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  • Celexa (citalorpam) can cause significant weight gain

    Posted by .(JavaScript must be enabled to view this email address)
    Thursday, November 17, 2005 8:25 am Email this article
    The antidepressant Celexa (citalorpam) can cause significant weight gain according to according to a new review paper about drugs that cause weight gain. WEIGHT GAIN

    A small study found Celexa caused weight gain in nearly half of patients

    One study found that nearly half of patients (8 of 18) given Celexa (citalorpam)—20 to 40 mg per day—developed a strong craving for carbohydrates and gained weight.

    Weight gain of 11-24 lbs in the first month

    Six of the eight patients stopped the drug after gaining 10.6 to 24.2 pounds during the first month of taking the drug.

    Carbohydrate cravings from mid-afternoon until late evening

    Details of two patients who gained weight noted that the drug was taken in the morning, then starting in mid-afternoon they developed a strong craving for carbohydrates which lasted until late into the evening.

    Carbohydrate cravings persisted 7 months after stopping the drug

    A male patient who had gained 19.8 pounds in five weeks, stopped the drug and went on an exercise program to lose the weight, but after seven months of exercise, still had not lost all the weight and still had carbohydrate cravings which he developed while taking Celexa (citalorpam).



    Comment: This is the first I have heard of this

    This is the first I have heard of this. I have not heard this from any of the doctors who specialize in weight loss.


    Malone M. Medications associated with weight gain (ce) (december). Ann Pharmacother. 2005 Nov 8.


    Department of Pharmacy Practice
    Albany College of Pharmacy
    106 New Scotland Ave
    Albany, NY 12208-3492
    518/445-7302 fax
    .(JavaScript must be enabled to view this email address)

    Articles on the same subject can be found here:


    On Nov 25, 2005 at 1:15 pm Randy Smith, MD wrote:

    . . . . .

    I have some anecdotal experience that confirms this.


    On Jun 01, 2006 at 5:31 pm Jolie wrote:

    . . . . .

    I took Celexa for 4 months and gained 40 pounds! I was taking if for slight depression partly do to my weight! I ended up gaining most of the 70 pounds I had lost back. In fact I contribute Celexa to the reason I have gained it back. My cravings were just outragious!

    On Jun 02, 2006 at 2:20 am Larry Hobbs wrote:

    . . . . .


    Thank you very much for sharing your experience.

    Congratulations on your 70 pound weight loss.

    Sorry to hear that Celexa caused you to regain 40 pounds.

    On Jun 02, 2006 at 5:17 am Monte Meldman MD wrote:

    . . . . .

    All the SSRI's are associated with marked weight gain if they are taken for long enough periods of time. Paxil is the most, followed by Zoloft and then Prozac and Celexa and Lexapro. Patients who experience a 45 pound weight gain on Paxil keep my weight loss practice thriving. These drugs work well with Phentermine and or Tenuat4e which ought to be taken with the SSRI's to combat depression and achieve the weight loss that the patient wants.

    On Jun 02, 2006 at 7:30 am Jolie wrote:

    . . . . .

    I am not depressed even though over weight,(I took celexa about 6 years ago)but I am taking phentermine. Do you recommend taking at SSRI just because I am on phentermine?

    On Jun 02, 2006 at 7:40 am Larry Hobbs wrote:

    . . . . .


    I sent your question to Dr. Michael Anchors who invented the use of SSRIs plus phentermine, a combination he calls Phen-Pro, as well as to several other doctors and asked for their input.

    On Jun 02, 2006 at 7:45 am Larry Hobbs wrote:

    . . . . .


    Here is a comment from Dr. Robert Skversky.


    "Larry, I believe a single study on Lexapro showed that a small [percent] of patients had increased cravings.

    "I have used Lexapro in many hundreds of patients in combination with phentermine/adipex [Adipex is diethylpropion] and on rare occasions someone will have increased cravings.

    "Prior to Lexapro we used Celexa as our main ssri and don't remember cravings as an untoward side effect.

