Sanctions and Medical Supply Shortages in Iran (Viewpoints No. 20)
Psychiatic medications and obesity Nasr Esfahani Associate Professor of Psychiatry Iran University...
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Transcript of Psychiatic medications and obesity Nasr Esfahani Associate Professor of Psychiatry Iran University...
Psychiatic medications and Psychiatic medications and obesityobesity
Nasr EsfahaniNasr EsfahaniAssociate Professor of PsychiatryAssociate Professor of Psychiatry
Iran University of Medical Science Iran University of Medical Science Rasool Akram HospitalRasool Akram Hospital
20092009
Introduction Introduction
Social and psychological consequences Social and psychological consequences
Appetite Appetite
Regulating eating behaviorRegulating eating behavior
Social and psychological consequencesSocial and psychological consequences
PsychologicaPsychologica BlameBlame
Subject of teasingSubject of teasing discriminationdiscrimination
OccupationalOccupational Income powerIncome power
SocialSocial Absence of romantic relationshipsAbsence of romantic relationships
Appetite Appetite
Appetite, defined as the desire for food.Appetite, defined as the desire for food.
Hungry person may eat to full satisfaction when Hungry person may eat to full satisfaction when food is available, but appetite can also induce food is available, but appetite can also induce a person to overeat past the point of satiety.a person to overeat past the point of satiety.
Regulating eating behaviorRegulating eating behavior(neurotransmetters)(neurotransmetters)
SerotoninSerotonin
HistamineHistamine
DopamineDopamine
NorepinephrineNorepinephrine
Regulating eating behaviorRegulating eating behavior(Hormones) (Hormones)
Corticotrophin releasing factor (CRF)Corticotrophin releasing factor (CRF)
Neuropeptide YNeuropeptide Y
Gonadotropin-releasing hormoneGonadotropin-releasing hormone
Thyroid-stimulating hormoneThyroid-stimulating hormone
A new subtance obestatin, made in the stomach, A new subtance obestatin, made in the stomach, is a homone that in animal experiments is a homone that in animal experiments produce satiety and may have potential use as produce satiety and may have potential use as a weight loss agent in humans. a weight loss agent in humans.
Cannabinoid receptorsCannabinoid receptors
Cannabinoid receptors are related to Cannabinoid receptors are related to appetiteappetite and and stmulated withstmulated with cannbis cannbis (marijuana). (marijuana).
A cannabinoid antagonist has been developed that block A cannabinoid antagonist has been developed that block appetite.appetite.
Rimonabant is an inverse agonist to the cannabidiol Rimonabant is an inverse agonist to the cannabidiol receptor,meanig that blocks appetite.receptor,meanig that blocks appetite.
Olfactory systemOlfactory system
The olfactory system may play a role in satiety.The olfactory system may play a role in satiety.
Experiments have shown that stong stimulation Experiments have shown that stong stimulation of the olfactory bulbs in the nose with food by of the olfactory bulbs in the nose with food by use of an inhaler saturated with a particular use of an inhaler saturated with a particular smell produce satiety for that food. This may smell produce satiety for that food. This may have implication for therapy of obesity.have implication for therapy of obesity.
Psychiatric Medications and Psychiatric Medications and Changes in Body WeightChanges in Body Weight
MechanismMechanism
No specific mechanism have been idetified as No specific mechanism have been idetified as causing weight gain, and it appears that the causing weight gain, and it appears that the histamin and serotonin systems mediate histamin and serotonin systems mediate changes in weight associated with many drugs changes in weight associated with many drugs used to treat depression and psychosis.used to treat depression and psychosis.
Serotonin receptorsSerotonin receptors
5-HT5-HT1A1A 5-HT5-HT2A2A 5-HT5-HT55αα
5-HT5-HT1B1B 5-HT5-HT2B2B 5-HT5-HT55ββ
5-HT5-HT1D1D 5-HT5-HT2C2C 5-HT5-HT66
5-HT5-HT1E1E 5-HT5-HT33 5-HT5-HT77
5-HT5-HT1F1F 5-HT5-HT44
5HT5HT2c 2c receptorsreceptors
Stimulation of 5HT2c receptors has been proposed to produced anxiogenic effects as well as anorectic effects (LSD)
Inhibition of 5HT2c receptors may play a role in the weight gain and development type II diabetes associated with atypical antipsychotics
Histamine receptorsHistamine receptorsH1, H2, H3, H4H1, H2, H3, H4
Antagonist of H1 : sedation and weight gainAntagonist of H1 : sedation and weight gain
Antagonist of H2 : treatment of peptic ulcer diseaseAntagonist of H2 : treatment of peptic ulcer disease
Antagonist ofAntagonist of H3 : propsed to treat sleep disorders, obesity, dementia H3 : propsed to treat sleep disorders, obesity, dementia
Antagonist of H4 : possible role as anti-inflemmatory agentsAntagonist of H4 : possible role as anti-inflemmatory agents
Psychotropic drugs and weight gain Psychotropic drugs and weight gain
Retained fluidRetained fluid
Decrease exerciseDecrease exercise
Altered metabolismAltered metabolism
Increased caloric intakeIncreased caloric intake
IncreasedIncreased appetiteappetite Anticholinergic effectsAnticholinergic effects
FoodFood cravingscravings Dry mouthDry mouth
Eating carbohydrats Increased thirst Eating carbohydrats Increased thirst
Tricyclic and Tricyclic and tetracyclic tetracyclic
antidepressantsantidepressants
Tricyclic and Tricyclic and tetracyclic tetracyclic
antidepressantsantidepressants
Selective Serotonin Reuptake InhibitorsSelective Serotonin Reuptake InhibitorsSSRIsSSRIs
Initial anorexia can also occur and is most common with Initial anorexia can also occur and is most common with fluoxetine.fluoxetine.
