From the Guidelines
Switching from Seroxat (paroxetine) to a more weight-neutral antidepressant, such as bupropion, is a viable option for a patient with borderline personality disorder and bipolar disorder experiencing weight gain, as bupropion has been shown to promote weight loss or weight neutrality 1. When considering alternatives to Seroxat, it's essential to weigh the potential benefits of weight neutrality against the specific needs of the patient's psychiatric condition.
- Bupropion, in particular, has been associated with weight loss and is a norepinephrine and dopamine reuptake inhibitor approved for the treatment of depression and smoking cessation 1.
- Other options like fluoxetine may also be considered for their relatively lower risk of weight gain compared to paroxetine 1.
- However, the choice of agent must be guided by best practice for the individual patient's circumstance, considering factors such as the patient's specific psychiatric diagnosis, medical history, and potential interactions with other medications like Lamictal (lamotrigine) 1.
- It's crucial to taper Seroxat gradually under medical supervision to avoid discontinuation symptoms, which can be particularly problematic with paroxetine 1.
- The transition to a new medication should be carefully managed while continuing Lamictal for mood stabilization, and the patient should be closely monitored to ensure the new medication effectively manages their psychiatric symptoms while providing the desired metabolic profile 1.
From the Research
Weight Gain and Medication
- The patient is taking lamictal and seroxat for borderline and bipolar disorder, but is experiencing weight gain.
- According to 2, second-generation antidepressants like paroxetine (seroxat) may cause modest weight gain.
- Switching to a weight-neutral antidepressant may be considered if significant weight gain occurs.
Alternative Medications
- 2 suggests that other second-generation antidepressants are weight neutral, but individual variations can occur.
- Bupropion is mentioned as a second-generation antidepressant that may cause modest weight loss 2.
- 3 notes that combinations of antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), with mood stabilizers like lamotrigine are common.
Pharmacokinetics and Interactions
- 4 discusses the pharmacokinetics of SSRIs, including paroxetine, and their potential interactions with other medications.
- The study highlights the importance of considering these interactions when switching or combining medications.
Managing Weight Gain
- 5 reviews pharmacologic interventions for managing weight gain in patients with severe mental illness, including metformin and topiramate.
- The study suggests that these agents may be efficacious and safe in promoting weight reduction compared to placebo.
- However, more studies are needed to define guidelines for using pharmacologic interventions to reduce weight gain in patients with severe mental illness.