Dear Dr. Roach: I was wondering whether Ozempic might be prescribed for somebody who gained weight due to antipsychotics or drugs for depression. I read some years ago that the weight gain associated with antipsychotics had something to do with blood sugar levels (or some other metabolic reason).
K.
You are quite right that many medications, including some antipsychotic and antidepressant medicines, are commonly associated with weight gain. There are many mechanisms at work here, but the blood sugar increase is probably secondary to the weight gain, rather than the other way around. Some medicines are worse than others, so a wise prescriber chooses the least harmful option when possible. But sometimes the only medication that works for the mental health issue does cause weight gain.
For decades, psychiatrists and others have prescribed metformin to help with weight gain due to medications. It’s certainly better than nothing, but you are right that semaglutide (Ozempic when prescribed for diagnosed diabetes and Wegovy when prescribed for weight loss) will be more effective. A 2023 study showed that for people who gained weight due to psychiatric drugs and did not respond to metformin, semaglutide was effective.
Getting insurance companies to cover these expensive medications is often the biggest barrier.
Dear Dr. Roach: You recently wrote about colitis, aka inflammation of the colon. Could you please explain how to treat and prevent it?
M.C.
“Colitis” does mean inflammation of the colon, but it isn’t just one disease. It’s a finding that is associated with many diseases, and treatment depends on the exact cause.
Colitis can be due to infection. Diseases like diverticulitis and gastroenteritis are inflammatory due to the presence of a pathogen. A pathogen is an unhealthy germ in the colon that leads to symptoms such as fever and diarrhea. Often these infections do not need antibiotics, just support until the body gets rid of the infection itself. Other infections are more serious. Clostridioides difficile (“C. diff”) can be very serious, even life-threatening, and requires powerful treatment.
Microscopic colitis diseases are unusual and possibly autoimmune. They are sometimes triggered by medications and treated with anti-inflammatory medicines such as budesonide.
The underlying cause of inflammatory bowel disease (Crohn’s and ulcerative colitis) still isn’t well-understood. Although anti-inflammatory medicines like steroids still form part of the treatment for IBD, current treatment uses biological agents to target molecules that form part of the disease response, without the long-term toxicity of steroids.
There are many other causes of colitis. Treatment is highly variable, and prevention isn’t always possible. Still, a healthy diet with a large variety of foods, especially plants, will help keep your colon in the best shape to ward off infections. It’s much easier to get an infection after antibiotics, for example, since the healthy bacteria are largely killed off.
I do not recommend probiotics in healthy people. Your microbiome — the “suite” of bacteria, viruses and other microbes that live in your gut — respond better to a good diet than a large number of limited bacteria. There is almost no evidence of benefit when it comes to probiotics in healthy people.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected]
