The Antidepressant Diet

The connection between carbohydrates, serotonin, and antidepressant weight gain

Are the Side Effects Worth It?

Performance enhanced diets have hefty risks yet unknown.

Adderall was used as a medication for children with ADHD, and somehow morphed into a recreational drug taken by teens who helped themselves to their younger sibling’s medication. Now adults are using it, and it’s not because they are hyperactive. They are hyper-worried about weighing too many ounces to fit into a ball gown or tight jeans. Adderall works, as do other amphetamine-like drugs such as phentermine, by decreasing eating and stimulating activity. The resulting combination of no appetite, together with being jittery and agitated (some of the side effects of amphetamines), work wonders to “melt” off pounds. When exercise and self-discipline over food intake begins to lag or become tedious, some cynics believe that there is nothing like a good stimulant to kick the diet into motion again.

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People are not picking up Adderall on street corners or in playgrounds. Rather, they are going to physician-run clinics around the country, where doctors are prescribing this drug alone or in combination with antidepressants such as Prozac. This use of such drugs is called “off-label,” which means that there are no clinical studies to show efficacy, side effects, or long-term results when used for medical conditions for which they have never been tested. But since these drugs passed FDA scrutiny when they were evaluated for use in other medical conditions, the physician is allowed to prescribe them for other uses.

And overprescribed they are. Per FDA guidelines, phentermine, an amphetamine-like stimulant that should not be used for more than 12 weeks because of its addictive potential, is now being combined with antidepressants as a potent weight-loss preparation. The antidepressants often have no effect on weight loss, and when used alone are often associated with weight gain. But antidepressants do improve mood, can decrease anxiety and also ameliorate the symptoms of severe PMS and fibromyalgia. Amphetamines, or their first cousins like phentermine, do take away the urge to eat; although once they are no longer taken, rebound binge eating may occur. So what a great idea: an anti-hunger pill combined with a good mood pill…It seems like a perfect prescription for weight loss.

But is it? All these medications have side effects and Adderall, phentermine and similar stimulant medications, may become addictive in only a few weeks. Hallucinations, abnormal heart rhythms, and numbness in the extremities are also little known side effects. The antidepressants have their own side effects. (In the movie “Silver Linings Playbook”, the two main characters in a very funny scene recite some of them.) Yet it’s the withdrawal from the amphetamine-like drugs is particularly unpleasant, because in addition to the tendency to eat everything not tied down, people feel an overwhelming exhaustion. This, of course, is a perfect prescription for weight gain. And so a vicious cycle can set in and seem intractable, frustrating the most motivated of dieter sold this bill of goods.

People who have a great deal of weight to lose may benefit from prescription weight-loss pills and the FDA agrees. The agency recently approved two drugs: Belviq, which increases satiety, and Qsymia, a combination of phentermine and the anti-epileptic drug Topamax. But according to the FDA, the prescribing of these drugs is supposed to be restricted to people who are overweight (a BMI of over 27) and have related health problems such as hypertension, and those who are obese (a BMI of 30 or higher and about 100 pounds overweight). Ideally, these drugs should allow enough of an initial weight loss to motivate the dieter to adhere to a long-term weight loss and exercise program. The long term strategy? That eventually weight is lost without using the drugs.

These new weight loss drugs have a long list of potentially injurious side effects, but the FDA considers the risks of obesity sufficiently great that they balance out the various side effects the drugs may produce.

But should people who have small amounts of weight to lose be taking these FDA approved drugs, or the off-label drugs dispensed by various physicians? The temptation to remove, seemingly without effort, those unwanted 5-10 pounds by using an appetite suppressant is easy to understand. This “Willpower in a Bottle” bypasses the tedium of forcing oneself to scrutinize every calorie, consider every gram of fat and carbohydrate, and measure meal size. With these pills, appetite vanishes and the dieter has no trouble eating very small amounts of food. Sounds great, doesn’t it? But in addition to the almost inevitable overeating that follows withdrawal from these medications, their high risk profile addictive potential, and many unpleasant side effects, they also act to mask the real problem: what is preventing the dieter from losing those unwanted 10 pounds?

Adderall and phentermine, when combined with antidepressants, may undo the consequences of too much food, alcohol and too little exercise. But do they help dieters gain a healthy eating and exercise lifestyle, in conjunction with lost weight? I doubt it. It is like someone with reflux who takes medication to diminish stomach acid pain but continues to eat the foods that cause the stomach distress. It’s a self defeating therapy that is best described as a lose-lose, and not of excess weight, but because a cycle of withdrawal, then failure to maintain weight loss, and the yet unknown long term side effects.

Sadly these quick weight loss drug therapies prevent learning how to eat healthily, understanding how to use foods such as low-fat carbohydrates to increase satiety naturally through the increase of serotonin, and finding out how to find emotional and mental well-being from exercise. The absence of these positive life style changes cannot compensate for the loss of a few pounds. Nor can off-label prescriptions for weight reduction lower the risks of potentially deleterious side effects. Best to leave the pills behind and keep weight loss on it’s time honored formula of balanced nutrition and exercise and positive mental models reframing emotional overeating. Consider ten extra minutes on the treadmill your enhanced performance, and leave the pharmaceuticals for their sole purpose.

Judith Wurtman, Ph.D., is the co-author of The Serotonin Power Diet and the founder of a Harvard University hospital weight-loss facility.

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