    " Have recently (past 10 days) begun to use some citalopram [Celexa] in my office due to considerable cost savings to patients and will give you follow up.

    "How did Jolie lose weight initially?

    "Suggest addition of phentermine, try brand name ssri and possibly add topamax.

    "(Possibly substitute wellbutrin for ssri)."

    "Email from Dr. Robert Skversky to Larry Hobbs"

    On Jun 02, 2006 at 7:57 am Jolie wrote:

    . . . . .

    Thanks so much for forwarding that to him! But good luck with my finding a doc who will do all that for me,ie all the medicines. I stay away from anti depressants except wellbutrin(it is the one I was taking because it helped me maintain my weight by reducing my cravings). I originally lost 70 pounds in 7 months on the fen-phen diet. It was the best I have ever felt in my life! Doc put me on celexa because Welbutrin was sooo expensive and my insurance did not cover it. Celexa definently increased my cravings 10 fold.I actually became depressed on Celexa, crying all the time, because cravings were driving me nuts, it was so unreal, and I was very tired. I had managed to only gain back about 15 pounds in 2 years, then I started welbutrin because I didn't want to gain it all back, this helped me maintain the entire time I was on it. The the doc switched me to celexa and it just put me into a tale spin,gaining 40 pounds in 4 months, and now here I am trying to lose it again with 37.5 of Phentermine. I did have twins 2 years ago which contributed to 30 pounds of weight gain. I was finally diagnosised with hypothyroidism but that has not helped me lose anything(the first 2 months I was on it I felt wonderful and lost 6 pounds and I changed nothing, but it does not do that for me anymore and she had to lower my synthroid because my tsh was .70)Thanks again!! Jolie

    On Jun 02, 2006 at 8:41 am Larry Hobbs wrote:

    . . . . .


    Thank you for sharing the additional details of your weight gain.

    I have forwarded your comments to a number of doctors and will post any comments that they send to me.

    On Jun 02, 2006 at 9:32 am Michael Steelman, MD, FASBP wrote:

    . . . . .

    Hi Jolie,

    It is quite common to see weight gain with celexa or other anti-depressants. People seem to have certain individual ones that cause more problems than others.It is a shame that insurance companies often favor people using CHEAPER medicines...not necessarily BETTER ones.

    The trick is to find a Dr. who specializes in the treatment of obesity and related conditions and understands the need to individualize treatment to meet YOUR individual needs. One source for finding a list of such physicians is http://www.asbp.org Unfor.tunately, not every member on the list will fit your needs...but it is a starting place.

    You need to have your thyroid situation reviewed by someone who takes a little different view. Synthroid will often lower the TSH without correcting the underlying symptoms (because synthroid contains a form of thyroid hormone which is not the most metabolically active form and some people cannot "activate" it well). A good source for learning more about this is ww.thyroid.about.com or the book Living Well With Hypothyroidism by Mary Shomon.

    Bewt wishes for a good outcome........

    Above all, son't give up hope. There ARE Dr.s out there who will keep working with you to find answers.

    On Jun 02, 2006 at 9:49 am Larry Hobbs wrote:

    . . . . .


    Here is an email from Dr. Charles Leroy that I just received.

    Note that Dr. Leroy and Dr. Steelman say the same thing about thyroid.

    They both noted that Synthroid (T4) may not be the correct medicine for hypothyroidism, but rather -- and I don't want to put words in Dr. Steelman's mouth because he did not say this specifically, but -- Armour Natural Thyroid (T4 and T3) as Dr. Leroy notes, or perhaps T3 (Cytomel) may work better.


    "Ms. Jolie may be hypothyroid as an at-least-partial-cause of her resistance to normalizing her body weight.

    "RE: Synthroid - it is pure T4 - humans live on T3 and many of us are incapable of 'down-regulating' T4 to T3, thus even though we are on thyroid our hypothyroid status does not correct.

