Psychiatric drug—not antibiotic—messes with gut microbes, spurs obesity

Mice burned fewer calories and had altered bacterial and viral communities.


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[panton41]

I took Invega, which is essentially a long-acting form of risperidone (technically it's a metabolite of the same molecule), and gained about 70 pounds and have had a terrible time losing it. I wonder if this explains it.

 

[Brendan McKinley]

the researchers transplanted microbe-loaded poop from the drug-dosed mice into normal mice that never had risperidone.

I pity the particular researcher given that job, but thank them for their service.

 

[peipas]

Fat and happy for the win!

 

[Nowicki]

If your unhappy because of your obesity and you get prescribed this medication it sounds like a catch 22

 

[Technoid.se]

Now could they please try and find something that reverses that condition and as a bonus something that makes your gut flora cause you to lose weight

 

[Rosyna]

Some members of my family call risperidone the "boob fairy" due to one of the most well known adverse effects of the drug.

 

[WaveRunner]

Rosyna[/url]":2e293hol]Some members of my family call risperidone the "boob fairy" due to one of the most well known adverse effects of the drug.

I wonder how many confuse this affect versus the regular fat that's added to the area due to weight gain.

 

[Zeboim]

WaveRunner[/url]":i5guburw]

Rosyna[/url]":i5guburw]Some members of my family call risperidone the "boob fairy" due to one of the most well known adverse effects of the drug.

I wonder how many confuse this affect versus the regular fat that's added to the area due to weight gain.

And this is the issue with metabolic adverse effects of antipsychotics. Extremely multifactorial. This will unfortunately continue to be an issue until we get closer to localised administration/refined antipsychotic targets

 

[Rosyna]

WaveRunner[/url]":3mci1gh1]

Rosyna[/url]":3mci1gh1]Some members of my family call risperidone the "boob fairy" due to one of the most well known adverse effects of the drug.

I wonder how many confuse this affect versus the regular fat that's added to the area due to weight gain.

I'd imagine not many (for boys, at least). The extra growth in male breasts looks very different from the way additional fat from weight gain would appear.

 

[FrankDCat]

"When the researchers transferred just the gut viruses from the drugged mice to healthy mice"

I think you mean bacteria, not viruses.

 

[themustafa]

As a psychiatrist, I just want to say that this is no reason for anyone who is on risperidone to stop taking it. Metabolic syndrome and gynecomastia are well known side effects of all atypical antipsychotics, and if you're on on one its for a good reason.

 

[bb-15]

Here is a link to a forum discussing using resperidone and weight gain. It seems to be a serious side effect for some people

http://www.drugs.com/answers/risperidon ... 47861.html

 

[SiberX]

Gut microbiota is, I suspect, going to be a very hot area of research in the next few years in terms of learning more about metabolism and weight gain/loss. If the microbiome can be altered by many different classes of drugs (even those not normally known to affect bacterial populations!) and that microbiome can have far-reaching impacts on a person's metabolic processes, we're going to have to take a much more careful look at which drugs are prescribed to whom and what procedures (such as fecal transplants and related) might be effective in reversing any imbalances introduced by those medications.

If better institutional knowledge of gut bacteria makes even a small dent in the western world's current obesity issues it will have dramatic positive improvements on overall health and life expectancy for the population as a whole.

 

[KGFish]

I'm always fascinated by how much impact the gut biome is found to have on people these days. Even a few years ago, that area was almost completely unresearched. Now, we're at the point where I've heard someone in the field describe humans as a fancy food-delivery mechanism to the gut bacteria.

 

[KingArthur10]

themustafa[/url]":95dr9cvc]As a psychiatrist, I just want to say that this is no reason for anyone who is on risperidone to stop taking it. Metabolic syndrome and gynecomastia are well known side effects of all atypical antipsychotics, and if you're on on one its for a good reason.

Correction: if you're on Risperidone and it's truly helping you (re: schizophrenia or Type 1 bipolar), keep using it. If you're unsure as to its usefulness for you, consider getting a second opinion to ensure that you aren't being misdiagnosed. I've seen it happen multiple times where docs or nurse practitioners will jump to a diagnosis, and once the diagnosis is made, they seem to have extreme difficulty taking new data into a revision of their diagnosis.

 

[lewax00]

As a psychiatrist, I just want to say that this is no reason for anyone who is on risperidone to stop taking it. Metabolic syndrome and gynecomastia are well known side effects of all atypical antipsychotics, and if you're on on one its for a good reason.

Of course not...the side-effect was already known about. All this did was determine how it accomplishes that side-effect.

