with your doctor.

How K Health Can Help

Think you might need a prescription for Prozac (fluoxetine)?

K Health has clinicians standing by 24/7 to evaluate your symptoms and determine if Prozac is right for you.

Get started with our free assessment, which will tell you in minutes if treatment could be a good fit. If yes, we’ll connect you right to a clinician who can prescribe medication and have it shipped right to your door.

Frequently Asked Questions

Why does Prozac make you gain weight?

Doctors and researchers do not fully understand why Prozac and other antidepressants are associated with modest weight gain. Theories range from addressing the depression that previously made appetite too low to the fact that serotonin and neurotransmitters exert an increasing effect on leptin, a hormone that increases appetite.

Does Prozac affect metabolism?

Prozac does not directly change the way that metabolism works. The weight gain associated with Prozac is not because it suppresses metabolic function.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions,
and medical associations. We avoid using tertiary references.

• Fluoxetine. (2022).
  https://medlineplus.gov/druginfo/meds/a689006.html

• Label for Prozac (fluoxetine). (2017).
  https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018936s108lbl.pdf

• The antidepressant fluoxetine acts on energy balance and leptin sensitivity via BDNF. (2018).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789051/

• Weight gain, obesity, and psychotropic prescribing. (2011).
  https://www.hindawi.com/journals/jobe/2011/893629/

• Metabolic effects of antidepressant treatment. (2017).
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5439472/

• Fluoxetine. (2021).
  https://www.ncbi.nlm.nih.gov/books/NBK459223/

Do Weight Changes Occur with Long-Term Fluoxetine Therapy?

BARBARA APGAR, M. D., M.S

Am Fam Physician. 2000;61(3):849

Data are limited concerning weight changes that occur beyond the acute phase of treatment with selective serotonin reuptake inhibitors. Michelson and associates analyzed changes in weight among patients who received long-term fluoxetine therapy.

Data were obtained from a study that initially included 839 patients who entered the 12-week acute-therapy phase of the study. After remission of depression had been achieved, 395 patients were randomly assigned to continuation of fluoxetine therapy, in a dosage of 20 mg daily, or placebo. Therapy was given for as long as 50 weeks.

Weight was assessed at each visit during the initial 12 weeks of acute treatment and at the 14th, 26th and 38th weeks during the continuation phase of therapy. Weight changes in the fluoxetine and placebo groups during the continuation period were compared.

A small (less than 0.5 kg) but significant weight gain occurred during the week following entry into the study but preceding the initiation of fluoxetine therapy. For all patients thereafter, a small but significant decrease in weight occurred during the 12 weeks of the acute-treatment phase. Data on patients who completed 38 weeks of continuation therapy revealed that weight loss occurred primarily during the initial four weeks of therapy. It was followed by stabilization of weight.

Significant weight gain occurred in the treatment and placebo groups from the beginning (week 12) of continuation therapy to 38 weeks of continuation therapy (a total of 50 weeks). Patients who received fluoxetine gained less weight than patients who received 12 weeks of fluoxetine therapy followed by 14 weeks of placebo, but it was not a significant value. Patients in each of the groups gained a mean of approximately 3 kg during the 50 weeks of follow-up.

The authors conclude that after recovery from acute depression, patients are likely to experience modest weight gain that increases over time. Fluoxetine may initially be associated with weight loss but does not appear to be associated with specific effects on weight during long-term therapy, even up to one year. The authors suggest that the weight gain during the continuation phase in the fluoxetine and placebo groups is consistent with previous studies. Recovery from acute depression is also associated with increased appetite, which could lead to increased food intake and weight gain.

Antidepressant OOO “Ozon” Fluoxetine – “💊Fluoxetine: influence on weight (gain or weight loss), depression, anxiety, OCD and other problems → Side effects, withdrawal syndrome, compatibility with alcohol and drugs → How to reduce the risk of serotonin syndrome 💊”

Today I want to talk about such a drug as fluoxetine. It is one of the many SSRI antidepressants I have taken. The review will focus on its antidepressant effect, side effects, compatibility, effects on weight and other properties of the drug. I will also tell you how to easily go in and stop this medication to smooth out the withdrawal syndrome as recommended by my doctor.

Fluoxetine weight

Appearance.
Light colored cardboard box. One package is designed for a month of admission. Of the minuses of the release form, I can note that the capsules are very difficult to divide. The capsule itself is difficult to open, and it is not always possible to start taking immediately with 20 mg. In many cases, this dosage can increase the side effects at the beginning of the intake.

How to use.