    "Some facts:

    "Knoll Pharmaceutical brought Synthroid out in 1976, claiming to anyone who would listen that it was superior to Armour thyroid (which is 60 % T3 and 40 % T4) - over 10 years ago Knoll admitted in open court in a class action suit that they had falsified the data that made Synthroid look good in 1976, cheerfully paying first $ 134,000,000 in fines (the wife of one of my friends?was in the class action suit - the attorneys got $ 40M, she received a check for $ 1.51 (not a typo!).

    "I call Knoll the company of failed diet pills - they also gave us Meridia - I was asked to be on the national medical advisory board for Meridia, but when I discovered they'd used double the prescribable amounts and a 500 calorie diet in their study, I refused.

    "Synthroid is now owned by Abbott and despite the fact the originator admitted a deception it is still the # 3 most prescribed medicine in America - of course, that is not surprising when one considers that Premarin and Provera are # 1 and 2.

    "Anti-aging physicians, and Neal Rouzier, MD in particular ( http://www.hormonedoctor.com ), test Free T3 when they look for subtle thyroid deficiencies, then prescribe Armour in amounts sufficient to optimize the Free T3 - optimizing is the watchword, not normalizing - for example, in my lab the normal range for Free T3 is 2.3-4.2 - I believe it should be 4.2 - when the TSH becomes so depressed as to become worrysome some docs suggest it no longer be ordered - it is a useless test.

    "I know people who take 6 to 10 grains of thyroid a day without symptoms of any kind. I take 3 myself. We do not believe it erodes bone and I've never seen a case of tachycardia or arrhythmia from thyroid repletion.

    "Ms. Jolie may also be receiving an inferior quality of even Synthroid - if it worked early on it should not have stopped - did she get a generic?

    "Read Neal Rouzier's article about Estradiol which I fowarded to you - very few people are aware of the wide range of quality in prescription drugs - I know of cases where an arrhythmia was repeatedly corrected in-hospital only to relapse because tha patient was getting an inferior quality prescription out-of-hospital.cMy brother-in-law, a cardiologist at Columbia sent his med students out to buy digitalis - the " 0.25 mg" tablets varied in strength from 0.1-0.5 and only BoroughsWelcome brand was consistently on target.?

    "There is a free thyroid test available called the (Broda) Barnes Basal Temperature Test - shake an ordinary thermometer down to at least 95 as you retire for the night - take your temp?orally (Barnes says axillary but oral is OK) for 10 minutes in the morning without becoming disturbed in any way (don't get up) - a temp of 97.8 or less is diagnostic of too little thyroid - the test can be used to titrate thyroid dosing- start with 1/2-1 grain and increase by 1 grain per month until the Free T3 reaches 4.

    "See http://www.alternate-health.com/thyroid.html?for the Barnes Test.?

    "The nearest the literature has come to acknowledging the error of Synthroid was to suggest patients on Synthroid be given Cytomel (pure T3) as well - which, afterall, is equvalent to Armour."

    "email from Dr. Charles Leroy to Larry Hobbs"

    On Jun 02, 2006 at 9:53 am Larry Hobbs wrote:

    . . . . .


    A note about the Broda Barnes temperature test for detecting low thyroid function.

    The reason Dr. Broda Barnes suggested checking the temperature under your arm rather than orally because he said that an infection in the mouth could give a falsely high reading, however, without an infection it should be the same if taken orally and is easier to do.

    On Jun 02, 2006 at 10:08 am Larry Hobbs wrote:

    . . . . .


    The belief that Synthroid (T4) should be used to treat low thyroid function seems to be very widespread.

    About 10 years there was a 30 minute program on thyroid on a television channel called American Medical Television, which is now defunk.

    There were three or four thyroid experts on the show and every one of them said, "You should only give T4 (Synthoid) for low thyroid function and let the body convert it to T3."

    Note: T4 contains 4 atoms of iodine and is considered by some to be the storage form of thyroid hormone in the body, whereas T3 contains 3 atoms of iodine and is the more active form.

