What Causes Sudden Gain Of Weight Inspite Of Being On Zyprexa?

Posted on Fri, 8 May 2015

Question: Thank you. I spoke with you on March 6th about my son. I'm not sure if you can access that conversation. I couldn't figure out how to send it to you. My son has been on zyprexa 5 mg for about 5 weeks. He has no energy and sleeps 14-16 hours per day and lays around the rest of the time. He said he feels very exhausted. He is normally very bright and active and involved. His thoughts were more clear for a few weeks after starting zyprexa. His anxiety came back a couple of weeks ago. His doctor increased effexor xr from 75 mg to 112.5 mg. it helped the anxiety. Now the last few days anxiety is back and he said his thoughts are "loud". No one is speaking to him and he isn't having hallucinations. He doesn't know how else to describe it. He successfully stopped using pot and it has been about 6 weeks I think. He gained 20 lbs first 4 weeks on zyprexa. Always hungry / never full / not eating healthy like usual.

I am wondering what you think could help him? I cannot stand to see him suffer any more. He has no fun in life and isn't accomplishing things. He was a very high functioning teenager in the past.

Thank you.

Answered by Dr. Shubham Mehta (5 hours later)

Brief Answer:
aripiprazole.

Detailed Answer:
Hello again.

I can access the previous conversation which we had on 6th march.

I have details which you have provided me now as well.

I understand your concerns for your son.

He has started gaining weight with zyprexa and sleeps for most of the time. He feel exhausted and his thoughts are 'loud' as he describes.

Well, in my opinion, switching to aripiprazole(prescritpion drug) MUST be considered at this time.

In addition to its mood stabilizing, antipsychotic and antidepressant properties, it can also help to reduce weight. This is also an activating drug and has to be given in daytime. This will help in reducing his excessive sleepiness.

Kindly talk to your doctor about this.

Hope this helps.

I wish good health for your son.
Feel free to discuss further.
Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shubham Mehta (23 hours later)

Thank you so much! We have an appointment tomorrow and I will discuss this with his doctor. My son confided in me last night that the ghost and haunting began right after he tried the drug ecstacy. He also said he took an abnormally large dose after falling for peer pressure. I thought you might be interested in what precipitated the delusions.

One question - Do you think his symptoms may resolve with antipsychotic treatment or so you think he will need antipsychotic meds for his whole life?

Last question - His chronic pain severity decreased significantly with antipsychotic medications. It was an unexpected result. Do you think this means his pain was psychiatric in nature or just that the adjustment of the brain chemicals lessened his pain?

Thank you so much! I am very impressed by your insight and this will help me to advocate for my son with his doctor here.

Answered by Dr. Shubham Mehta (1 hour later)

Brief Answer:
long term antipsychotic treatment.

Detailed Answer:
Hello again.

Your are welcome.

Please allow me to include some details in my response so that you can understand this easily.

Even a single shot of Ecstacy can cause psychosis.
As he accepted that he took heavy dose of ecstacy (even though under peer pressure), this must have precipitated his delusions.

Regarding the duration of drug treatment, right now, its very difficult to determine the duration of treatment.
If this would have been just a single episode of psychotic symptoms caused by Ecstacy, it would have resolved in few days treatment.
But, your son is having the symptoms prior to ecstacy use and also has long history of abuse of pot, I think long term antipsychotics would be needed.

I understand that this do have side effects. But, Its absolutely necessary for your son to continue treatment for a longer term.

Another important point which I would like to mention here is, your son confided in you and accepted that he used ecstacy. He gave up to peer pressure. This suggests that he needs much emotional support and you are the best person for this.
Teach him to stay confident and say NO to his peer if they force him for such things.

Regarding the severity of pain, it was decreased by antipsychotics or may be venlafaxine.
I would like to tell you that the pain of psychiatric origin (better term would be somatoform pain) is also found to be caused by certain neurochemical imbalances in the brain. The antipsychotics and antidepressants correct these imbalances and reduce the intensity of pain.
As they also decrease anxiety, this also reduces the pain.

Hope this helps you in some way.

You can approach me directly anytime if you have more queries. I will try to help you in all the possible ways.

I wish good health for your son.

Kindly close the discussion if you have no more queries and give your valuable feedback.

Take care.
Thanks.

Dr. Shubham Mehta, MD (Psychiatry).

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shubham Mehta (21 hours later)

Hello again, I hope it is ok that I write another question. Also, thank you for the advice regarding emotional support and peer pressure. I will definitely work on this with him. We had the appointment with his psychiatrist today. I mentioned switching to Abilify and his doctor felt it was too closely related to the latuda, which was the third drug he tried. My son developed akathesia (?spelling) from this drug and could only tolerate it for 3 days. The doctor also mentioned he wasn't sure Abilify would be strong enough and he was also hesitant to make another drug change since he is relatively stable. We go back in 2 weeks to see his colleague, who he said may have a different opinion.

