1. Psychiatic medications and obesity Nasr Esfahani Associate Professor of Psychiatry Iran University of Medical Science Iran University of Medical Science Rasool Akram Hospital 2009

2. Introduction Social and psychological consequences Appetite Regulating eating behavior

3. Social and psychological consequences Psychologica Blame Blame Subject of teasing Subject of teasing discrimination discriminationOccupational Income power Income powerSocial Absence of romantic relationships Absence of romantic relationships

4. Appetite Appetite, defined as the desire for food. Hungry person may eat to full satisfaction when food is available, but appetite can also induce a person to overeat past the point of satiety.

5. Regulating eating behavior (neurotransmetters) SerotoninHistamine Dopamine DopamineNorepinephrine

6. Regulating eating behavior (Hormones) Corticotrophin releasing factor (CRF) Neuropeptide Y Gonadotropin-releasing hormone Thyroid-stimulating hormone

7. A new subtance obestatin, made in the stomach, is a homone that in animal experiments produce satiety and may have potential use as a weight loss agent in humans.

8. Cannabinoid receptors Cannabinoid receptors are related to appetite and stmulated with cannbis (marijuana). A cannabinoid antagonist has been developed that block appetite. Rimonabant is an inverse agonist to the cannabidiol receptor,meanig that blocks appetite.

9. Olfactory system The olfactory system may play a role in satiety. Experiments have shown that stong stimulation of the olfactory bulbs in the nose with food by use of an inhaler saturated with a particular smell produce satiety for that food. This may have implication for therapy of obesity.

10. Psychiatric Medications and Changes in Body Weight

11. Mechanism No specific mechanism have been idetified as causing weight gain, and it appears that the histamin and serotonin systems mediate changes in weight associated with many drugs used to treat depression and psychosis.

12. Serotonin receptors 5-HT 1A 5-HT 2A 5-HT 5 α 5-HT 1B 5-HT 2B 5-HT 5 β 5-HT 1D 5-HT 2C 5-HT 6 5-HT 1E 5-HT 3 5-HT 7 5-HT 1F 5-HT 4

13. 5HT 2c receptors Stimulation of 5HT 2 c receptors has been proposed to produced anxiogenic effects as well as anorectic effects (LSD) Inhibition of 5HT 2 c receptors may play a role in the weight gain and development type II diabetes associated with atypical antipsychotics

14. Histamine receptors H1, H2, H3, H4 Antagonist of H1 : sedation and weight gain Antagonist of H2 : treatment of peptic ulcer disease Antagonist of H3 : propsed to treat sleep disorders, obesity, dementia Antagonist of H4 : possible role as anti-inflemmatory agents

15. Psychotropic drugs and weight gain Retained fluid Decrease exercise Altered metabolism Increased caloric intake

16. Increased appetite Anticholinergic effects Increased appetite Anticholinergic effects Food cravings Dry mouth Food cravings Dry mouth Eating carbohydrats Increased thirst Eating carbohydrats Increased thirst Tricyclic and tetracyclic antidepressants

17. Selective Serotonin Reuptake Inhibitors SSRIs Initial anorexia can also occur and is most common with fluoxetine. SSRI- induced appetite and weight loss begin as soon as the drug is taken and peak at 20 weeks, after which weight often returns to baseline. This effect is mediated through a metabolic mechanism, increase in appetite, or both. it happens gradually and is usually resistant to diet and exersise regimens.

18. Atypical antipsychotics Insulin resistance Insulin resistance Weight gain Type II diabetes Type II diabetes olanzapine, clozapine

19. Tendency to Increase Appetite and Body Weight Antidepressant drugs GreatestIntermediateLeast Amitriptyline ( Elavil ) Doxepin (Sinequan) Imipramine (Tofranil) Mirtazapine (Remeron) Nortriptyline (Pamelor) Phenelzine (Nardil) Trimipramine( Surmontil ) Amoxapine (Asendin) Desipramine (Norpramin) Trazodone (Desyrel) Tranylcypromine (Parnate) Fluoxetine (Prozac) Sertraline (Zoloft) a Bupropion (Wellbutrin) Venlafaxine (Effexor)

20. Tendency to Increase Appetite and Body Weight Mood stabilizers GreatestIntermediateLeast Lithium (Eskalith) Valproic acid (Depakene) Carbamazepine (Tegretol) Topiramate (Topamax)

21. Tendency to Increase Appetite and Body Weight Antipsychotic drugs GreatestIntermediateLeast Chlorpromazine (Thorazine) Thioridazine (Mellaril) Thioridazine (Mellaril) Mesoridazine (Serentil) Mesoridazine (Serentil) Olanzapine (Zyprexa) Olanzapine (Zyprexa) Sertindole (Serdolect) Sertindole (Serdolect) Risperidone (Risperdal) Risperidone (Risperdal) Haloperidol (Haldol) TrifluoperazinePerphenazineThiothixenefluphenazine Ziprasidone (Geodon) Aripiprazole (Abilify) Molindone (Moban) a

23. Brain serotonergic pathway

24. Brain dopaminergic pathway

25. Brain noradrenergic pathway

26. Histaminergic pathway

27. Brain cholinergic pathway