 

[WaveRunner]

KingArthur10[/url]":1t6sfdbs]

themustafa[/url]":1t6sfdbs]As a psychiatrist, I just want to say that this is no reason for anyone who is on risperidone to stop taking it. Metabolic syndrome and gynecomastia are well known side effects of all atypical antipsychotics, and if you're on on one its for a good reason.

Correction: if you're on Risperidone and it's truly helping you (re: schizophrenia or Type 1 bipolar), keep using it. If you're unsure as to its usefulness for you, consider getting a second opinion to ensure that you aren't being misdiagnosed. I've seen it happen multiple times where docs or nurse practitioners will jump to a diagnosis, and once the diagnosis is made, they seem to have extreme difficulty taking new data into a revision of their diagnosis.

I don't know about misdiagnosis and god help you if you got diagnosed by a nurse and not a specialist... but I would agree that some doctors tend to have a go to drug which might not be the best for your biological make up. But that's true for any disease it seems.

 

[B'Trey]

I don't follow how the transfer works. How would the transfer change the makeup of the recipient? Unless organisms exist in the donor which do not exist in the recipient, then why would the introduction of a small amount of poop change the makeup of the gut environment of the recipient?

 

[andyveryhandy]

I agree with themustafa and others. As someone who has taken a small number of antidepressants and antipsychotics over the last decade (with a few mentally related hospitalizations) it is fairly well known that some drugs cause severe weight gain. If you've got a competent psychiatrist (95% are) they will discuss this with you. Still, the patients best advocate is himself.

But to suggest that the new information is: drugs can cause weight gain is disingenuous. As the article and other comments point out, it's the mechanism behind the weight gain that is interesting here.

 

[NonsuchClark]

Wikipedia entry says Risperidone "is taken either by mouth or by injection into a muscle." If taken by mouth, it ends up in gut. But I wonder if injection into a muscle would side-step the problem?

 

[svgpithon]

Guys, guys, the answer is clearly to just prescribe the same people amphetamines to help them lose weight. That's how drugs work, right?

Spoiler

/s

 

[AcidTec]

Risperdal is often a first-line treatment because it is usually effective, cheap, and well-studied. It's one of the older 2nd gen APs. I, unfortunately, get items from the lists of "rare" and "this shit isn't supposed to happen" lists of side effects, so I quit it cold-turkey. Dystonia in my jaw, aggression, panic attacks, mixed episodes, random nosebleeds, excess salivation, constipation, and more shit I can't remember. That was 4 years ago.

I am glad to see that people are investigating why these drugs cause such massive weight gain. It appears it's not just the D2 blockading. There are no new APs in the pipeline, they've moved on to the massive money makers; obesity and diabetes. For those of us who will be stuck on APs for the rest of their life, it's nice to see researchers still paying attention to these drugs. Now if they could isolate the weight gain in quetiapine, although I think that one is pretty obvious...

Also, as someone who suffers from IBS, I find the gut studies very interesting. IBS episodes are a combination of diet, stress, exercise, and (sometimes medications, especially APs.) As an aside, to anyone else with IBS-D, I've had great success with low-dose lamotrigine (50-75mg) to help control the symptoms (discovered as a secondary effect.) The only other drug that helped control the symptoms was Donnatal, and there are no longer any generics, or extend-tabs being made. $230 for 30 tabs is ridiculous, that shit was single digits when the generics were still in production. Yeah, it's old, and margins are razor thin on it, but that's no excuse. It's not like there are newer drugs that have surpassed Donnatal; it's (until recently) the only medication to help IBS-D.

 

[Oldmanalex]

In the first place the big advantage of this study, if shown to be correct, is that may offer a quite simple way to look for these rather common metabolic side effects of drugs. A mouse screen would not be difficult to set up to look for this effect, but the correlation might not be good across different drug classes. A lot easier than trying to work out the real mechanism, where the primary target might be human gut or inflammatory cells, or a direct or indirect bacterial effect.

 

[AcidTec]

andyveryhandy[/url]":g9816a4m]I agree with themustafa and others. As someone who has taken a small number of antidepressants and antipsychotics over the last decade (with a few mentally related hospitalizations) it is fairly well known that some drugs cause severe weight gain. If you've got a competent psychiatrist (95% are) they will discuss this with you. Still, the patients best advocate is himself.

But to suggest that the new information is: drugs can cause weight gain is disingenuous. As the article and other comments point out, it's the mechanism behind the weight gain that is interesting here.

I would say 95% are incompetent. I've been through 5 in 4 years, including hospitalization, and most just throw drugs at you until something sticks. One of my psychiatrists said that less than 5% of med school residents are specializing in psychiatry.

It's a dark art, and you have to be a little crazy to treat crazy.