I am wondering if you think my son will have akesthesia from Abilify given his response to Latuda?

Drug history -1. seroquel - took 4 months - couldn't increase dose high enough to be very therapeutic because of constant sleeping. 2. Risperdone - took 4 days but hot flashes, dizziness, and tachycardia/heart racing did not improve after 4 days and my son didn't want to take any more. 3. Latuda - took 3 days but had intolerable feelings of inner restlessness. 4. Current med - 25 lb weight gain, increased LFTs (monitoring again in a couple of weeks) and excessive fatigue.

Should I try to address Abilify with the new doctor in 2 weeks?

Thank you!!

Answered by Dr. Shubham Mehta (1 hour later)

Brief Answer:
apripirazole; amisulpride.

Detailed Answer:
Hello.
You are most welcome with any number of questions you have. :)

I would like to tell you that almost all antipsychotics are known to cause akathisia.

Akathisia is dose independent and can occur at any dose of drug. Akathisia with latuda does not imply akathisia with aripiprazole as well (Thats my personal view and experience).

Abilify, zyprexa and risperidone are most commonly implicated in akathisia.

But this side effect is easily controllable with drugs like propranolol, clonazepam or clonidine.

If were his treating doctor, I would be more concerned about weight gain with zyprexa than akathisia with aripiprazole.
He has gained 20-25 lbs in 4 weeks. Thats huge...

I think he wont be motivated to carry out dietary and lifestyle modifications (regular exercise, reducing fatty foods etc.) that are needed with zyprexa in case of weight gain. (Not only he, its difficult for anyone for that matter).
And, in my clinical practice, I have seen so many patients discontinuing the treatment because of weight gain.
Also, this huge weight gain will increase the risk of metabolic syndrome in your son.

Regarding the efficacy of zyprexa and aripiprazole, they both are very effective in treating psychotic symptoms.

But, I do understand your concerns. Your son has been struggling with drugs in past. This is the unfortunate part of antipsychotic treatment.
There is lot of inter-individual variation in tolerability of these drugs.

Another drug which I feel should be considered for him is amisulpride (I mentioned this drug in our earlier conversation of March 6).
This is relatively safe in terms of metabolic side effects as well as akathisia.

You can talk about apriprazole and amisulpride with your new doctor.

Hope this helps you in some way.

Do not hesitate to ask further.

Thanks.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shubham Mehta (3 days later)

Thank you for the response. I had to think about it for a couple of days. We go to the doctor every two weeks. His current doctor is leaving the practice for one year, so we have to see his partner next time. I am going to ask again about a medication change. I have come to realize over the last few days that my son's level of functioning seems to be declining. He hasn't done any college home work for several weeks. he told me yesterday he doesn't think he can work such long shifts at work - he works two 8.5 hour shifts per week! He has been going to classes and says he is passing, but I'm not sure. he takes 3 classes. His doc increased his Effexor from 75mg to 150 mg and it isn't helping his energy and motivation. My son sits home laying around on couch even on Friday and Saturday night. He used to be a very high functioning high school student - driven and motivated. He now says he thinks this is his last semester of college. He wants to make money by doing things that aren't realistic and it is making me very angry. I try not to show him how angry I am because I know how sick he is. He spends his spare time lately writing a children's book because he saw someone make a lot of money online by doing this. He gets ideas that are unlikely to happen and he has no interest in a college education. I don't know what to do. Thank you so much. Do you get paid each time you respond because I feel guilty asking so many questions. Sincerely, XXXXXXX

Answered by Dr. Shubham Mehta (35 minutes later)

Brief Answer:
control your anger.

Detailed Answer:
Dear XXXXXXX

I understand your situation. My sympathies with you.

I know its a difficult task to manage a family member with mental illness. And, when its your own son, you feel sad, angry, frustrated and what not! Hard time for you..

But despite all this, you are his mother, friend, caretaker and teacher. Only you can make him understand the pros and cons of dropping out college and doing an uncertain business.
Make him realize that whether his ideas are practically possible and worthful or not.
However, never argue with him.

Along with drugs, this is also very important.
You have to control your anger.

You can discuss my drug suggestions with your new doctor.
I think switching to aripiprazole should work for him in reducing psychotic symptoms and lifting his mood and energy.

I hope we together can reach to a effective drug regime for your son.

Do not worry about my payment.
I feel happy if you are benefitted with my advice. Thats more important.

Hope your son gets well soon.

Take care.
Thanks.

Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Raju A.T