    An enzyme called -- enzymes are like chemical scissors -- removes one of the atoms of iodone from T4 which turns it into the more active T3.

    Anyway, many enlightened doctors, such as Dr. Steelman and Dr. Leroy, believe that Armour Thyroid (T4 and T3) is preferable to Synthoid (T4), however, many doctors still believe that only Synthroid (T4) should be used.

    On Jun 02, 2006 at 10:25 am Jolie Molino wrote:

    . . . . .

    Thank you Dr. Leroy and Dr. Steelman,
    I am currently taking:
    50mcg of Synthroid(Sample from Doctor so I do not believe its generic)
    5mcg cytomel(only after I told the Dr. I wanted to take this. I found out about it myself. She says she will never give me more then 10 mcg but at this time she even refuses to give me that)
    37.5 Phentermine

    11/28/2005- TSH was 4.10 and free T3 was 4.5(high)
    2/14/2006-TSH was .10 and free T3 was 3.5
    05/09/2006-TSH was .07 and free T3 was 3.5
    (I ask for copies of all my labs so I can look at them, she originally did not want to treat me for Thyroid because my TSH she said was borderline, she would rather treat me for PCOS because my total testo was high. She put me on Glucophage along with Thyroid meds because I told her I wanted my thyroid treated. The Glucophage made me very tired, which I know is unusual. I am no longer taking it)

    I would like to note that since treatment ALL my liver panels are within normal range now(yeah!) and my cholesterol is done 38 points and LDL down 64 points and my HDL is down 25 points(normal range still). All this I knew would start to happen if my thyroid would be treated. I just wish it would have also given me more energy and help with the weight loss. Being treated also improved my sleep.
    Oh well, it was difficult journey to find this Doctor to treat me! Luckily I have a PPO and could find my own without a referral. The first Dr. said that Thyroid problems were not common so he doubted I had one. Needless to say, I left without getting my lab test down and soon found another Doctor. Atleast she is working with me, even if she laughes at me for finding most of my info on the internet(like the cytomel).
    Do you ever prescrible Phentermine for longer the 3 months? If so, how long? It seems to be my miracle pill, giving me energy and cuts the cravings. I don't think it really quits working after a while. Yes, I don't feel as full BUT I eat the same as I did when I felt that full, I turn away food the same way, I don't crave sugar much, and I am exercising more then I did the first 2 weeks when I felt the fullest.
    Thank you so much. Talking to a Doctor who knows something about how I feel is great. I know that you know, we are not just fat, lazy people. You realize there are underlying issues that determine our weight and how we feel.
    Now, if you know of any Doctors in Phoenix, Az that you can recommend that would be great!

    On Jun 02, 2006 at 10:33 am Jolie wrote:

    . . . . .

    I forgot to add, I did do the Basal Temp test for 7 days in a row. My temps, under the arm, were between 96.9 and 96.2. Sorry I forgot that one.

    On Jun 02, 2006 at 2:25 pm Larry Hobbs wrote:

    . . . . .


    5 mcg of T3 is a small amount.

    25 mcg of T3 is the equivalent of 1 grain of Armour Natural Thyroid.

    On Jun 02, 2006 at 2:33 pm Larry Hobbs wrote:

    . . . . .


    Yes, many doctors prescribe phentermine for longer than 3 months.

    The phentermine labeling suggesting that it be taken for no longer than 3 months came about a long time ago.

    Papers from the 1960's suggested that phentermine only seems to suppress appetite for the first couple of months and then appetite returns to normal, therefore, for this reason, the FDA said it should not be taken longer than 3 months.

    In 1997, after it was revealed that fenfluramine caused heart valve damage, the FDA tried to rewrite history and said something like, "That's why we limit the use of phentermine to 3 months, because of safety concerns."


    This was not the original reason for 3 month limit.

    On Jun 02, 2006 at 2:36 pm Larry Hobbs wrote:

    . . . . .


