It’s an established scientific fact that some medications prescribed for mental health disorders have a direct effect on appetite and eating. Stimulant medications for conditions such as attention deficit hyperactivity disorder (ADHD) can cause a decrease in appetite, which may lead to weight loss. Some studies connect early exposure to ADHD medication to adult obesity, but that evidence is inconclusive. Current research indicates the relationship between ADHD and obesity is complex and warrants further research.
However, the evidence connecting weight gain with antipsychotic medication and antidepressant medication is definitive. This is important because of the significant overlap between depressive and anxiety disorders and eating disorders. In addition, some medications for depression or anxiety do result in significant weight gain for some people.
With that said, we need to make two points immediately:
- There is no evidence that psychiatric medication causes eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), or other specified feeding and eating disorders (OSFED).
- On the other hand, there is evidence to suggest that some antipsychotic medications can exacerbate pre-existing eating disorders or lead to a recurrence of binge-eating symptoms.
To read about the connection between antipsychotic medication and eating disorders, please read the articles here and here. Fair warning: these are peer-reviewed journal articles with lots of jargon and statistics. If you like diving into the technical side of things, we encourage you to have a look.
Now, let’s get to the question we pose in the title of this article: is there a connection between psychiatric medication and disordered eating?
To clarify, disordered eating is a phrase used to describe a range of non-typical eating behaviors that do not meet the clinical criteria for eating disorders described above such as anorexia, bulimia, binge eating, or OSFED.
So, what’s the answer?
Psychiatric Medication and Weight Gain: The Facts
In some cases, maybe.
We understand maybe may not be the most helpful answer. But in this case, it’s the most accurate – and it’s the one the experts agree on. In the article “Weight Gain in Psychiatric Treatment: Risks, Implications, and Strategies for Prevention and Management” (see the second link above), researchers describe the situation:
“Many patients suffering from mental disorders, when exposed to psychotropic medications, gain significant weight with or without other side-effects. In addition to reducing the patients’ willingness to comply with treatment, this weight-gain may create added psychological or physiological problems that need to be addressed.”
That’s why we say maybe. The weight gain may cause psychological issues that include disordered eating, and those issues may need to be addressed – but that doesn’t happen to everyone. And there’s not a clear and simple relationship between disordered eating and psychiatric medication.
Weight gain itself, though, is another story. According to the American Academy of Child & Adolescent Psychiatry (AACAP), the following medications have the potential to cause weight gain:
- Antipsychotics including aripiprazole, chlorpromazine, clozapine, olanzapine, pimozide, quetiapine, risperidone, ziprasidone
- Mood stabilizers including lithium, valproic acid, carbamazepine
- Antidepressants: such as mirtazapine, paroxetine, imipramine
Therefore, if you’re the parent of a teenager who gains weight after beginning a course of psychiatric medication, the weight gain itself should not be alarming or cause for significant concern. What parents should watch for are the signs of what mental health professionals call subclinical disordered eating.
Subclinical Disordered Eating: Signs and Symptoms
If you think your teen may have developed unhealthy eating habits in response to weight gain associated with psychiatric medication, it’s critical to monitor them closely. Signs and symptoms of disordered eating include, but are not limited to:
- Excessive dieting
- Fasting (not eating)
- Extreme body dissatisfaction
- Preoccupation with body image
- Preoccupation with weight
- Binge eating (eating a lot all at once)
- Compulsive exercising
- Purging (self-induced vomiting)
- Guilt and shame around eating
- Extreme rituals related to food and exercise
- Lack of control around food
Please understand that one or two of these signs or symptoms in isolation does not mean your teen has developed disordered eating habits. When these symptoms occur in groups and affect the overall quality of life and daily functioning, that’s when they are cause for alarm. In addition, purging – the act of self-induced vomiting to make up for overeating – is always a red flag, independent of anything else. If your teen purges, we advise informing their therapist or counselor.
Note: typically, we’d advise seeking a full assessment from a mental health professional if you have a teen who purges, but since this article is directed toward parents of teens on psychiatric medication already, we’re operating under the assumption that they’ve had a full assessment already. That’s why our advice is to inform their counselor about any new habits around eating – all of the above, especially purging – that may have developed after beginning a psychiatric medication.
How To Avoid Medication-Related Weight Gain
The most important factor here is to know where your teenager starts. If they have a pre-existing eating disorder, their psychiatrist should know about it before they receive treatment for a mood or anxiety disorder – especially if that treatment includes medication. If they do not have an eating disorder, then, before treatment begins, clinicians should measure and record key metrics such as height, weight, and body mass index (BMI). Their pediatrician or psychiatrist should also order blood work to establish baseline levels of blood sugar and cholesterol. Finally, their therapist or psychiatrist should know about any family history of problems with diabetes, cholesterol, or cardiac issues.
Once you address those things, you can take a no-nonsense, practical approach to weight management. If your child is prescribed any medication that may lead to weight gain, you can take practical steps in three areas: diet (not diet as in going on a diet, but rather, the food they eat), mealtimes, and activity.
Here’s what the AACAP recommends:
Diet:
- Portion control: monitor portion size, especially with carbohydrates such as pasta
- Fruits and vegetables: make sure your teen eats 3-5 servings of fruits and vegetables per day
- Whole grains: choose whole grain bread, whole grain pasta, and brown rice as opposed to the processed alternatives
- Reduce consumption of soda and sugary snacks
- Eat healthy meals as a family
[Note: desserts are fine – just not every day and not too much. Birthday cake: yes. Soda and candy every day: no.]
Mealtime:
- Eat real meals at regular times: breakfast, lunch, and dinner
- Avoid eating in front of the television: distractions can cause overeating
- Plan healthy meals, and avoid fast food takeout
- Sit down to eat, take your time, and enjoy the meal
Activity:
- Be mindful of sedentary time: sitting all day can lead to weight gain
- Take family walks. You decide: before dinner, after dinner, first thing in the morning – whatever works for your family. We advise you to take initiative and make it happen.
- Support your teen in participating in team sports
- Encourage any type of independent or group exercise. From team sports to riding a bike around the neighborhood, any amount of activity is better than none.
To read the latest CDC guidelines on activity for adolescents, please read our article “New CDC Guidelines on Exercise and Activity: What They Say for Adolescents.”
An Integrated Approach
You may have noticed one thing in the bulleted lists above. The recommendations from the AACAP about avoiding medication-related weight gain mirror the lifestyle adjustments common to an integrated, holistic model of treatment for mental health and/or psychiatric disorders. A strong foundation of sensible eating and regular daily activity form the foundation of a healthy lifestyle. This is true for anyone, but it’s especially true for adolescents with a primary mental health diagnosis. When these elements are in place – including eight hours of sleep a night – an adolescent has an increased chance of treatment success. By our definition, treatment success is when a teenager with a mental health disorder learns practical skills that allow them to lead a productive and fulfilling life on their terms. We know it can happen, because we see it happen every day.