Alcohol/Carbs/Hypoglycemia/Weight Gain/SSRI's...et al

I hope a doc is reading this, because I'd really like some answers... I'm not saying that this is the case for everyone. And I'm not slamming SSRI's. They certainly have their place in the medical world and have really saved the sanity of ALOT of people. The following is just my observations and theories through ALOT of reading the past month. I've heard that about 25% of post ops become alcoholics through addiction transferrance. I've also heard that ALOT of post ops become hypoglycemic. I've read that 95% of alcoholics are hypoglycemic. If about 75% of the population are on SSRI's for depression/anxiety and they can cause hypoglycemia and carb/alcohol cravings, is it possible that it is the SSRI's are causing the problems and NOT the surgery? I'm assuming that alot of people are on SSRI's "before" surgery. People who have had surgery have been able to get off of meds for hbp, diabetes, etc...after losing weight. Is it possible that alot of us don't need the SSRI's anymore too? I noticed alot of people posting about having anxiety and depression issues after surgery and their doctors keep upping their dose or go on a spree of changing their SSRI's to find the right one. Is it possible that maybe instead they should be getting off of them? I believe in addiction transferrance, but I have a hard time swallowing the massive numbers of people that are becoming alcoholics all of a sudden when they never had problems with alcohol in their life. Some never had a drop! And all of a sudden are craving it? I also have a hard time believing that addiction transferrance would happen all of a sudden 2 years and beyond post op. Over the past few weeks I have read hundreds of posts from people (post ops or non surgery people) on the internet that have posted this phenomenon. They also posted that the cravings miraculously stopped after weaning off the SSRI. I'm not trying to make excuses, I just think something is really fishy here. lol Alcohol Cravings Induced via Increased Serotonin by Ann Blake Tracy, Director, ICFDA There is an alarming connection between alcoholism and the various prescription drugs that increase serotonin. The most popular of those drugs are: PROZAC, ZOLOFT, PAXIL, LUVOX, SERZONE, EFFEXOR, ANAFRANIL, and the new diet pills, FEN-PHEN and REDUX. For seven years numerous reports have been made by reformed alcoholics (some for 15 years and longer) who are being "driven" to alcohol again after being prescribed one of these drugs. And many other patients who had no previous history of alcoholism have continued to report an "overwhelming compulsion" to drink while using these drugs. (A few personal accounts: #1 A young woman, a recovering alcoholic, reported that during the eight month period she had been using Prozac she found it necessary to attend AA meetings every day in order to fight off the strong compulsions to begin drinking again. #2 In the Southeastern United States a middle aged psychologist, also a recovering alcoholic, after being prescribed Prozac, found herself needing to attend AA meetings morning, noon, and night to keep from destroying the sobriety she had achieved. #3 A young father, who was Mormon and had never before in his life used alcohol, found himself drinking Ever Clear and exhibiting bizarre as well as violent behavior, after being prescribed Prozac and Ritalin. #4 A young mother who had never used alcohol before began drinking large amounts within weeks of being prescribed Prozac and quickly found herself committed to a mental institution due to the psychotic behavior that resulted. Added to her Prozac prescription were anti-psychotic meds and electric shock treatments. She then began to experience seizures and was started on anti-seizure meds. #5 A concerned neighbor reported her friend was drinking straight Vodka on a regular basis after being prescribed Zoloft. #6 A daughter reported her father, sober for 15 years, began drinking again on Prozac. The consistant report from these patients has been an "overwhelming craving or compulsion" for alcohol.) For some time we did not have specific medical documentation to help us understand why