Teenage Boy, SSRI Change for Weight Gain
May 30, 2014 3:43 AM   Subscribe

Kinetic 3, 15, was diagnosed with OCD and has been on Celexa for 7 years. Over the past few years, despite working with a nutritionist, eating a healthy diet and getting lots of exercise, his weight has ballooned into the technically obese category. He's 5'5" and weighs over 155 lbs. Going to see prescribing psychiatrist next week to consider changing medications, looking for advice. My son is a healthy, active kid. He runs, bikes, hikes, kayaks, swims. He eats colorful foods, a mostly vegetarian diet and very little in the way of bread, pasta, potatoes, junk food, ice cream, soda, etc. He's worked with a nutritionist who feels that his diet and portion sizes are fine and she thinks at this point, he needs to consider a medication change. I'd like to go to the prescribing doctor with some knowledge.

About three years ago, his weight started slowly creeping up, seriously disproportionately to his height. His face looks puffy and his stomach almost like he swallowed a basketball. The boy is getting large and unhealthy. He feels okay but would like to slim down to something more healthy. So, I am not driving this change...this is his concern as well as his doctor's.

I'm hoping to find some recommendations to share with the psychiatrist (who is open to changing meds). It's been years since my son was diagnosed so I don't really know what meds are helpful with OCD and can help curb weight gain.

**To be clear, we don't want to try to take him off the meds at this point. I am also not a crazy diet parent; my kid is officially unhealthy, weight-wise, and his doctors say he needs to lose weight. His diet is clean and healthy and he exercises, so I don't need advice about that. I'm looking specifically for medication suggestions.
posted by kinetic to Health & Fitness (27 answers total) 1 user marked this as a favorite
* I realize that I said he's healthy and also unhealthy, sorry. I meant that his weight is unhealthy but in all other ways, he's a very healthy teenager, able to bike ride 20 miles no problem, can hike for 6 hours straight, runs a 5k in under 30 minutes, etc.

AND...I forgot to mention (sorry, it's early and I just had jaw surgery), he takes extended-release Ritalin on school days and has been for 3 years. He has severe ADHD as well; the difference when he's on and off that medication is night and day. He went from failing all of his classes to straight A's and B's on the meds.

So the weight gain started, he went on the stimulant, and he continued to gain weight.
posted by kinetic at 3:57 AM on May 30, 2014

Apologies for not being on point, so feel free to flag this.

Two angles to consider:

"his stomach almost like he swallowed a basketball" This sounds like a bloated belly. Could he be sensitive to food? Personal anecdote: I am gluten intolerant and get this kind of weird sticking out stomach whenever there was (traces of) gluten in my food.
Different foods can cause bloating for different people. Are his meds gluten& lactose free? If he's known his belly being like this for the better half of his life, he might not realize that it feels weird. About passing gas: 13 to 21 times a day is normal. More indicates a problem.

A girl I know hoarded sweets/junk food and hid it from her family. Her diet was clean and healthy - normal sized home cooked meals every day. She also was overweight and it seemed unexplainable. Turns out she spent her entire allowance on candy. She had some mental health issues to work through and that was her way of coping. Once she started therapy the comfort/over eating got better. Could your son be eating more on occasions that you are not aware of?

Good luck. Hope mefites versed on pharmaceuticals will chime in soon.
posted by travelwithcats at 4:20 AM on May 30, 2014 [2 favorites]

Could he be sensitive to food?

He's been allergy tested and we did food elimination trials years ago. Nothing.

Could your son be eating more on occasions that you are not aware of?

He says no.
posted by kinetic at 4:24 AM on May 30, 2014

One, only a little random, but at that age you might encourage him in the direction of strength training stuff, because more muscle mass helps with weight maintenance, especially for guys, and also a confidence-booster while you're still overweight.

That said, seven years is a long time to be on the same medication, especially while growing up--brains change, bodies change, I don't think you should have any problem just saying "these side effects are a problem so this medication isn't working anymore" and looking at trying something different.

You guys might also consider asking about just tapering, generally, and seeing how he does. I know a couple people whose kids were medicated for stuff like that at some point or another in their childhood, but who later ended up off meds again and fine. That doesn't mean they weren't necessary in the first place, it's just that things like that don't always require lifelong medication.
posted by Sequence at 4:28 AM on May 30, 2014 [3 favorites]

Has he been evaluated by his pediatrician for other causes of unusual weight gain like thyroid problems or Cushing syndrome?
posted by The Elusive Architeuthis at 4:50 AM on May 30, 2014

Has he been evaluated by his pediatrician for other causes of unusual weight gain like thyroid problems or Cushing syndrome?

Yes. All signs point to the medication.
posted by kinetic at 5:03 AM on May 30, 2014

[A couple of comments deleted. Please note that OP says "I'm looking specifically for medication suggestions." Thanks.]
posted by taz (staff) at 5:37 AM on May 30, 2014 [1 favorite]

Maybe a stupid question, but: Is his psychiatrist/prescribing doc a pediatric specialist? I ask because I know that meds are often a black box when it comes to how they'll affect someone during puberty, and if his doc has a lot of pediatric patients, they may have seen more kids do better (weight-wise, at least) on XYZ med. It might be worth finding someone who treats kids his age for a second opinion, if his current doc doesn't, so much.
posted by rtha at 5:43 AM on May 30, 2014 [5 favorites]

This might be a silly question but has anyone considered that this might just be an extended awkward phase of puberty? I remember several boys that I grew up being short/pudgy/overweight in the first few years of high school and then sprouting up later.

