Magnitude of the problem
Kathleen M Berg, Dermot J Hurley, James A McSherry, Nancy E Strange, ‘Rose’ in Eating Disorders, 2018
DSM-IV-TR includes a condition called ‘binge eating disorder’ within the category EDNOS, but does not classify it as a separate discreet entity. Strongly associated with mood disturbances, particularly depression, binge eating is thought to be a major factor in about 5% to 8% of persons affected by obesity, especially in its more severe forms (Marcus, 1995). Affected individuals have recurrent episodes of uncontrollable consumption of excessive quantities of food over a short period of time. Eating past satiety to the point of physical discomfort, they dissociate eating from hunger, eat rapidly and alone, and feel guilt and disgust at their own behaviors. They do not purge, fast or undertake excessive exercise. Increased appetite may be a feature of psychiatric conditions such as depression, dementia and mania, or a consequence of systemic corticosteroid therapy and use of psychotropic drugs.
Medical Management of Obesity Associated with Mood Disorders
Susan L. McElroy, David B. Allison, George A. Bray in Obesity and Mental Disorders, 2006
In short, some children with depressive disorders will require acute and maintenance treatment with antidepressants for optimal response, whereas others may develop behavioral disinhibition. Similarly, some bipolar patients will require acute and maintenance treatment with antidepressants (usually in combination with mood stabilizers) for optimal response, whereas others will destabilize upon antidepressant exposure. Importantly, for any patient who worsens on an antidepressant, it is crucial to determine whether or not the drug has induced manic symptoms or mood cycling. In our experience, affective dysregulation, including that induced by antidepressants, may be associated with increased appetite, hyperphagia, weight gain, and exacerbation of comorbid conditions, including eating disorders with binge eating (187). Indeed, it is our opinion that antidepressant-induced affective dysregulation may be one cause of weight gain in bipolar patients, including those with occult or soft spectrum forms of the disorder.
Pregnancy
Kate B. Daigle in The Clinical Guide to Fertility, Motherhood, and Eating Disorders, 2019
However, even for women who desire to have a family so badly, the changes that occur emotionally and physically during pregnancy may take them off-guard. Your body changes more rapidly when you are pregnant than at any other time of your life. In the first trimester, your body may once again feel as if it’s against you, or you against it. Symptoms of early pregnancy include nausea, constipation, weight gain/bloat, dizziness, lack of appetite or increased appetite, and sleep disturbances, among other things. All of these are messages from your body to you, saying that it’s working extra hard and trying to grow another human inside of it.
A comprehensive review of the clinical utility of and a combined analysis of the clozapine/norclozapine ratio in therapeutic drug monitoring for adult patients
Published in Expert Review of Clinical Pharmacology, 2019
Georgios Schoretsanitis, John M. Kane, Can-Jun Ruan, Edoardo Spina, Christoph Hiemke, Jose de Leon
It is believed that antipsychotic-induced and CLO-induced weight gain is mainly mediated by appetite increase. As a matter of fact, an RCT in patients has verified that CLO is associated with increased appetite [56]. It is usually hypothesized that increased appetite is mediated by H1 antagonism [42]. CLO affinity for H1 is three times larger than NCLO affinity (Box 1) and CLO serum concentrations are also higher, but in a study of Chinese CLO patients randomized to fluvoxamine versus placebo, Lu et al. [57] found that plasma NCLO concentrations, but not CLO, were associated with increases in weight and serum glucose and triglyceride levels. In summary, this study suggested that NCLO may be important in weight gain and secondary metabolic disturbances. Some animal studies indicated that blockade of others, particularly serotonin 2C receptors (5-HT2C) and muscarinic receptors beyond H1, may be needed to produce hyperphagia [58].
Nutrition and bipolar disorder: a systematic review
Published in Nutritional Neuroscience, 2023
Fernanda C. Gabriel, Manoela Oliveira, Michael Berk, Elisa Brietzke, Felice N. Jacka, Beny Lafer
Nutrition in BD is important for two factors. Firstly, individuals with BD have high rates of unhealthy lifestyle habits. Appetite fluctuation and changes in the energy are core features of this illness, often associated with poor nutritional choices [12]. Depression in bipolar disorder, the predominant phase, is often characterized by atypical symptoms including increased appetite. Secondly, there are disproportionally high rates of general medical comorbidities in BD, such as diabetes mellitus, metabolic syndrome, cardiovascular disease, osteoporosis and endocrine dysregulation compared to the general population [13]. These rates are driven by both the intrinsic pathophysiology of the illness, which includes systemic factors (e.g. brain and systemic immuno-inflammatory activation [14–16], glucose-insulin abnormalities [13], oxidative stress imbalances [17], mitochondrial dysfunction and premature/accelerated aging [18]), as well as medication side effects and unhealthy lifestyle. Diet, nutritional patterns, and specific nutrients may have an influence on these mechanisms [19]. For instance, the Mediterranean diet has anti-inflammatory properties, Omega-3’s can have anti-inflammatory activity and impact neuroplasticity, and calorie control can present antioxidant effects, while excess sugar can impair mitochondrial activity and excess gluten can increase inflammation [20,21].
Adding liraglutide to diet and exercise to maintain weight loss – is it worth it?
Published in Expert Opinion on Pharmacotherapy, 2022
As increased appetite is probably associated with weight regain, medications that reduce appetite like GLP-1 receptor agonists are a rational treatment for this condition. S-LITE showed that liraglutide, with or without exercise, was effective in reducing weight regain in a group of subjects with obesity. However, this group of the obese was limited by the enrollment criteria, and the findings of S-LITE cannot be generalized to all subjects with obesity. The increased heart rate with liraglutide did not occur when liraglutide was combined with exercise, and this suggests that liraglutide should probably not be used alone, but only with exercise to maintain weight loss. As the only presently available medicine to have been shown to be effective against weight regain, liraglutide should probably be preferred to other weight-loss medicines in this circumstance. However, without clear-cut direct evidence from clinical trials, that liraglutide treatment reduces diabetes or further cardiovascular risk in subjects with obesity, it is difficult to justify using it for the prevention of diabetes and/or cardiovascular risk in this group.
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