    Regarding Glucophage (metformin) and PCOS...

    One study found that women taking higher doses of metformin (2250 mg per day) lost more weight (7.9 lbs vs 3.3 lbs) than those taking a lower dose (1500 mg).

    The article is posted here:


    On Jun 02, 2006 at 2:44 pm Larry Hobbs wrote:

    . . . . .


    You might be interested in reading about a woman who has taken diet pills such as phentermine for more than 20 years.

    Her story is posted here:


    On Jun 02, 2006 at 2:48 pm Larry Hobbs wrote:

    . . . . .


    The American Society of Bariatric Physicians (ASBP) lists their members by state on their website.

    They list a few doctors in Phoenix here:


    On Jun 03, 2006 at 12:30 am Michael Steelman, MD, FASBP wrote:

    . . . . .

    In my practice I use phentermine in patients for as long as I believe it is benefitting them. The 3 month cut off makes no sense...we should use a medication for as long as it is needed and helpful.

    Larry Hobbs was right; I find that Armour thyroid or Westhroid, both forms of natural T4 and T3 combinations, tend to work better for most people than combinations of synthroid and cytomel. You can also check out the website http://www.thyroid.about.com for a list of "top docs" who understand the thyroid issue from this perspective (I don't know if any are in Az., though).How you feel may be as important as your TSH level.And it is critical to have lab drawn at the same time of day and evaluated relative to when your last dose was taken.

    Dr. Scott Rigden in Tempe is very knowledgeble and "user friendly" regarding weight management issues...but I don't know his take on the thyroid issue.

    On Jun 04, 2006 at 5:14 am Michael Anchors, MD, PhD wrote:

    . . . . .

    A recent discussion among you has recommended the use of Armour thyroid or a combination of Synthroid and Cytomel instead of Synthroid monotherapy for treating hypothyroidism. A few years ago I explored this area in response to a book I read. I've forgotten the title, but I think one of you recommended it to me. The book said that since many people have impared conversion of T4 to T3, Synthroid monotherapy does not adequately relieve their symptoms of hypothyroidism.

    I should think this unusual condition would be signaled by the failure of the TSH to decline adequately during Synthroid therapy.

    Furthermore, some of you have suggested driving the TSH all the way down to near zero.

    I don't have a problem with that, but I HOPE you guys follow up the patient's complaints. I do. And I have NEVER seen anyone with complaints of fatigue, hair loss etc cease such complaints after shifting from Synthroid to Armour thyroid.

    A couple of patients who came to me already on Armour thyroid have said they feel worse on Synthroid, but NO ONE I originally put on Armour thyroid ever noticed any difference compared to Synthroid. Nor have I noticed any difference between the generic and the brandname Synthroid. I have an idea why . . .

    Years ago I developed a multinodular goiter. My endocrinologist started me on Synthroid to see whether my 3 cm nodule could be reduced. Even though I was 54 years old at the time, he started me directly on 150 mcg. I asked, "Isn't that a big dose for an old man like me?" He said, "Nah, you'll do fine." I did fine, noticed nothing.

    After a year when my nodule had reduced in size, the endocrinologist told me to stop the Synthroid. I said, "Can I just cold turkey?" He said, "Sure. You won't notice a thing." He was right. I didn't.

    So now I'm wondering why the company makes so many dosage sizes of Synthroid? What difference does it make?

    If you reach into anyone's neck and yank out their thyroid, the replacement dose is about 150 mcg. Almost no one should be on a higher dose (exception: people taking lithium), and most people on a lower dose will, probably, eventually wind up on 150 mcg, as their thyroid poops out.

    Keep in mind that TSH responds logarithmically to the thyroid hormone level (mainly T3). If the thyroid hormone level [DECREASES BY HALF], the TSH goes up by a factor of 10! So if the TSH goes from 4 to 5, what do we have? . . . only a very small change in T3.