Seven years is a long time to be on an ssri. I would think maybe with all the changes going on with hormones that it definitely is something to look at. I had much better luck with lexapro than celexa fwiw.
posted by fluffy battle kitten at 6:22 AM on May 30, 2014 [1 favorite]

There is a well-known association between SSRIs and weight gain.
Mayo Clinic:
Weight gain is a possible side effect of nearly all antidepressants. However, each person responds to an antidepressant differently. Some people gain weight when taking a certain antidepressant, while others don't.

Generally speaking, some antidepressants seem more likely to cause weight gain than others.
Web MD:
Experts say that for up to 25% of people, most antidepressant medications -- including the popular SSRI (selective serotonin reuptake inhibitor) drugs like Lexapro, Paxil, Prozac, and Zoloft -- can cause a weight gain of 10 pounds or more.
I have seen this first hand with family members.

I believe the OP is looking for specific advice regarding medications that may be less likely to cause weight gain while still having the desired therapeutic effect. My understanding is that some drugs are more or less likely to cause weight gain, but that the effects vary by person as well, and that often it is a matter of trying different drugs until you find a combination that has the greatest benefit and least harm.

Unfortunately many doctors don't take the weight gain issue seriously, either because they are unfamiliar with it, or they believe the benefit of the drug substantially outweighs the harm of the weight gain.
posted by alms at 6:31 AM on May 30, 2014 [2 favorites]

I am not a doctor, this is not medical advice, but maybe ask the doctor about bupropion? I don't know think it specifically treats OCD so maybe it could be used with Celexa. There have been studies regarding its use to treat ADHD but not much has come from that.

Bupropion is not an SSRI though both bupropion and SSRIs treat depression. However, unlike SSRIs, bupropion is not associated with weight gain. The biggest concern with bupropion is that it can affect an individual's seizure threshold but absent other risk factors for seizure, I don't know that this is something you should be especially concerned about.

Good luck. I think it's really wonderful that your kid is so active and eats so well and I hope that he finds something that works for him.
posted by kat518 at 6:46 AM on May 30, 2014

He is technically just barely overweight, not obese, using the BMI guidelines. Obese would be 180 or more at his height. Just don't make him too self conscious if possible.
posted by miyabo at 6:46 AM on May 30, 2014 [7 favorites]

Are his meds gluten& lactose free?

To go back to this possibility for a second, extended release ritalin is absolutely not lactose free. If he does have a lactose sensitivity, Ritalin LA will absolutely exacerbate this. In the beginning, it can show up as just bloating and mild discomfort.

Extended release ADHD meds without lactose include the Daytrana patch and Adderall XR.
posted by elizardbits at 6:57 AM on May 30, 2014

As you're kind of seeing here, there's a reason that it's best to rely on trained doctors to recommend medications.

Antidepressants (which it seems are the main medications used to treat OCD) are often associated with weight gain, yes. Wellbutrin is the one that often tends to stall weight gain, but it looks like it's not approved by the FDA for treating OCD; psychiatrists can prescribe it "off-label," however, as either a replacement for other antidepressants or in addition to them, but "off label" means there is no govt-approved consensus saying that it will help the OCD symptoms.

If you are seeing a psychiatrist who has training and experience in treating pediatric OCD, however, that doctor is going to have much more knowledge than you are about which medications seem to work and which side effects seem to occur on them. This is a good situation in which if you trust your son's doctor, you should also trust their judgment and suggestions about medications. The one thing that would be helpful for your doctor to know is whether your son has any blood relatives, especially male relatives, who have done particularly well (or particularly poorly) on any particular antidepressant. Responses to meds can be genetic and a good (or poor) response in a relative can help predict the same for the patient.

I would definitely keep in mind (as you seem to be doing) that "healthy" includes "psychologically healthy," and that treating your son's mental-health symptoms is likely a much higher priority, health-wise, than his losing weight, especially if he's active and eating healthy foods. There is often a trade-off in treating mental illness between reducing symptoms and being skinny, and it's important to remember that all the societal stigma about how "fat = unhealthy" is not always true or helpful in such situations.
posted by jaguar at 7:06 AM on May 30, 2014 [2 favorites]

He is technically just barely overweight, not obese, using the BMI guidelines. Obese would be 180 or more at his height. Just don't make him too self conscious if possible.

If he were an adult, he isn't. There is a different scale for teens and children.

But it is worth considering that your "obese" son will be only just barely overweight (and possibly not even that if he's very active, has a large frame and gains muscle easily - he could be an outlier BMI wise) - medically speaking if he can prevent gaining any more weight for the next 3 years.