this was happening. Could it be that Prozac, Zoloft, Paxil, etc., being mood altering substances, were removing the inhibitions that individuals had placed upon themselves to stop their additions? But beyond this mood altering effect of Prozac, etc., there seemed to be a physiological cause for this alcoholic obsession as well. There were reports of people who rarely drank before Prozac, etc., consuming excessive amounts of alcohol after starting usage of these various drugs. For example we have the case of a young newly wed in Southern Utah who was given Prozac for a hormonal imbalance. Before that time she would have two or three social drinks a year, yet soon after being prescribed Prozac she began bringing alcohol home by the case. Many similar reports followed. Could it be that because these drugs have such a strong adverse effect upon the pancreas [Manufacturer's warnings include such side effects as hypoglycemia, diabetes and pancreatitis.] they are producing a potent disruption in the body's blood sugar balance? This would in turn cause a "craving" for alcohol as the body reaches out for a "quick fix" to raise the blood sugar level thus triggering a vicious self-perpetuating cycle as the alcohol pushes the blood sugar level even lower after the brief high it produces. This means that those suffering a tendency toward alcoholism or any other blood sugar disorder would suffer the most disastrous repercussions of Prozac, etc., (including psychosis, suicidal ideation and violence) much faster than most. Patient reports support this conclusion. In November of 1994 Yale published a study that gave us one answer to the alcohol cravings associated with these drugs. The study demonstrated that an increase in brain levels of either of two neurotransmitters (brain hormones), serotonin or noradrenalin, produces: #1 a craving for alcohol, #2 anger, #3 anxiety. They found this to be especially true for those who have a history of alcoholism. All of the drugs listed above are designed in one way or another to increase serotonin which in turn also increases noradrenalin. Anyone who has a history of alcoholism should heed the warning contained in these reports. And anyone who has developed a problem with alcoholism while using these drugs deserves answers as to why they have experienced such an overwhelming compulsion to drink. America already has an estimated 10 -15 million alcoholics. To increase that number with a reaction from prescription drugs which causes a compulsion to drink is a tragedy! What a sad state of affairs that drugs which are actually being promoted as a treatment for alcoholism have the potential to create alcohol craving behavior. This is not only frightening, but absurd. It is heart-rending to listen to those who have had years of sobriety destroyed almost overnight or those who have never touched alcohol before Prozac, yet began drinking compulsively due to a medication prescribed by doctors unfamiliar with this connection. By chemically inducing an overwhelming urge to drink this effect also causes patients to mix alcohol with these powerful drugs. When alcohol and drugs are combined, one can compound the effects of the other so the resulting impairment is far worse than if the two were taken separately...even small amounts, mixed with some medicines, will deaden your senses or change your perceptions which can lead to psychotic behavior, seizures, etc. Those in this situation need to be made aware that they are not alone, and that this is a common report which is now substantiated by medical documentation. They also need to understand that it is possible to very gradually withdraw from these drugs and overcome these adverse drug reactions. Other references for this material: Krystal JH, Webb; E, Cooney N.; et al., "Specificity of Ethanol-like Effects Elicited in Serotonergic and Noradrenergic Mechanisms," ARCHIVES OF GENERAL PSYCHIATRY, Vol. 51, Issue 11, pgs 898-911. (This is the Yale study mentioned above.); In a study conducted by Liisa Ahtee and Kalervo Eriksson (Physiology and Behavior, Vol. 8, pp. 123-126, 1972) rats which preferred alcohol had 15-20% higher concentrations of serotonin in the brain.