    I don't think bariatricians should encourage patients in hanging on to metabolic causes for their obesity, instead of facing up to overeating. Didn't we have hypothyroid people in 1970? How many fat people did we have then? I turn the pages of college yearbooks and don't see any, almost none, not faculty, not students. Any honest student of obesity must face facts. The proof of truth is always, always observation. Never, never theory.


    (This comment was posted by Larry Hobbs for Dr. Anchors with his permission.)

    On Jun 04, 2006 at 9:10 am Jolie wrote:

    . . . . .

    Dr. Anchors,
    I may not be a doctor but I will point this out. Before treatment for my thyroid, my liver panels were all high, my cholestrol and ldl high. With my liver panels not working efficently, how can I expect to lose weight correctly. A properly functioning liver is needed to lose weight, or atleast a proper amount of weight. Yet, my doctor kept telling me that nothing was wrong with my thyroid, diet and exercise. Of course, it did not matter that I was and that it changed little. I finally found a doctor to treat me and after 5 months on synthyroid, I wasn't really feeling any better, YET, my liver panels are all normal, my cholesterol has gone down 38 points and my ldl down 64. All these things my previous doctor said could only be done with diet and exercise. Not to mention the other things that have improved. Yet, you can not see the link between metabolic causes and obesity? You can't see that metabolic problems cause issues within a person body to prevent weight loss and promote weight gain?

    If a person were really just an overeater, then explain why they wouldn't just continue to eat even while taking medicine like phentermine. I mean your saying its just a choice to overeat, so medicine would have no benefits.
    "The proof of truth is always, always observation. Never, never theory." I take it you did not take many science classes to become the doctor you are today. That whole hypothesis thing must have really bugged the heck out of you. Oh and the world is really flat, cause it sure does look like it from where I am standing.

    1970? Hmm, has anything changed since 1970 which could influence a person body chemistry? More pollution, more foods and drinks with preservatives and additives in them,school systems taking PE out of the classrooms,fast food places going up everywhere serving fake food and people don't even realize it, and the list goes on.
    Did you know that Diet Coke only just came out in 1982, made with aspartame. Aspartame is linked to many health problems. So maybe you should actually do some observations beyond 1970 and see what could possibly haved changed since then.

    You are the kind of doctor, and human being, I try to stay away from. Your answer is the same for all overweight people. If you would just diet and exercise, then you wouldn't be overweight. If only that were the case, I would be one thin person.

    Good day to you,
    Jolie Molino

    On Jun 04, 2006 at 9:58 am Larry Hobbs wrote:

    . . . . .


    In defense of Dr. Anchors...

    He is a very good doctor.

    I've known him since 1997 and he always seems to try and do what is best for his patients, often forgoing monetary gain in order to help people.

    Dr. Anchors owns the patent for Phen-Pro, but, as far as I know, has never charged a dime for it so that everyone can benefit from it.

    He always seems open to new ideas but also wants to make sure that he does not accept them blindly and that they are supported by real world data.

    Regarding his comment about 1970...

    I believe he was trying to say that it seems unlikely that low metabolism could explain the dramatic increase in obesity since 1970 since hypothyroidism is probably no more common today than it was then. Therefore the cause of the recent rise in obesity must be something other than low metabolism and is mostly likely due to an increase in calorie consumption.

    It's OK if people express different opinions. It is how problems are solved.

    On Jun 04, 2006 at 10:32 am Jolie wrote:

    . . . . .

    "I don't think bariatricians should encourage patients in hanging on to metabolic causes for their obesity, instead of facing up to overeating."