 

[FlibberyGiveit]

Technoid.se[/url]":1j8f4pmm]Now could they please try and find something that reverses that condition and as a bonus something that makes your gut flora cause you to lose weight

Probably been ninja'd but are microbes that cause weight loss. They aren't worth it.
Amoebic dysentery springs to mind.
edit: wasn't ninja'd.
edit0: edited "edit:" for accuracy, fixed capitalization in post.

 

[Ben G]

Pendentic question about the title. If Risperidonel inhibits some bacteria growth, isn't it an antibiotic by definition? Granted, it may not be a particularly good one...

 

[perrosdelaguerra]

SiberX[/url]":tr7icu6v]fecal transplants

I didn't think this was a thing.

It is.

::shocked face::

 

[jonahs]

this has interesting implications... thinking out loud.

your gut microbes are responsible for a majority of hormone and neurotransmitter activity?

schizophrenia and 'psychotic' reactions are associated with elevated dopamine?

serotonin makes your body think it's hungry, but also happy?

so does risperidone tip the scales enough that serotonin producing bacteria can compete? why doesn't it continue working mentally, do the physical effects continue? it seems likely then that if it too much dopamine its something more intrinsic in gene expression, maybe body is hyper efficient at recycling it or very inefficient with serotonin? it probably means that the amounts of hormones and neurotransmitters don't mater as much as balance.

 

[AcidTec]

jonahs[/url]":2j0umj9n]this has interesting implications... thinking out loud.

your gut microbes are responsible for a majority of hormone and neurotransmitter activity?

schizophrenia and 'psychotic' reactions are associated with elevated dopamine?

serotonin makes your body think it's hungry, but also happy?

so does risperidone tip the scales enough that serotonin producing bacteria can compete? why doesn't it continue working mentally, do the physical effects continue? it seems likely then that if it too much dopamine its something more intrinsic in gene expression, maybe body is hyper efficient at recycling it or very inefficient with serotonin? it probably means that the amounts of hormones and neurotransmitters don't mater as much as balance.

Not quite. Bipolar disorder is understood as a problem with D2 levels fluctuating, but schizophrenia and psychosis are not as clearly understood. We know that anti-psychotics can help mitigate the symptoms of schizoprenia and psychosis, although it's much like a mental sledgehammer. Also, there is no link between serotonin and depression. You've conflated dopamine and serotonin, which do not act on the same pathways. There are some APs that act on serotonin receptors as well as D2 receptors (wide affinity), but their primary target is still dopamine.

But there are receptors in various place in your body, including your gut, so there may be some link there. And a lot of the high weight gain APs due to a high affinity for H1 receptors, which appears to be pretty well determined.

Although I would love someone to suppress the H1 binding without affecting D2 binding. I would be in bipolar heaven.

 

[Starway]

Fwiw, a relative of mine was diagnosed with schizophrenia as a teenager and one of the things we, his family, noticed was that his flatulance aroma changed radically depending on which antipsychotic he was taking. As with most such patients, he changed meds every year or so trying to find the best ones. Along with that came huge weight gain and a lot of gas. The nature of his fecal matter also changed and is very different from family members eating the same food.

Lately he has been on a reduced dose of different meds and lost close to 100lbs in about 18 months. He still eats. And in fact probably eats more junk food than ever. But he still looses weight.

For my part, I have noticed taking a probiotic booster has helped change my waste and appears to have a positive effect on wound healing and reduction in dry skin. I am glad to see gut bacteria getting so much attention. These things really do seem to be the code that runs our system and unlocks or locks features we aren't even aware of.

 

[modemthug]

Nowicki[/url]":28e17mpw]If your unhappy because of your obesity and you get prescribed this medication it sounds like a catch 22

You're trivializing mental illness

 

[feistypenguin]

This is one of the reasons I shy away from using antibiotics, unless I have an honest-to-god bacterial infection that won't go away.

The more I read about research into gut microbes, the more it seems that there is an entire set of feedback mechanisms in the gut that our current suite of medications do not account for.

It reminds me of the early days of psychology/psychiatry, in which many mental disorders were lumped under the umbrella of "mentally deficient". I think over the next 10-20 years, the crude and blunt symptom of "indigestion" will be replaced with a spectrum of microbiome effects. Maybe a microbiome test will become a part of the standard yearly physical.

 

[Fatesrider]

SiberX[/url]"rjkuoob]Gut microbiota is, I suspect, going to be a very hot area of research in the next few years in terms of learning more about metabolism and weight gain/loss. If the microbiome can be altered by many different classes of drugs (even those not normally known to affect bacterial populations!) and that microbiome can have far-reaching impacts on a person's metabolic processes, we're going to have to take a much more careful look at which drugs are prescribed to whom and what procedures (such as fecal transplants and related) might be effective in reversing any imbalances introduced by those medications.