Interesting thoughts. I would think that most post-ops that turn to alcohol are not doing so due to SSRIs but instead are doing it because they have lost their coping mechanism FOOD. Overeating can be an addictive behavior and when one cannot do that - it is not that far fetched to see where folks would transfer that to an addiction of another sort - some alcohol, some overspending/shopping - I've seen both. As for hypoglycemia, I know severals folks that are suffering from this. Our pre-op bodies were overfed carbohydrates in large amounts and adapted to give off tons of insulin in response. The pancreas ends up with tons of insulin producing cells. More than the normal non-obese person. I think our bodies oversense carbohydrates and can give off more insulin than is needed which drives blood sugars down into hypoglycemic episodes which can be dangerous. It is really important that post-ops not eat carbohydrates by themselves (eating them with proteins/fats changes the rise in blood sugar) and to eat regularly throughout the day to keep sugar levels level. Kathy

As I have said NUMEROUS times...There needs to be more extensive study of the after effects of WLS. There are so many factors to consider post op. 1. Depression- Is it predisposed, normal adjustment, Family/social dysfunction, chemical/nutrional. 2. Hypoglycemia- Was diabetes present prior to surgery, is there fluctuations in blood sugar, is diet balanced, is there enough exercise. 3. Alcohol- Is there a predisposition, is there a biologic need or emotional need As a nurse and critical thinker, I too believe that there is too much interconnection to be random. I suffered from depression pre op and was diabetic, hypertensive and rarely used alcohol. I am going to use myself as a case study. To date I am off all meds. I do have boughts of hypoglycemia, but that can be attributed to lack of calorie intake. I have no great fluctuations in reading but do test regularly to be sure. I do have boughts of depression, due to changing body image, and interpersonal dynamics, but have opted not to medicate. I get through and Im fine. To date (18 months post op) I have transferred my addiction to shopping for new clothes and beauty products. WHile this has yet to become a problem, I can see trouble on the horizen. I pay cash, but my husband thinks Im overdoing it. I do crave carbs!!!! But I think that is natural for our bodys to crave quick energy for possible retreat. I think anyone who was/is diabetic will also have those concerns. The trick is to eat smart carbs. Stay away from processed carbs...baked goods, candy etc. If I need a carb fix I usually have a 1/4c bowl of oatmeal with raisins or cranberries with splenda and cream (3 tbsp). Its got fiber and iron and its comfort food for me. THIS is not a daily or even weekly treat. I eat lots of fruit and veggies, and have to be sure to get my 100 grams of protein daily. I am not losing very much anymore, but I am still losing a little and am happy where I am.

Thank you for your input. I totally agree with all you say. There "definitely" needs to be more post op studies done. I'm in the midst of weaning myself from all meds.

Oh give me a break. For every "example" of a person becoming a raging alcoholic after taking anti-depressants, you can give another example of a person overcoming alcoholism with the help of anti-depressants. I just don't understand these campaigns against certain pharmaceuticals. Is there some Scientology involved here? Tom Cruise, are you posting to our little message board now? I'm wondering just how up to date this quoted study is when it mentions the "new diet pills, FEN-PHEN and REDUX". New? All I can say is, anything you read in your research, take with a gigantic grain of salt. Even well-documented, scientific studies have over the years proven to be questionable at best and bogus at worse when certain facts are revealed. Sometimes having a suspicious nature is a good thing. Carole

Did you read my entire post? Especially the beginning? I wasn't bashing SSRI's. No need for flames...please take a chill pill.

1. If you thought I was flaming, you've led a seriously sheltered online life. I was addressing some of the more salient points of the quoted material. The only comment addressed to you personally was to advise caution in your research approach. 2. Interesting that you post a potentially flammable post but when answered with something other than "yeah, what you said", you take exception to being flamed. If you had a profile where I could get some read on who you are, I probably would have refrained from answering at all to avoid upsetting you. I am not intentionally unkind. 3. That instruction to me to take a "chill pill" was singularly funny, although unintentional I think, considering the subject matter.