    I have no problems with others stating their opinions, but I can disagree. Just like he can with me. My problem is with generalized statements like the one above. He is pretty much stating that all overweight people just need to face up to the fact that the eat to much and that its their choice, and no underlying issues to prevent weight loss. That is not true for everyone.
    As for as the hypothyroidism being no more common today then it was then. Considering that in the 1970's, they considered TSH levels of 5 and above to be Hypothyroidism. And it was until the last few years they finally realized that TSH levels of 3 and above to be Hypothyroidism. I say they have no way of knowing how many actually had Thyroid problems in 1970's. And if it were a simple issue of calorie consumption, the your saying if you put 2 women of the same weight and height on the same exact diet and exercise program, they would both lose the same amount of weight. We know that is very unlikely to happen. Its this type of thinking is what keeps overweight people from getting the right help.
    Like I said there are other things in the last 30 years that could influece our body chemistry, and yes change our metabolic functions over time. Am I correct in saying that Hypothyroidism is not the only metabolic condition that causes weight gain, overeating,cravings, or not feeling full? 1970 is nothing like today, so you can't compare today to 1970.
    I am sorry if I offended you or the Dr., but again this is my opinion, though it may be strong and he can respond in kind.

    On Jun 04, 2006 at 10:50 am Jolie wrote:

    . . . . .

    Just wanted to say it does make me feel better that he is behind Phen-pro. My doctor gives me Phentermine, but she doesn't really believe in it. She feels that I should just diet and exercise. Sometimes, what we all need, is someone who believes that after 30 years of living with our body, that we know a little something about it. That, since we have dieted and are exercising, and nothing is happening, something else might be going on that maybe even the doctor can't understand. Otherwise, if they do not believe that, they are essentailly saying we are lieing. That we are not dieting or exercising. We put a lot of worth into what our Doctors say. But, I have learned we can't.I have learned to respect them and to listen to their opinion but I have also learned that they are not always right and they don't always know whats best and that I have an opinion when it comes to my health. Once I finally realized this, I was actually able to find a Doctor that finally diagnosised me as hypothyroid. If I would have stayed with the other Doctors that told me nothing was wrong, I would be stuck with a bad liver and high cholesterol until I eventually died much earlier then I should have. This is why I feel so strongly about generalizing obesity as to one cause; too many calories.

    On Jun 04, 2006 at 10:58 am Larry Hobbs wrote:

    . . . . .


    Thank you for the feedback. I appreciate it.

    You did not offend me. I just wanted to defend my friend, Dr. Anchors, who sends out more emails than anyone else I know discussing varioius ideas on how best to help people lose weight.

    I agree with you that other things have changed in the last 30 years that may affect metabolism, appetite and body weight.

    Even things such as compounds found in some plastics which leach into the water from some plastic water bottles increase body weight in animals, and there are thousands of new chemicals introduced every year.

    There is a good book on chemicals in our environment called "Our Stolen Future".

    The article about plastics is posted here:


    Our Stolen Future's website is located here:


    On Jun 05, 2006 at 12:03 pm G. Michael Steelman, MD wrote:

    . . . . .

    I just wanted to weigh in with a few more thoughts of the thyroid issue. I really appreciate your willingness to open debate.

    Deiodination [that is the removal of an iodine atom from T4 to turn it into the more active T3] takes place through different pathways in the pituitary and the "periphery" and transformation of T4 to T3 can continue normally in the pituitary while being slowed down in the periphery (e.g. during caloric deprivation) (see Medeiros-Neto. Obesity and the Thyroid. Progress in Obesity Research. Guy-Grand and Aihaud, eds. Libby and Co. Ltd. 1999).

    Therefore, in such a state the pituitary would not react to peripheral deficiency of T3, since it is still converting T4 to T3.

    This makes evolutionary (survival) sense? the pituitary doesn't want to stimulate more thyroid activity during famine while the decreased peripheral conversion allows one to survive longer on a given fat mass.

    I do check with my patients aboutsymptoms and I see people very frequently benefit by switching from Synthroid [T4 only] to dessicated thyroid [Armour Thyroid, T4 plus T3].

    I also see their symptoms worsen again if another physician switches them back.

    That seems to be a shared experience with a lot of doctors I talk with. Objective evidence for impact of combination [T3 plus T4] vs levothyroxine [T4] aloneshows up, as well, in the article by Bunevicus, et al, NEJM, 340:6, 2/11/99,p 424-429.

