Anti-Anxiety Medication that doesn't cause weight gain?

I suffer from extreme anxiety which has transferred from being anxious/stressed about my SMO for years to anxiety about maintaining my weight loss.  I've been told that my anxiety has gotten worse since the surgery because I now obsess about keeping the new body and not f'ing up this gift. I just cannot unclench.  I am ready to admit I cannot completely talk therapy this away and need some medicinal help.  

I've heard lots of anti-anxiety and antidepressant meds can cause weight gain and for obvious reasons I want to avoid those.  Mirtazipine is one my doctor recommended but the stuff I've read about it and the huge and immediate weight gains have me avoiding it like the plague. I think that would really send me to a dark place if I took a med that stimulated my appetite.  Both my doctor and pharmacist confirmed it's one of the most common side effects of that drug.

I did some reading about Buspar in that it seems to be VSG friendly as an anti-anxiety med so long as it's not the extended release and is actually a bit of an appetite suppressant.  I'm also wondering about Vyvanse.  Would it help my symptoms?  Does anyone have experience with either of those? Good, Bad or Ugly?  I spend most of my day thinking about food, stressing about eating or not eating and can easily go from super controlling anal person to completely disconnected when overwhelmed.  And if I open the flood gate to stressed out eating I cannot control it. It a constant tug of war.

My PCP is not super in-the-know about VSG and its limitations since its still relatively new here in Canada so I look to you for ideas.  I'm taking a huge trust step here by posting this so please be gentle.

I take Vyvanse, but I don't believe it's an anxiety medication?  Since it's an amphetamine class drug, it seems like it would be more likely to exacerbate the issue.  It's only approved for treatment of ADHD and Binge Eating Disorder.  

I've had Xanax for anxiety before with no issues, but my understanding is that it's better for acute episodes.  Do you have a psychiatrist or can you see one?

Unfortunately, in Canada wait times are very long. Like 6-12 months to see one.

Stimulants often cause anxiety, or exacerbate it.  Vyvanse can make it worse.  They often will not prescribe it for someone who has uncontrolled anxiety.

I take bupropion (buspar) two times per day (75mg each).  My doctor specifically prescribed it because it's known to oftentimes suppress appetite.  I also take a low dosage of clonazepam (0.5mg) daily.

I started the bupropion about a year after I had surgery.  My anxiety and depression became overwhelming and I knew I needed to address it.  Seems to help.

I'd love to start on Vyvanse for my BED, but it's not in my insurance's drug formulary.  I'm aghast at how much it costs so I'm on the fence right now whether I want to start it.  I'm hoping it might get cleared at some point in the near future.  I'll probably have to drop the other psychotropics that I'm on.  Decisions, decisions.

It takes much courage to overcome anxiety.  Congratulations on having the bravery and strength to tackle the first step. :)

There are two ways we treat anxiety with medications.  The first are a class of medications also used to treat depression.  These include SSRIs and SNRIs.  Sometimes they will also use tricyclic antidepressants.  These are daily medications that stabilize levels of neurotransmitters in the brain.  They take several weeks to see an effect.  Many do cause weight gain.  The second are benzodiazepines, which are almost typically prescribed PRN.  This means "taken as needed."  Benzodiazepines are powerful drugs that have anesthetic and amnesiatic effects.  Ativan, which is used for anxiety, is also given before surgery often, for instance.  A tolerance is built up to these quickly and they are highly addictive.  They also often cause weight gain.

Most psychiatric medications can cause weight gain, though.  Many PCPs are not aware of all the drugs that may, but some are better than others.  It is always my suggestion to see a psychiatrist rather than a PCP, as they are far more familiar with these intricacies.  I know there's a long wait in Canada, but it will be worthwhile.  I'd get on the list ASAP.

As for Vyvanse, Vyvanse is a stimulant, and they are typically contraindicated for individuals with severe anxiety, as they can, and often do, cause it or exacerbate it.  If you are anxious and obsessing, stimulants will make it worse.  It also can spike your blood pressure.  If you are prone to HPB it's best usually to avoid stimulants if at all possible.

The reason Vyvanse works for binge eating disorder is not primarily the appetite suppression.  Stimulants affect how the brain uses dopamine, so for binge eating disorder there may be a mechanism awry here for us.  However, they actually do not understand yet why it works entirely.  I'm not saying it's out of the picture, however the anxiety must ideally be addressed first. 

I was wondering if you were already in counseling.  I have treated many people with anxiety that is food-related and not.  The #1 most effective way to conquer anxiety is a combination of therapy and medication.  Medication helps with the biological aspect, but many environmental factors cause anxiety and change the way we think and our cognition.  Medications will never change it.  In fact, most people with severe anxiety disorders get far more benefit from therapy in the long run, as that is what stops the anxiety - medication just stops the symptoms, it doesn't fix the cause.  

I would encourage you to seek out a specialist who has experience with disordered eating.  What you are describing could benefit from several kinds of therapy, alongside medication management.  I would definitely suggest getting screened for an eating disorder.

No matter what you decide, I hope that things work out for you:)

I take Effexor. One of the side effects is loss of appetite and I already had loss of appetite / no hunger from the VSG so I have to make very sure I eat enough every day,  whether I want to eat or not.

my grandpa is 80 yrs old and has an anxiety issue. he isn't WLS patient but he did recently start on mirtazipine and he did gain about 5 pounds. but I have also noticed that hes not eating as often as he used to. so I think it could go either way. good luck on your search for a medication. having Anxiey sucks!

First thanks for being vulnerable on this sight.  I fight depression and anxiety and chronic pain.  I feel your pain.  I have treatment resistant depression which means medications work briefly or not at all.  I have tried a host of medications.  Some would last 2 weeks or 6 months.  One I gained a pound a day, others didn't seem to have a weight relation.  Most have weight gain as a side effect but you will not know for sure unless you try them.  I would suggest as others have that ... Stimulants and anti-anxiety meds are not usually prescribed together.  Find a psychiatrist to manage your meds rather than a PCP. Keep trying to find a medication that can help manage your anxiety.  Sometimes it takes dose adjustment and/ or medication changes.  Sounds like you are in talk therapy. If not find someone you are comfortable with and that can guide you to a more peaceful place.  Try meditation, prayer, relaxation techniques proven to decrease anxiety. Try The Anxiety Workbook.  Can't remember the author.  Hope this helps.

I have bipolar and tend towards anxiety, so been there done that. 

The sucky thing about psych meds is that their effects and side effects can vary SO much from patient to patient. Some of the things that have worked small miracles for me have been completely unbearable for others, and it's all a big game of trial and error until you find the right one. Good on you, though, for being willing to try-- I think that's the single scariest part of the mental health journey.

I took BuSpar for the better part of 15 years. It worked VERY well, and was completely weight neutral. I took a smallish dose, 15mg, often in combination with an antidepressant and it's one of the best meds I've taken. Other meds made my weight yo yo like mad, and BuSpar never seemed to affect things.

I'm currently on Lexapro, an antidepressant that works very well on my anxiety and intrusive thoughts. It's the weight-neutral cousin of Celexa, which I took a decade ago and gained a lot of weight with. The biggest issue with SSRI's and weight gain is that psych meds can affect your blood sugar. Wonky blood sugar leads to weird eating patterns, which lead to overeating and weight gain. It's by no means certain that you'll gain weight on any given medication.

Vyvanse is a stimulant, which is generally No Bueno for those of us with anxiety issues. Ditto to other antidepressants that tend to be more activating.

Feel free to PM if you ever want to chat mental health :)