I'm going to be perfectly honest and admit right up front that I didn't read your entire post. When I got to the "personal accounts" my mind went into a haze and I just couldn't read any more. But, having some personal experience, growing up with a raging alcoholic who in his later years managed to get it together and give up the bottle, I feel that I did gather a few bits and pieces of knowledge. Alcoholics don't drink because they are depressed. They are depressed because they drink, or want to drink, or think about drinking, or think about not drinking, or can't imagine how they'll live if they don't drink, and on and on and on. They're depressed because drinking is the first and foremost thing in their minds and they can't get it out of their head. They drink because it's a compulsion they mostly can't control. No wonder they're depressed! Kinda like us prior to WLS, huh? As for SSRI's, I can say without a doubt they saved my dad's life. When Prozac first came out, his doctor tried it and he had good results with it. Not the best, but as he told me, for the FIRST TIME since he was about 13, he could see that there was more to life than the way he felt with a bottle in his hand. Over the years, with the release of better SSRIs and the learning curve that comes with new meds, my dad's dosage was adjusted and by the end of his life, he had been sober for over 20 years. Sure, research shows that SSRIs cause assorted issues, blah blah blah, but here's the thing... depends on which side of the research issue you're standing, doesn't it? Yes, we definately need more research on the medical issues that affect post-WLS patients, but that will come in time. As for me, I don't think that blaming SSRIs for any kind of behavior is sensible. I mean, come on, I was going nuts before I started taking the SSRIs. I sure as hell can't blame the meds for making me crazy, I took the meds to help me control my issues I already had. So many of use used food as a drug, and when we can't do that any more, we turn to other things, be it alcohol and drugs, or even exercise in some cases. I think blaming the SSRIs for this is a good bit like killing the messenger because you don't like the message.

I'm glad they helped you and your father. They helped me a great deal at a point in my life. I have nothing against SSRI's. I just feel that as with any medication, one size does not fit all. =)

Brenda, Interesting, But a little more than fuzzy on the logic end. Looking at the statistical connection of people Who are prescribed SSRI's would naturally be 100% Of people who are already depressed. Yes? Whether or not Alcoholics have been Diagnosed as Depressed, They are. Alcohol is a Depressant far stronger than Anti-Depressant properties Of ANY of the Drugs on the market. Yes? Also, People who have WLS are Obese, Morbidly Obese, or Super-Morbidly Obese. One of the side-effects of Obesity, is (naturally) Depression. A correlation of Morbid Obesity and Use of anti-depressants Would naturally be increased among those who opt for WLS Because they are most likely to be the people who have decided to Do something about their condition in life. Therefore, They are the group that would "Go to The Doc" and Seek treatment for depression. I would put a big bet that of the people who have received treatment for sleep apnea, Who are Morbidly Obese, are most likely the same MO Folks who Are checking into WLS. Yes? Those who are just suffering at home without seeking WLS May never have sought out treatment for other ills that are co-morbidities of Obesity. The (ICFDA) International Coalition for Drug Awareness And it's "director" Ms. Tracy, do nothing BUT preach against, Pharmaceutical Companies. Most of their material is based totally on Dismissing ALL of the Studies and Medical Journals as "Skewed and False" Because most studies and Medical organizations receive financial support in the form of grants From leading pharmaceutical Companies. What the website FAILS to explain in any way, The (ICFDA) is not an organization of any kind But rather the Book promotion site of Tracy's Book, And an extension of her personal website selling her book and tapes. Also it is a promotion and sales site for "RELIV PRODUCTS." A fly-by-night Vitamin sales company that is a "MLM" Or "Multilevel Marketing" Scam that makes other "Pyramid" money making schemes pale in comparison. The Reliv Site claims that their Herbs can- Reverse Aging, Stop Aches and Pains, Cure-Arthritis, Migraines, ADD, Crohns disease, eczema, asthma, Irritable Bowel Syndrome, etc... How has this managed to avoid the evening news? Perhaps that is why none of the information in Tracy's "Article" Is Study-based, but relies solely on anecdotal information. By these standards, one could easily "Prove"- "99.9% of all people who have been diagnosed with Cancer, Have eaten Birthday cake in the last 2 years!" "Here are some people who offer their tales of Whoa- "It happened to me almost at once, that evening, my 32nd Birthday, led to my demise..." "After becoming a sales-rep for "RELIV," I received these Life-Saving, Natural, Herbal Remedies, At half the Cost, and had immediate remission!" Anyone can post ANYTHING on the Web. Just Always, Consider the Source. Best Wishes- Dx