The drug is taken orally, at any time, regardless of food intake. The initial dose is 20 mg 1 time / day in the morning, regardless of the meal. If necessary, the dose can be increased to 40-60 mg / day, divided into 2-3 doses (20 mg / day weekly).

Application experience.
I had a course experience with fluoxetine. Reception was prescribed from ten milligrams with a gradual increase in dosage to twenty milligrams. There was such a dosage on sale from this brand, but it was not possible to find it in pharmacies. I bought fluoxetine at a dosage of twenty mg, as I already had the experience of dividing capsules of another antidepressant. The very first difficulty was just that. The capsules are very difficult to open. The doctor did not recommend starting immediately with 20 mg. If you drink at once in a large dosage, there can be many side effects. It is better to increase slowly.

The first days I still divided the powder from fluoxetine capsules into equal parts, and later I started taking twenty milligrams. Antidepressants must be taken at the same time in order to ensure an equivalent concentration of drugs in the body. I drank fluoxetine in the early morning, because it has a stimulating effect and taking it at night can lead to insomnia.

True, despite taking fluoxetine in the morning, many people have problems with sleep. I managed to stop this with another antidepressant (in some cases, we allow the simultaneous intake of two hells from different groups). In addition, there was drug-induced restless leg syndrome. In order to stop the last side effect, and at the same time maintain normal sleep, I began to drink the antidepressant tritikko.

Antidepressant

The instructions for fluoxetine say that it interacts with many drugs, including triticco. Fluoxetine is able to raise the concentration of the second in the blood, which is why in the end I had to stop tritikko after about two weeks of taking it together. At first, everything was fine, and then after taking the pill, symptoms began similar to serotonin syndrome or an overdose of trittiko. So fluoxetine really increases its concentration and it is better not to take them together to reduce the risk of serotonin syndrome.

Many people take fluoxetine to lose weight. The fact is that among the side effects of the drug, there is a decrease in appetite. But it does not reduce appetite for everyone. Moreover, some drink it for weight loss, violating all the rules of taking antidepressants. They do not drink every day or in different doses, etc. because of this, they have a number of side effects, up to very serious ones. Then they blame the drug, even though they themselves took it wrong. I believe that fluoxetine is not the drug to be taken without a doctor’s prescription for this purpose.

Fluoxetine reviews

Moreover, for weight loss, not SSRI antidepressants, but antidepressants of another group are much more effective. From fluoxetine, you can not only lose weight, but rather get better. Personally, during the months of taking fluoxetine, I gained a few kilograms because it reduced my appetite only in the first days of taking it. And then, due to its effect on metabolism, the weight, on the contrary, began to grow. So instead of losing weight, there was the opposite effect – his weight gain. There was nothing similar from the antidepressants of the SNIOZSIN group. I lost weight very well on Cymbalt and duloxetine

From SSRIs only on sertraline.

Fluoxetine

It is quite an effective antidepressant. Depression and its symptoms are removed quite well already at 20 mg. The effect is noticeable after the first three weeks of taking fluoxetine at this dosage. It has little effect on anxiety, most likely because fluoxetine is the only SSRI antidepressant that has a stimulating effect. Not the best option for treating anxiety. Ocd works effectively, but the effect will have to wait longer. In general, the condition on it was good. Of course, except for the side effects and withdrawal syndrome.

Antidepressants are recommended to be reduced slowly, as well as increased. For about five days I drank fluoxetine ten milligrams, and then completely stopped taking it. From the withdrawal syndrome there was a slight deterioration in mood and mild anxiety, which then disappeared. The weight gained on fluoxetine went away immediately after the drug was discontinued.

Fluoxetine drug compatibility is quite good. It is combined with drugs such as phenazepam, atarax, phenibut, corvalol, gabapeptin, picamilon, pantogam, nootropics and other frequent combinations. I drank it with many of them. Alcohol and antidepressants do not have the best compatibility, but when used in small quantities, I did not have any negative effects.

Summing up, I can say that fluoxetine is a good antidepressant. It does its job perfectly, but it has some side effects. I recommend that you consult with your doctor before taking the drug and do not self-medicate. Below you can read about the effect of other drugs ➡️

💊 Simbalta. Antidepressant of the SNIOZSIN group. How to use antidepressants correctly

💊Reksetin. The famous analogue of Paxil. Myths about the dangers of antidepressants and the effect of the drug

The newest among antidepressants. They say it is devoid of side effects, is it so.

💊Valdoxan. An antidepressant that can restore sleep. Ideal, but there is a nuance

💊Zoloft antidepressant. One of the most frequently nominated. Is it good?

