65: Weight Challenges with Mental Health Treatments: Insights from Psychiatrist Dr. Mark Novitsky

While psychiatric medications can be essential for improving mental health–and even life-saving for some–they often come with unwanted side effects, including weight gain. Historically, a lack of integration between psychiatrists and other healthcare providers has meant that the impact of these medications on weight has often been overlooked.

Someone who has a deep understanding of the relationship between psychiatric medications and weight gain is Dr. Mark Novitsky, who is board certified in child and adolescent psychiatry, adult Psychiatry, and obesity medicine. Dr. Novitsky emphasizes a therapy-first approach and promotes healthy lifestyle choices for his patients, addressing issues like ADHD, anxiety, and depression through holistic strategies that include sleep habits, exercise, and nutrition.

Here, I’ll be sharing his insights into the influence of psychiatric medications on weight gain, common medications that may affect weight, the role of genetic testing in personalized treatment, and practical strategies for managing weight concerns associated with ADHD and psychiatric medications.

Weight Considerations with Psychiatric Medications

When Dr. Novitsky assesses a patient, knowing how medications might affect weight is an important consideration. Safety always comes first, so if urgent action is required, then the priority is choosing an agent that's going to work really quickly. But for patients seeking stability and mental health improvement, Dr. Novitsky empowers patients by providing options and involving them in treatment decisions right from the start.

For example, if it transpires that someone has struggled with weight-related issues or has a history of negative body image, prioritizing medications that are less likely to cause weight gain is going to lead to better treatment outcomes. This approach acknowledges the patient's perspective and aims to align treatment with their goals and concerns.

These conversations are key to help patients become aware of the potential side effects of medications, including weight gain, and it allows them a voice in their treatment plan. By encouraging open communication and informed decision-making, patients can feel more supported in achieving their mental health goals while minimizing adverse effects on their overall well-being.

Common Depression Medications that Cause Weight Gain

When it comes to common depression medications that can contribute to weight gain, there are several to be aware of. One of the biggest culprits is Seroquel (quetiapine), which is often prescribed for sleep. This medication affects histamine receptors in the brain and GI tract, leading to what's known as "Seroquel munchies" late at night. Patients might report improved sleep but waking up feeling extremely hungry.

Other medications in the atypical antipsychotic class, like Abilify (aripiprazole) and Risperdal (risperidone), are also known to cause weight gain. It's interesting to note that Abilify and Risperdal are FDA-approved for children with autism spectrum disorder (ASD) due to their effectiveness in managing irritability associated with ASD. However, these medications can contribute to weight gain in children, which is a concern given rising rates of childhood obesity.

Among the SSRI (selective serotonin reuptake inhibitor) antidepressants, medications like Zoloft (sertraline) are effective but can also increase appetite. It's important to balance the benefits of these medications with the potential for weight gain and discuss concerns with your psychiatrist or healthcare provider.

If weight gain is a significant concern, options like Prozac (fluoxetine) or Wellbutrin (bupropion) might be considered. Wellbutrin, in particular, tends to be more weight-neutral and may even decrease appetite, but it's less effective for anxiety compared to other antidepressants. Always discuss your preferences and concerns with your healthcare provider to find the best treatment option for you.

Genetic Testing to Personalize Treatment

Dr. Novitsky routinely utilizes genetic testing to inform medication choices. While it doesn't provide a definitive answer, it acts as a roadmap, helping to minimize the trial and error typically associated with finding the right medication. By analyzing genes like SLC6A4, which impacts SSRI effectiveness, we can avoid the frustration of discovering months later that a chosen medication isn't suitable.

Genetic testing also plays a crucial role in obesity medicine. It can predict emotional eating patterns and validate genetic barriers that affect metabolism and weight management. For patients, this understanding shifts the perspective from a personal struggle to a biological reality. It explains why some individuals can eat without consequences while others face challenges.

The Three Pillars of Health

In Dr. Novitsky’s  practice, he always starts by discussing the importance of the three key pillars of health: exercise, sleep, and nutrition. Many people might wonder why a psychiatrist is focusing on these areas, but they are foundational to overall well-being and can significantly impact mental health outcomes.

• Exercise: Regular physical activity, including both cardiovascular exercise and strength training, plays a critical role in maintaining optimal mental health. Exercise increases levels of brain-derived neurotrophic factor (BDNF), which supports nerve communication and enhances focus and mood. It also allows for lower medication doses to be effective, minimizing side effects like weight gain.
• Sleep: Achieving good sleep hygiene is essential for mental health. Standardizing wake-up times helps regulate circadian rhythms. Avoiding screens before bed and establishing a relaxing pre-sleep routine, such as listening to calming music or taking a warm shower, can improve sleep quality. Consistency in sleep patterns is key to optimizing mental and physical health.
• Nutrition: Proper nutrition is crucial for overall health and mental well-being. Processed foods and late-night snacking can disrupt the gut microbiome and lead to increased cravings. Opting for whole foods and balanced meals supports a diverse microbiome and promotes stable energy levels throughout the day. Mindful eating practices can help individuals recognize the impact of food choices on mood and energy levels.

By prioritizing these three pillars, we can lay a strong foundation for mental health and optimize the effectiveness of psychiatric treatments,  similar to how they are all crucial for anyone on weight loss medications.

Impact of ADHD on Eating Behaviors

ADHD (Attention Deficit Hyperactivity Disorder) affects attention and impulse control due to dopamine regulation issues in the brain. This can lead to impulsive eating behaviors and challenges with maintaining healthy eating habits.

Medications used to treat ADHD, like Adderall or Ritalin, work by increasing dopamine levels in the brain, which helps improve attention and reduce impulsivity. However, these medications can also suppress appetite while active in the system, leading to reduced food intake during certain times of the day.

Managing ADHD with medications focuses on attention and impulsivity, not weight control. Lifestyle factors like diet, exercise, and sleep remain important for overall health, especially for individuals with ADHD.

Strategies to Help Manage ADHD and Weight Concerns

Dr. Novitsky recommends some practical strategies to support individuals managing ADHD and weight concerns:

• Meal Timing and Hydration: Encourage awareness of meal timing and hydration patterns. Journaling can help identify when hunger or dehydration tend to occur, allowing for adjustments in meal timing and fluid intake.
• Medication Awareness: Understand the timing and effects of ADHD medications. Note when medications wear off to anticipate changes in appetite and energy levels.
• Behavioral Journaling: Use simple methods like phone notes to track behaviors and identify patterns.
• Medication Management: Discuss medication schedules with healthcare providers. Adjust dosages or consider med holidays based on individual needs and lifestyle demands.
• Normalize Symptoms: Instead of labeling yourself as "having ADHD", switch the focus to managing symptoms effectively. 
• Open Communication: Maintain open communication with healthcare providers about medication adjustments, side effects, and lifestyle impacts. This partnership ensures tailored and effective treatment strategies.

If you have any concerns about your health, diet, medication, or mental well-being, please reach out to a professional. You are the captain of your health care team, and it's crucial to discuss any questions or information you come across with your doctor.

We live in an age where there's a wealth of information available online, but not all of it may be applicable to your specific situation. Bring up what you've read or heard with your healthcare provider. They can provide personalized insights and guidance based on your unique physiology and needs.

Remember, your doctor is there to work with you and help navigate your treatment journey, whether it's for mental health, obesity management, or any other health concern. Communication and collaboration with your healthcare provider are key to achieving your health goals effectively and safely.