If better institutional knowledge of gut bacteria makes even a small dent in the western world's current obesity issues it will have dramatic positive improvements on overall health and life expectancy for the population as a whole.

Gut bacteria malfunctions explains a lot with regard to obesity, and the recent revelations that certain "bad foods" really aren't that bad.

While antipsychotic drugs having a detrimental effect on gut bacteria is a rather surprising find, it's widely known that antibiotics can do the same thing. One side effect is diarrhea (which indicates gut function issues).

When you look at how the "fat" generation grew up, much of it was under the watchful (or maybe not so watchful) eye of a doctor prescribing antibiotics for all sorts of stuff that either didn't need them, or even did. I'll bet that, genetics aside, if you asked folks if there's any correlation between their weight gain and antibiotics, you'd likely find out most of them did.

Of course, nutrition and exercise play into it, but how much of it was exacerbated by gut bacteria being wiped out by modern medicine? We've only had antibiotics about as long as we have the obesity epidemic. Given the effects of antibiotics on our gut bacteria, it would not be unreasonable to think there may be a bigger link between how we've done medicine since the 1950's and how much bigger we are on average since then.

I'd love to see more studies on that, and what to do about it. There's some research into fecal transplants for treating C. Difficile (not as gross as it sounds) which had a major negative impact on the subject's weights. Other studies (done in mice) shows weight loss is possible by tweaking the gut bacteria.

It's an emerging field of study that is exciting to those of us who have major issues losing weight (even with diet and exercise - which don't work with me and may others). It gives a lot of us hope that there will be a viable way to finally lose weight, and let us thumb our noses at the pretentious doctors who kept trying the same old methods that never, ever worked.

 

[Old_Fogie_Late_Bloomer]

IBS: Solution: one cigarette a day.

Depression and other mental problems: Solution: develop a weightlifting/muscle-building regimen that works for you.

My upvote/downvote score: Unknown, anticipating a reactionary downward trend.

Ars Technica pretty much saved my life (no lie) a year ago, when a random poster completely changed my understanding about how to lose body fat (I owe that poster so many beers, you don't even know).

I am not any kind of medical professional, but I can personally vouch for the mental well-being that comes from lifting heavy objects for the sake of temporarily damaging muscle tissue, so that you can lift heavier heavy objects in the future.

 

[Flaming Sasquatch]

Zeboim[/url]":viny982q]

WaveRunner[/url]":viny982q]

Rosyna[/url]":viny982q]Some members of my family call risperidone the "boob fairy" due to one of the most well known adverse effects of the drug.

I wonder how many confuse this affect versus the regular fat that's added to the area due to weight gain.

And this is the issue with metabolic adverse effects of antipsychotics. Extremely multifactorial. This will unfortunately continue to be an issue until we get closer to localised administration/refined antipsychotic targets

Or until we modify our culture to be less toxic to all of us, such that the majority of its citizens don't need to take mood-leveling meds just to tolerate their day-to-day existence.

 

[Rosyna]

Romberry[/url]":1u15dgn3]

themustafa[/url]":1u15dgn3]As a psychiatrist, I just want to say that this is no reason for anyone who is on risperidone to stop taking it. Metabolic syndrome and gynecomastia are well known side effects of all atypical antipsychotics, and if you're on on one its for a good reason.

You're right, this is not the reason to stop. The reason to stop is....because antidepressants are no better than placebo in blind studies. These drugs don't work. They have never worked. When they do seem to work, it's almost always down to the patient believing that they work, or ascribing feeling "different" to feeling "better."

That's really only ever applied to Prozac, not the others.

The drugs do work but finding the correct antidepressant requires a dance of first using lesser drugs and seeing if they work because the side effects of antidepressants can be severe, especially if the drug is not the one best for you.

Also, I think you're mistaking the purpose of antidepressants? They're not really there to stop the depression but to prevent it from doing a nasty mental->physical->mental cycle that spirals downward into the abyss. (That is, a thought triggers depression which triggers a physical response which triggers more thoughts that trigger worse depression).

Sometimes stopping that cycle is all that can be done, even though it may make you feel numb.

I took myself off of a cocktail of antidepressant meds over a decade ago. I had developed something called "essential tremors" which made drinking a hot cup of coffee an adventure and eating soup with a spoon an impossibility. I still struggle with depression, but at least I don't shake. (And ya know, while I did feel "different" when taking the SSRI flavour de jour, I most certainly was not "better.")

Zoloft?

I had bad luck with every SSRI, including those tremors (although I always have tremors and Zoloft magnified them so much I couldn't walk up stairs). Then I got an SNRI and that worked wonders.