💊 Omega 3 from Solgar. What are the benefits for depression

💊Antidepressant Torin. Analogue of Zoloft is much cheaper

Causes of ineffectiveness of obesity treatment and ways to overcome it | Voznesenskaya

The main problem faced by doctors involved in the treatment of obesity is the recurrence of the disease. There are 4 main causes of relapses [1, 2, 4].

The first cause of is emotional instability resulting from the use of strict diets, which is called “dietary depression”. “Dietary depression” was first described by A. J. Stunkard (1953), uniting under this concept a whole range of negative emotional sensations that occur in patients on the background of diet therapy: increased irritability and fatigue, a feeling of internal tension and fatigue, aggressiveness and hostility, anxiety, low mood, etc. [8]. A high level of anxiety can also contribute to the formation of vegetative crises or panic attacks during adherence to strict diets. Severe emotional and vegetative discomfort leads to a refusal to further adhere to dietary recommendations and to a relapse of weight gain.

Unnecessarily strict diets, leading to pronounced “dietary depression” with subsequent refusal of treatment and relapse of the disease, contribute to the emergence of secondary emotional and personality disorders: feelings of guilt, decreased self-esteem, disbelief in the possibility of a cure. Patients with emotional eating behavior who are accustomed to normalizing emotional discomfort by eating and for whom food has become a medicine are especially poorly tolerated by diet therapy [1, 6, 8].

According to our data, obese patients with emotiogenic eating behavior experience symptoms of “dietary depression” of varying severity in 100% of cases when using isolated diet therapy [2—4]. Moreover, in 30% of obese patients without clinically pronounced forms of eating disorders, on the background of diet therapy, there is a noticeable emotional discomfort, forcing them to refuse therapy [4, 5].

T. Wadden presented data on 259 patients, 20% of whom, despite the simultaneous use of psychotherapeutic correction, developed symptoms of depression during diet therapy (International Congress on Obesity, May 31 – June 1, 2002, Seville). However, a severe depressive episode was observed in only 3% of patients, which contrasts sharply with the data of the same author on 133 patients who underwent surgical treatment of obesity. In this group, depression has already developed in 60% of patients, with mild depression in 25% of cases, moderate depression in 15%, and severe depression in another 15% of cases. Such a significant increase in the incidence of depression after surgical treatment of obesity is associated with two main factors: 1) after surgery, patients are forced to abruptly switch to an extremely limited, unusual for them, new diet, which is a strong stress; 2) lack of necessary psychotherapeutic correction in the postoperative period. Decompensation in the emotional and affective sphere after surgical correction of body weight can be considered as a kind of model for the development of “dietary depression” against the background of forced restrictive eating behavior. The same consequences are caused by the simultaneous appointment of unreasonably low-calorie diets, which is often observed in everyday therapeutic practice.

Some degree of restrictive eating behavior is observed in every obese patient seeking to reduce body weight. As a rule, these are chaotic and unsystematic food restrictions that do not lead to weight loss [6–8]. In obese patients, restrictive eating behavior can even be combined with an increase in body weight, since periods of overly strict, but unsystematic food restrictions are usually followed by periods of overeating. Personality characteristics of patients, as well as the appearance in many of them of emotional-affective (“dietary depression”) and vegetative disorders when they refuse their usual foods, make it possible to put food addiction on a par with alcohol, nicotine and drugs. In particular, “dietary depression” can be considered as a manifestation of a kind of withdrawal syndrome that occurs when a habitual diet developed over decades is abandoned. Correction of eating behavior with the rejection of the wrong food stereotype is sometimes as difficult as the treatment of other addictions, and must necessarily include behavioral therapy.

Second reason. The patient continues to comply with the recommendations, but body weight ceases to decrease on the background of ongoing therapy. The appearance of a “weight plateau” leads to disbelief in the effectiveness of treatment and, accordingly, to its termination. In the process of therapy, a “weight plateau” necessarily appears when, despite the ongoing efforts of the doctor and the patient after losing 6-10 kg, body weight stops decreasing. This period can last from 1 to 3 months, and then, if you do not quit therapy, weight loss will continue. The emergence of a “weight plateau” is explained primarily by the mechanisms of self-regulation with the transition of the body to a more economical mode of calorie expenditure, imperceptible to the patient. This is a complex process of metabolic restructuring. Clinically, it manifests itself only in a number of features that are still possible to fix: body temperature decreases by a few fractions of a degree, the patient begins to dress warmer, his movements become slower, and sleep becomes deeper and longer. In other words, the patient begins to burn fewer calories. If the patient is aware of the regular occurrence of a “weight plateau” in the course of treatment, he will overcome it easily, without an emotional breakdown and will not stop fulfilling the prescriptions prescribed by the doctor. After a period of stabilization, if the patient continues to comply with the recommendations, his body weight begins to decrease again.