    I think the contribution of sub-optimal thyroid function has a very small role in causing weight gain. But I also believe it may make a huge difference in some people's ability to lose excess fat.

    I think bariatricians should keep an open mind about "causes" and confounding factors.

    I don't believe every obese patient has exactly the same biochemistry or the exact same mix of etiological factors.

    We nowknow things about obesity that we didn't know just a few years ago. Who knows what we will know in the future.

    If I remember correctly, there has been a significant increase in the incidence of hypothyroidism over the last several decades.

    Some have blamed increasing exposure to fluoride (excess fluoride can cause hypothyroidism) and other chemical toxins. It would be interesting if anyone knows stats on that and how it correlates with the rise in obesity.

    Yes, it ultimately boils down to caloric balance. But what are the factors that determine caloric expenditure?

    Why do formerly obese have a lower BMR [basal metabolic rate] than never obese subjects at the same weight?

    Ifit proves to be a causative agent, how does the virus from Atkinson's work produce obesity?

    Observation is important, but one must be careful, especially when evaluating one's own experience, to notgeneralize individual experience to the whole population.

    Some observations are subjective and some are objective.

    The observations of those who do see differences between T4 therapy andT4/T3 combination therapy must be given equal weighting with the observations of thosewho don't. We may be looking at different populations.

    And, finally, the truth is not in the observation, it is in the reality/results whether they are properly observed or not.


    (This comment was posted by Larry Hobbs for Dr. Steelman with his permission.)

    On Oct 23, 2007 at 10:34 am Ann Pearson wrote:

    . . . . .

    I didn't read all of the comments, but will add that I am one of those who gained weight while taking Celexa. The carb cravings in late afternoon and evening were terrible - I've never felt that out of control in my life. Forcing myself to not eat was like forcing myself to not breathe. It was one of several reasons I discontinued the therapy. None of the literature I read about the product suggested that this would be a problem, nor did my doctor mention it. However, when I ran into her at the grocery store about a month after beginning therapy, she asked me, "So how much weight did you gain?" She knew it was likely to be an issue, but chose not to inform me. (I no longer see her.)

    Incidentally, my answer to her was "12 pounds in three weeks." I had, quite literally, no clothes that I could wear to work.

    On Oct 23, 2007 at 10:57 am Larry Hobbs wrote:

    . . . . .


    Thanks for sharing your story.

    It is unfortunate that patients are not told about the possibility of weight gain with all drugs capable of doing so.

    I imagine doctors are afraid patients may not take the drug if they tell them.

    The research suggests that the fear of weight gain is one reason people often resist the idea of stopping smoking.

    On Jul 18, 2008 at 10:18 pm james wrote:

    . . . . .

    I had been on Celexa for quite a long time and that too caused great weight gain for me - also over 25 pounds worth.

    On Oct 07, 2010 at 1:56 pm Lynn wrote:

    . . . . .

    Thanks to Celexa, I gained 100 lbs in less than 11 months. My doctor just kept on increasing the dose (100mg per day), and my stupid mistake I trusted my doctor!! I informed my doctor on first visit that I had a history of binge eating.

    What's even more discouraging is I informed my doctor that I had gained 30 pounds in 6 weeks. He says, "oh ok, let's add Topamax to help." Topamax helped me forget everything, and celexa increased my cravings. Male doctors think oh well weight gain, whatever the patient is happier. Maybe it was because I was eating myself to oblivion (carbs increase serotonin). I think female doctors are the ones to truly understand and empathize.

    Now I will forever have scars and stretch marks everywhere on my body due to this drug.

    This is a toxic drug. It should be banned.

    Fortunately, I changed physicians and changed my medicine and have lost the 60lbs!

    On Oct 07, 2010 at 2:25 pm Larry Hobbs wrote:

    . . . . .


    Thanks for sharing your story.

    I posted your comment as an article here so that more people will see it.


    Please feel free to share your comments about this article.




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