Does his stomach seem to change size - are there days when he doesn't look like he's swallowed a basketball? Bloating could be a part of the problem and food issues can be hard to diagnose. My partner's waist can grow 4+ inches if he eats something that disagrees with him. (he's still overweight, just not as much as he looks)
Do you think he looks obese? He's about 15lbs overweight which isn't massive, if he were an adult, he'd be only about 5lbs overweight. Your description makes it sound *much* worse than that. I was just looking at a photo of myself when I was that age and a similar amount overweight and it looks like nothing (especially by modern standards) - at the time I thought I was a whale but it really wasn't that noticeable at all.

For the medication you're just going to have to trust your doctor, no-one here can tell you what definitely will or wont work for your son - if we could, you wouldn't be going through this because your son would have got the "right" medication for him from the start.
posted by missmagenta at 7:28 AM on May 30, 2014 [1 favorite]

Hi, have you looked into Luvox? It's an SSRI which is used mainly for OCD. It also prescribed for depression/anxiety. It doesn't have weight gain as a side effect. I believe weight LOSS is a common side effect. It was for me.
I personally came off of it after a few months because it seemed to make my panic attacks more frequent.
posted by KogeLiz at 7:42 AM on May 30, 2014 [1 favorite]

15 and only 5'5" - is he a late bloomer? Boys have their growth spurt later than girls. Maybe his body is prepping for puberty growth (by putting on weight). I pudged up around puberty and lost it soon thereafter. Just a thought.
posted by St. Peepsburg at 8:00 AM on May 30, 2014

Is his psychiatrist/prescribing doc a pediatric specialist?

Yes. He's been treating my son for years and has a great handle on him and knows a lot about medication.

...your son would have got the "right" medication for him from the start.

He did. The Celexa works incredibly well for calming the OCD part of his brain. He's been able to access CBT and learn strategies and he hasn't had severe bad thoughts in years. His p-doc explained a few years back that puberty and the meds may bring on weight gain and it has, hence we are looking to switch meds. I do recognize that I have fear about him going off the meds because before he was medicated, he was in a very bad state and had some terrifying episodes, and I hate to think of him going through that again if it can be avoided. I don't want him to sacrifice his mental health for his weight, but like I said, if there's another med he could try...that would be good.

...is he a late bloomer? Actually he is and now that I think about it, his older sisters also put on weight first and then got taller. But they never got as disproportionate as he is, and my son's nutritionist and pediatrician have both expressed concern.

Thanks for the responses and the kindness everyone is showing.
posted by kinetic at 10:35 AM on May 30, 2014 [3 favorites]

If you're concerned about changing his meds since he's currently stable and they're working well for him, honestly - I would wait until he's done growing (and hormones level out) to make any decisions, 15lbs overweight isn't majorly endangering his health, particularly when its not due to a bad diet or sedentary lifestyle.
posted by missmagenta at 11:13 AM on May 30, 2014 [3 favorites]

This is just a data point: I also take extended release Ritalin (Concerta), however I usually take it every day. The medication does curb my appetite, but on the occasional day I do not take it, I have a seemingly insatiable appetite and it's very easy for me to overeat. I am also pretty sensitive to lactose (I'm unable to drink milk, have to avoid most lactose containing foods except in very small amounts), and do not have any issues with taking Concerta.

Is he on any other medications? Could you get a second opinion from a registered dietitian regarding his diet?
posted by inertia at 12:18 PM on May 30, 2014 [1 favorite]

I agree that his mental health is as important as his physical well-being, but I would like to point out that teenagers can be cruel and while of course it is not okay to tease or bully someone because of weight issues, it could happen. I hope it doesn't, though!

I've been taking Cipralex since December (I'm in my mid-twenties, though) and only put on a couple of pounds, but I think that's because I started eating again after I didn't want to puke because life hurt so much during my depression. Cipralex is an SSRI, though, and may not help your son.
posted by LoonyLovegood at 2:17 PM on May 30, 2014

I gained weight on Celexa but then lost it when I added Wellbutrin on top of my Celexa. I was being treated for depression and anxiety, not OCD, so YMMV.
posted by Jacqueline at 4:53 PM on May 30, 2014

Maybe you'd want to consult an endocrinologist to rule out any other issues before changing the Celexa if it has been working for him.
posted by CrazyLemonade at 5:18 PM on May 30, 2014

Topiramate has off label uses and is known to curb appetite. As always, ask your doctor. Its primarily migraines and bi polar, not sure the effectiveness with OCD...
posted by vonstadler at 9:55 AM on May 31, 2014

His psychiatrist wants to try tapering off the Celexa slowly over the next 9 weeks.

He felt, as Sequence noted, that it's time to see if the boy can function without it.
posted by kinetic at 2:46 AM on June 6, 2014 [1 favorite]

I wanted to update.

He tapered off his medication and when he was down to 1/4 dose, within three days he began having panic attacks, severely bad OCD and suicidal thoughts.

So we had a few pretty intensely scary weeks with him requiring constant monitoring and he's getting better, not quite there yet.

Definitely needed to try going off the meds; it became clear he needs them to function.
posted by kinetic at 6:43 AM on July 20, 2014

Sorry you all had to go through that. At least you have that piece of data, now.
posted by jaguar at 8:54 AM on July 20, 2014

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