Third reason. After the course of treatment, the patient returns to the previous way of life and he has a rebound weight gain. This frequently occurring situation is due to the fact that short-term courses of treatment of 1–3 months are still practiced and there is no long-term therapy strategy. In fact, the new eating habits that are developed in the patient at the initial stage of therapy should remain with him all his life. A return to the previous way of life is guaranteed to lead to a relapse of the disease.

Fourth reason. When prescribing treatment programs, as a rule, the features of the patient’s eating disorders are underestimated, which significantly reduces the effectiveness of therapy or leads to “dietary depression”. To achieve optimal results in the treatment of obesity, when prescribing therapeutic programs, it is necessary to take into account the type of eating disorder, primarily external and emotional eating behavior [1–4, 6].

External eating behavior is manifested by an increased response of the patient not to internal, homeostatic stimuli for eating (blood glucose and free fatty acids, stomach fullness, gastric motility, etc.), but to external stimuli, such as the type of food or food advertising. Obese people with external eating behavior eat regardless of when they last ate [6,7]. With this type of eating behavior, the availability of products is of decisive importance. It is this feature that underlies overeating for the company, snacking on the street, eating too much at a party, buying too much food. According to our data, external eating behavior is expressed to some extent in almost all obese patients. The basis of an increased response to external stimuli for eating is not only an increased appetite, but also a slowly developing, inferior feeling of fullness. In the delay in the feeling of satiety, the habitual, excessively rapid absorption of food also plays a certain role.

Another type of eating disorder is emotiogenic eating behavior, which, according to our data, occurs in 60% of obese patients. The incentive to eat is not hunger, but emotional discomfort; a person eats not because he is hungry, but because he is restless, anxious, irritated, he is in a bad mood, he is depressed, depressed, offended, annoyed, disappointed, failed, he is bored, lonely, etc. In other words, an incentive to take food becomes not hunger, but emotional discomfort. Man eats up his sorrows and misfortunes. This type of eating disorder has other names: hyperphagic stress response, emotional overeating, “food drinking”. Figuratively speaking, a person with emotional eating behavior “jams” his sorrows and misfortunes in the same way as a person who is accustomed to alcohol drinks them down.

Emotional eating behavior can be represented by a paroxysmal form (compulsive eating behavior) or overeating with a violation of the daily rhythm of eating (night eating syndrome). These forms are somewhat less common in clinical practice: compulsive eating behavior – in 25%, night eating syndrome – in 9-10% of obese patients.

Compulsive eating behavior is clinically manifested by bouts of overeating – not constant, but as if compressed into short periods of time, not exceeding two hours. In this case, the patient eats obviously more than usual and faster than usual. He gets the feeling that he cannot regulate his own food intake and stop overeating. Loss of control over food intake is an important diagnostic feature of compulsive eating attacks. Eating can occur without feeling hungry. The attack of overeating is interrupted spontaneously, as a rule, due to excessive overflow of the stomach; sometimes because of the arrival of outsiders, as patients, embarrassed by such attacks, carefully hide them. During and after attacks, patients experience self-loathing, depression, or guilt due to overeating. Diagnostic criteria for compulsive eating behavior (Bingeeating disorder) were developed by A. J. Stunkard [8] and included in the DSM-1V classification.

Night eating syndrome is manifested by a clinical triad of symptoms: morning anorexia, evening and nocturnal bulimia, sleep disturbances.

Patients with night eating syndrome usually do not eat during the first half of the day. In the morning their appetite is obviously reduced or absent, the sight of food can be disgusting. By evening, they experience a pronounced feeling of hunger, which leads to significant overeating. Moreover, the stronger the emotional discomfort, the more pronounced the evening overeating, when they eat too much, quickly and greedily. Patients cannot sleep without eating too much food. Their sleep is superficial, disturbing, restless, they can wake up at night and eat again [3, 6, 8].

The listed types of eating disorders always aggravate or appear for the first time during the appointment of dietary therapy. This can be avoided only by simultaneously using behavioral modification of the disturbed food stereotype and pharmacotherapy. Let’s take a look at their main points.

Treatment of obesity is desirable to begin with increasing the patient’s motivation to reduce body weight. To do this, it is necessary to analyze the reasons why the patient wants to lose weight, and find out who initiated his desire to reduce body weight. Many patients want to do this solely on the recommendation of doctors or at the request of loved ones. In such a case, we are dealing with insufficient awareness by the patient of his problems. Some patients are solely concerned with their appearance and are not aware of the harm to health caused by excess body weight. Strengthening the motivation to reduce body weight should begin with the formation of a desire to lose weight in the patient himself, fixing attention and specifying absolutely all the positive changes that follow its decrease. For each patient, of course, it is necessary to build an individual list of motives based on his problems, needs and requests.

