Anti anxiety medication thwarting weight loss?

Nutrition Q&A [Moderated]
1

Hi Dr. Feigenbaum,

I have a bit of a strange situation that I am hoping you might be able to offer guidance on. I’ve included a TL;DR below as this became a lot longer winded than I had intended.

Background:
In May of 2020, I began taking an anti anxiety/anti depression drug called Venlafaxine. Since beginning this medication, I feel like my willpower when it comes to weight loss has plummeted. I find that even when I am cognizant that my eating will negatively impact me, I think to myself, “I’d rather have this food now”, almost like I’m starving and need to eat. Of course, I do not as I am already quite overweight since beginning this medicine, though it is worth noting that I have been obese in the past, and have always struggled with weight loss to varying degrees.

The past year or so:
For quite a while, I figured it was just a me issue. I even tried a consultation with a hypertrophy company before coming back to strength training. Despite spending a lot of money, I was not able to adhere to the plan for longer than a couple to few weeks at a time. I have gone from ~220lb up to 258lb today.

Anxiety/ADHD medications:
Previously, my psychiatrist recommended Vyvanse for my ADD, because she believed it would help with my binge eating. I declined and insisted that we go with Strattera since it is not a stimulant. The reason for that being that I am afraid of becoming addicted to the stimulants, though I am rethinking that as I sit here, grossly overweight and anxious about being in public due to my weight, even while clothed. That said, the Strattera has been extremely effective in removing the mental fogginess, stuttering and stammering that I had.

Stats:
Gender: Male
Height: 6’3
Weight: 258lb
S/P/B/D (lbs): 230x4/135x4/200x5/335x4
Conditioning: Generally, at least 8,000 steps/day.
Medicines: Venlafaxine 225mg/day, Strattera 80mg/day

TL;DR:
-I am finding it extremely difficult to lose weight, and it seems to be caused, in part, by Vanlafaxine
-I was obese when I was younger but lost the weight
-I still struggle with weight
-I’ve considered taking a stimulant ADHD medication in addition to or in place of Strattera to better control my appetite

Question:
What, if any, recommendations might you offer to someone in my position?

2

Thanks for the post and sharing here. While I think the specifics of your situation are best addressed via consult, I have a few thoughts in general that may be helpful.

I’m not sure about your exercise habits here, but I do think that meeting or exceeding the current guidelines would be key. In short, lifting 2-3x/wk and doing 20-30 min of dedicated cardio per day (probably more than walking your dog) would be great. I also think that changing your home food environment to exclude sugar-sweetened beverages, highly processed foods, etc. would be beneficial as well.

As far as weight change secondary to psychotropic medications, e.g. antipsychotics, antidepressants, anti-anxiety medications, mood stabilizers, sedative-hypnotics, medications for attention-deficit/hyperactivity disorder, and other psychotropic medication, there are a number of agents that have higher risk of weight gain (or loss) compared to others (e.g. fluoxetine). Finding the medications and lifestyle changes that work best for you may take some work, of course.

As far as venlafaxine in particular goes, there is data on both sides here, e.g. weight gain and weight loss. It is generally considered to be weight neutral, but individuals respond in their own individual ways. In a situation like this, asking your provider to consider switching agents may be worthwhile.

Vyvanse would also be a reasonable treatment for ADHD and binge eating disorder, though I think consultation with an eating disorder specialist may be beneficial at further characterizing what’s going on and square that with your physician.

There are many lifestyle modifications, medications, and other treatments available.

-Jordan