Weight gain is a notable concern for individuals considering antidepressant treatment. A recent study has provided new insights into which antidepressants are more likely to contribute to weight gain.
Researchers analyzed electronic health records from over 183,000 adults in the United States who were starting antidepressant therapy for the first time. The study, published in Annals of Internal Medicine, tracked weight changes over a 24-month period, comparing various drugs to Zoloft (sertraline), the most frequently prescribed antidepressant among the participants.
Key Findings
At the six-month mark, participants using Zoloft gained approximately half a pound. Prozac (fluoxetine) users experienced similar weight changes. In contrast, those taking Paxil (paroxetine), Cymbalta (duloxetine), and Celexa (citalopram) saw slightly higher average weight gains. Lexapro (escitalopram) users had the highest weight increase, starting at 1.4 pounds after six months and rising to 3.6 pounds by the end of two years.
In contrast, Wellbutrin (bupropion) did not show weight gain at six months but led to an approximate one-pound increase after 24 months.
Joshua Petimar, ScD, assistant professor of population medicine at Harvard Pilgrim Health Care Institute and Harvard Medical School, and lead author of the study, emphasized the importance of understanding these weight gain patterns. “Patients who experience significant weight gain may struggle with medication adherence. Our goal was to compare common antidepressants to help clinicians make informed decisions for their patients’ overall health,” Petimar told Health.
Understanding Weight Gain with Antidepressants
The precise reasons behind weight gain associated with antidepressants are not fully understood, but several theories exist. Increased serotonin levels, a common effect of selective serotonin reuptake inhibitors (SSRIs) like Celexa, Lexapro, Prozac, and Paxil, might lead to enhanced appetite and cravings for carbohydrate-rich foods. Additionally, some research suggests that antidepressants could affect metabolism, slow down metabolic rates, alter hormones like insulin, and promote fat storage.
Dr. Markus Ploesser, MD, board-certified psychiatrist and chief innovation officer at Open Mind Health, noted that these factors might contribute to weight gain. “Increased serotonin can drive appetite changes, and altered metabolism might contribute to weight gain. Long-term effects on weight may persist even after stopping medication,” Ploesser said.
Weighing the Risks and Benefits
Weight gain is a significant factor in choosing an antidepressant, as it can lead to or worsen conditions like diabetes, hypertension, and cardiovascular disease. It may also negatively affect self-esteem and mental health. “Addressing these concerns proactively is crucial for healthcare providers,” Ploesser advised.
However, weight gain is just one consideration in selecting an antidepressant. Each medication class works differently, so factors like individual symptoms, medical history, and specific conditions are important. For example, Wellbutrin might not be suitable for those with a history of seizures or eating disorders due to potential risks, while other antidepressants may have different side effect profiles.
Dr. Frances Javier, MD, psychiatrist and medical director at Neuro Wellness Spa, highlighted the variety of available antidepressants. “There are multiple classes of antidepressants with different mechanisms. Some may increase appetite and lead to weight gain, while others have minimal effects on weight,” she said. She encouraged individuals to seek mental health treatment without fear of weight gain, emphasizing the importance of addressing untreated depression and mental health issues.
The study underscores the need for a balanced approach in managing depression, considering both potential side effects and the benefits of treatment. Mental health professionals can tailor treatment plans to fit individual needs and help manage any concerns about weight gain.