The next task is to form in the patient the desire not for illusory, but for realistic goals. Exaggerated, unrealistic desires of patients can give rise to tangible difficulties in mutual understanding with the doctor and cause patient dissatisfaction with the slow pace of weight loss. This is often followed by refusal of further therapy. It is desirable to shift the goal of the patient from the desire to lose as many kilograms as possible to a more important goal – gaining good somatic and emotional well-being.

The next stage is the gradual formation of the correct style of eating behavior, which is described in detail in domestic monographs [1-4]. Here are just a few very important recommendations.

1. Instead of prescribing any strict diet at the first stage of treatment, it is only necessary to exclude from the patient’s diet 2-3 of his most favorite and most high-calorie foods, which will avoid the occurrence of “dietary depression”, which necessarily occurs with a sharp change in the usual style of eating.
2. Food intake should be increased to 4-5 times a day. Fractional nutrition is the best fit with one of the principles of obesity therapy: “If you want to lose weight, never bring yourself to severe hunger.”
3. It is strongly recommended not to eat on the go, out of hand, standing up, etc. The patient should be in the habit of eating at fixed times, in the same place, at a well-served table, in a room, and not in the kitchen. It is desirable to gradually develop a certain eating ritual that would develop and satisfy the patient’s aesthetic needs and prevent imperceptible, automatic overeating.
4. All food restrictions of the patient are recommended to be extended to his entire family. At home, in no case should there be products that are prohibited to the patient. This recommendation helps reduce external eating behavior, avoid unnecessary tension in the family and make relatives not passive observers, but like-minded people and active participants in the patient’s weight loss process.
5. It is necessary to try to break the patient’s habitual stereotype – to calm down while eating. To reduce the manifestations of emotional eating behavior, the patient should be taught to distinguish between states of hunger and emotional discomfort; then offer ways to relax other than eating. This can be physical activity, autogenic training, talking on the phone, playing solitaire, music, knitting, sewing, walking, showering, bathing, dancing, etc. The patient should be helped to choose the most appropriate way of mental relaxation for him.

Modern drugs currently used for the treatment of obesity and the correction of eating behavior are divided into 2 classes: central and peripheral action.

Of the drugs of central action, we should mention fluoxetine, which belongs to both antidepressants and anorexigenic drugs. The appointment of fluoxetine in obesity with impaired eating behavior is pathogenetically justified, since this normalizes impaired serotonin metabolism in the central nervous system. Fluoxetine is used at a dose of 20-40 mg per day for 3 months. It is indicated for obese patients who have reduced satiety, emotional eating behavior, anxiety and depressive disorders, chronic pain syndromes, panic attacks. It is also recommended to prescribe it to those patients in whom decompensation in the mental and psycho-vegetative spheres occurred against the background of previous diet therapy [5].

Another centrally acting drug is sibutramine. It affects not only the serotonergic, but also the noradrenergic systems of the brain. This drug reduces appetite, increases the feeling of satiety, reduces the amount of food consumed, normalizes eating behavior, corrects the state of the mental and psycho-vegetative sphere. An increase in basal metabolism, which occurs as a result of stimulation of the noradrenergic systems, also contributes to a decrease in body weight. However, sibutramine should not be prescribed to highly anxious patients prone to tachycardia and / or panic attacks, as well as to persistent arterial hypertension.

Xenical is the main and leading drug of peripheral action. The drug acts exclusively in the intestines, where it partially blocks lipase, an enzyme that breaks down fats. Undigested fats cannot pass through the intestinal wall and are excreted from the body along with feces. The recommended mode of administration is three times a day with main meals. The drug is approved for long-term use (up to 4 years) [9]. Xenical can be used not only as a remedy, but also as a diagnostic. The patient is explained the mechanism of action of Xenical and is asked to monitor changes in the stool. If it becomes greasy and oily, then the patient is overeating fats. It is essential that the patient himself is convinced of the overeating of fats, which he often initially denies – not because of a conscious desire to mislead the doctor, but simply out of ignorance. As a rule, patients only consider visible animal fat and completely ignore hidden fat. In addition, some patients, switching to plant foods, begin to abuse vegetable oils, forgetting about their very high calorie content. Thus, the appearance of fatty stools while taking the drug serves as a kind of marker for excessive fat intake and requires a correction in the diet.

Xenical allows the patient to independently, as the stool changes, make adjustments to his diet, evaluate the success of the transition to proper nutrition, and eliminate the consequences of situational overeating on his own.