Mood & Food

This weekend (June 8) I was part of a lunch symposium on the Complex Depressed Patient at the 30th Annual Meeting of the Canadian College of Neuropsychopharmacology (CCNP), held in Toronto.

Other members of the panel were Claudio Soares (McMaster), Pierre Blier (Ottawa) and Valerie Taylor (McMaster).

While Soares and Blier focused their discussion on a case of peri-menopausal depression, Taylor and I discussed a patient who was non-compliant with her antidepressant medication due to weight gain.

As blogged previously, weight gain is a common complication of neuropsychiatric medications and there are few proven strategies to treat or prevent it. While there is some data to support co-prescription of metformin or sibutramine with some of the psychotropic medications, this is clearly not current medical practice.

As always, prevention of weight gain may be easier than treating obesity. Thus it may perhaps be advisable to start patients on weight-gain prevention strategies (which may include both behavioural interventions and antiobesity medications) right off the bat rather than trying to treat the excess weight gain or risk non-compliance resulting from the weight gain.

As pointed out by Taylor, based on her own (unpublished) observations and other studies, weight gain with psychotropic medications is by no means benign, resulting in all of the usual complications of weight gain.

We know that simply telling people to eat less and move more is as effective for treating obesity as simply telling people to cheer up is for depression.

Both are complex multifactorial conditions that need to be addressed by behavioural, psychological and often medical interventions - not uncommonly for life!

AMS
Edmonton, Alberta

Hat tip to Bryan Ashuk for suggesting the title for this post