New Study Offers Answers
Written by Sherri Gordon - Published in health
Fact Checked by Nick Blackmer
A new study investigated how different kinds of antidepressants affected weight gain, a common side effect of the drugs.
The research found that after six months, Lexapro users experienced the most weight gain while people taking Wellbutrin gained the least.
Psychiatrists say that weight gain can be an important factor to consider when choosing an antidepressant, but that medical history also plays a role.
Antidepressants can cause weight gain, making some people reluctant to take them. Now, a new study has shed light on which drugs are more likely than others to result in extra pounds. Researchers reviewed the electronic health records of more than 183,000 people aged 18 to 80 in the United States taking antidepressants for the first time. The team tracked participants’ weight for 24 months. The findings, published in the journal Annals of Internal Medicine, reveal how certain drugs stacked up against Zoloft (sertraline), the most prescribed antidepressant among the participants.
After six months, those taking Zoloft gained half a pound, and people taking Prozac (fluoxetine) had a similar risk of weight gain. Meanwhile, those on Paxil (paroxetine), Cymbalta (duloxetine), and Celexa (citalopram) gained a bit more on average. Lexapro (escitalopram) users experienced the most weight gain—1.4 pounds—at six months, which shot up to 3.6 pounds after two years.
Those taking Wellbutrin (bupropion) did not experience weight gain at six months but gained about a pound after 24 months. “Patients who experience unwanted weight gain as a side effect of antidepressants may be less likely to adhere to their medication,” Joshua Petimar, ScD, an assistant professor of population medicine at Harvard Pilgrim Health Care Institute and Harvard Medical School and the study’s lead author, told Health. “We wanted to compare weight gain across common first-line antidepressants so that clinicians can make the best overall decision for the health of their patients.”
Why Is Weight Gain a Common Side Effect of Antidepressants?
Although the exact mechanism is not fully understood and was not explored in the study, there are some possible explanations as to why taking antidepressants might cause some people to put on a few added pounds. Some experts suspect that it has to do with an increase in the chemical serotonin, which plays a role in mood. Selective serotonin reuptake inhibitors such as Celexa, Lexapro, Prozac, and Paxil raise serotonin levels, as do histamine receptors such as some tricyclic antidepressants, Markus Ploesser, MD, a board-certified psychiatrist and chief innovation officer for Open Mind Health, told Health. “Increased serotonin can enhance appetite and cravings for carbohydrate-rich foods,” he said.
Some research suggests that antidepressants also can alter metabolism by slowing down metabolic rate, he added. In addition, they may influence hormones like insulin, promote fat storage, and make people sluggish and less likely to move their bodies.2
While some people may be able to lose weight once they go off of an antidepressant, “some changes, especially those related to long-term metabolic alterations, may persist,” Ploesser said. “The extent of weight loss after discontinuation varies among individuals and depends on factors like duration of medication use, lifestyle, and metabolic changes.”
Balancing Weight Gain With Other Factors
Experts agree that weight gain is an important factor to consider when choosing an antidepressant. Weight gain can lead to or exacerbate underlying medical conditions such as diabetes, hypertension, and cardiovascular disease, Ploesser said. “For some patients, weight gain also can negatively impact self-esteem and worsen mental health symptoms, including depression.” Plus, someone who is depressed may only feel more overwhelmed by having to add weight management to their to-do list. “This is why it’s essential for healthcare providers to address these concerns proactively,” Ploesser added.
But weight gain isn’t the only factor to consider when it comes to picking an antidepressant, experts said. Each class of antidepressants works differently, so medical professionals have to consider a person’s symptoms, medical history, and specific condition.
“People with a history of seizures, eating disorders (such as bulimia or anorexia), or those who are undergoing abrupt discontinuation of alcohol or sedatives,” for example, “should not take Wellbutrin due to an increased risk of seizures,” Ploesser pointed out. “Some may experience side effects such as anxiety, insomnia, and increased risk of hypertension,” he said.
The good news is that people have many options, Frances Javier, MD, a psychiatrist and medical director of Neuro Wellness Spa, told Health. “There are several different classes of antidepressants with different mechanisms of action that can be beneficial for depression,” she said. “Some are known to increase appetite, and therefore lead to weight gain, while others less so.”
Her hope, she added, is that people struggling with depression don’t avoid seeking mental health treatment due to fears about weight gain. “Untreated depression and mental health conditions have been shown to have poor morbidity and mortality,” she said. “A mental health professional can customize a treatment plan that is right for the individual.”
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