How To Reduce Weight?
Have little food at short intervals.
Detailed Answer:
Hello
Welcome to HCM.
You appear to be tensed a lot with your weight. I understand your concerns.
See, cutting off the diet to extremes and having tea excessively is not the solution. Restricting the diet to extremes might lead to weakness and hypotension.
Here are some suggestions which you can follow:
1. Take small meals at short intervals. This will keep you full throughout the day and will take care of your body's need of nutrition.
2. Take a balanced diet. Increase the amount of fibres in your diet like salads and fruits.
3. Cut out on fatty foods and junk foods.
4. Your breakfast should be adequate, lunch relatively light and dinner still lighter.
5. Engage in physical activities like brisk walk in morning or aerobics.
6. Drink a glass of hot water in sips twice daily in morning and evening.
7. Go for a light walk in night after dinner before going to bed.
There are few things which i would like to ask to you:
1.Why are you taking antidepressants? Just for weight loss or whether you suffer from depression?
2. As you have not specified medical history, i would like to know whether your thyroid function tests and blood sugar levels are normal?
3. Is there any family history of obesity or any other medical illness?
There are some anti-obesity drugs like topiramate, sibutramine etc which can be given keeping in mind there risk-benefit ratio. The choice of drug will depend after medical history.
I advice you not to go for MAO inhibitors as they have quite high number of side effects. Instead a combination of other antidepressants are a better choice if depression is the issue.
Hope these suggestions are helpful.
Any further queries are always welcome.
I wish you good health.
Thanks.
you may need a drug change and psychotherapy.
Detailed Answer:
Thanks for posting about your problem in detail. I have gone through your description thouroughly and understand your concerns.
Let me answer your queries point-wise:
1. Regarding MAO inhibitors: These drugs are potential antidepressants but have lots of drug interactions with over the counter and prescription drugs. Also, these have interactions with foods containing tyramine like coconut, pineapples, yogurt, meat, cheese etc. So you would have to be extremely cautious with that. I dont think MAO inhibitors are a good option.
2. Regarding major depression: It appears that you have a drug resistant depression. You are taking Pristiq and Lamictal.
Has your treating doctor tried fluoxetine as high as 80-100mg? If not, this would be my first choice. This will take care of your eating disorder as well.
Secondly, resistant and recurrent depression are suggestive of bipolar disorder. If you are not responding to a mood stabiliser like lamotrigine, you can take tablet topamax with upward titrations of dose upto 200mg, depending on response (other mood stabilisers like divalproex and tegrital can cause weight gain). Topamax would act as a mood stabiliser as well help you in weight loss.
Thirdly, in resistant depression, antipsychotics like olanzapine or aripiprazole can also be used. The drug of choice would be Aripiprazole as this can promote weight loss and normalise metabolic parameters. All other antipsychotics can cause weight gain.
The other treatment line would be to go for cognitive behaviour therapy and behavioural activation alongwith medicines. For this you would need a trained psychotherapist.
3. Regarding Lifestyle modifications: Intensive lifestyle modification programs wont be feasible for you as you have had back surgeries. Still i would advise you to use a treadmill for slight physical activity under supervision initially, and then on your own.
4. Regarding anti-obesity medicines- Recently a drug combination called CONTRAVE has been approved by US FDA for obesity. This is a combination of bupropion and naltrexone. Talk to your doctor about its regime. It might prove helpful for you as bupropion itself is an antidepressant.
Please discuss these issues with your treating doctor.
Hope this information helps you.
I wish you good health.
Thanks.