SSRI- induced appetite and weight loss begin as soon as the SSRI- induced appetite and weight loss begin as soon as the drug is taken and peak at 20 weeks, after which weight drug is taken and peak at 20 weeks, after which weight often returns to baseline.often returns to baseline.
This effect is mediated through a This effect is mediated through a metabolic mechanism, metabolic mechanism, increase in appetite, or both. increase in appetite, or both. it happens gradually and is it happens gradually and is usuallyusually resistant to diet and exersise regimens. resistant to diet and exersise regimens.
Atypical antipsychoticsAtypical antipsychotics
Insulin resistance Insulin resistance
Weight gainWeight gain
Type II diabetesType II diabetes
olanzapine, clozapineolanzapine, clozapine
Tendency to Increase Appetite and Body WeightTendency to Increase Appetite and Body Weight
Antidepressant drugsAntidepressant drugs
GreatestGreatest IntermediateIntermediate Least Least Amitriptyline (Amitriptyline (ElavilElavil)) Doxepin (Sinequan)Doxepin (Sinequan)
Imipramine (Tofranil)Imipramine (Tofranil)Mirtazapine (Remeron)Mirtazapine (Remeron)Nortriptyline (Pamelor)Nortriptyline (Pamelor)
Phenelzine (Nardil)Phenelzine (Nardil)
Trimipramine(Trimipramine(SurmontilSurmontil))
Amoxapine (Asendin)Amoxapine (Asendin)Desipramine Desipramine (Norpramin)(Norpramin)Trazodone (Desyrel)Trazodone (Desyrel)Tranylcypromine Tranylcypromine (Parnate)(Parnate)Fluoxetine (Prozac)Fluoxetine (Prozac)
Sertraline (Zoloft)Sertraline (Zoloft)aa
Bupropion (Wellbutrin)Bupropion (Wellbutrin)
Venlafaxine (Effexor)Venlafaxine (Effexor)
Tendency to Increase Appetite and Body WeightTendency to Increase Appetite and Body Weight
Mood stabilizersMood stabilizers
GreatestGreatest IntermediateIntermediate Least Least
Lithium (Eskalith) Lithium (Eskalith)
Valproic acid Valproic acid (Depakene)(Depakene)
Carbamazepine Carbamazepine (Tegretol)(Tegretol)
Topiramate Topiramate (Topamax)(Topamax)
Tendency to Increase Appetite and Body WeightTendency to Increase Appetite and Body Weight
Antipsychotic drugsAntipsychotic drugs
GreatestGreatest IntermediateIntermediate Least Least
Chlorpromazine Chlorpromazine (Thorazine)(Thorazine)
Thioridazine (Mellaril) Thioridazine (Mellaril)
Mesoridazine (Serentil) Mesoridazine (Serentil)
Olanzapine (Zyprexa)Olanzapine (Zyprexa)
Sertindole (Serdolect)Sertindole (Serdolect)
Risperidone (Risperdal)Risperidone (Risperdal)
Haloperidol (Haldol)Haloperidol (Haldol)
TrifluoperazineTrifluoperazine
PerphenazinePerphenazine
ThiothixeneThiothixene
fluphenazinefluphenazine
Ziprasidone (Geodon)Ziprasidone (Geodon)Aripiprazole (Abilify)Aripiprazole (Abilify)Molindone (Moban)Molindone (Moban)aa
Brain serotonergic pathwayBrain serotonergic pathway
Brain dopaminergic Brain dopaminergic pathwaypathway
Brain noradrenergic Brain noradrenergic pathwaypathway
Histaminergic pathwayHistaminergic pathway
Brain cholinergic pathwayBrain cholinergic pathway