Weight gain can have adverse effects for those suffering from anxiety and depression, potentially affecting medication adherence and overall treatment success.
A new study released on Monday by Harvard Medical School and Harvard Pilgrim Health Care Institute reveals the varying impacts of commonly prescribed antidepressants on body weight. Published in the Annals of Internal Medicine, these findings provide essential insights for clinicians and patients concerned about the side effects of antidepressant medications.
Key Findings of the Study
The Harvard-led research examined the impact of eight commonly prescribed first-line antidepressants on weight gain over two years. Analyzing electronic health records of 183,118 adults from eight U.S. health systems who began taking the antidepressants between 2010 and 2019, the study included sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, and venlafaxine.
Researchers identified small but notable differences in weight changes among the medications. Bupropion (Wellbutrin) users experienced a slight average weight loss over time compared to sertraline (Zoloft) users, the reference group.
At six months, bupropion users lost an average of half a pound; by two years, they had lost an average of two pounds. Conversely, patients on escitalopram (Lexapro), paroxetine (Paxil), and duloxetine (Cymbalta) gained more weight, with increases ranging from 0.75 to 0.90 pounds more than sertraline users at six months.
The study also investigated the likelihood of gaining significant weight, defined as at least 5 percent of baseline weight. Bupropion users had a 15 percent lower risk of substantial weight gain compared to sertraline users, while escitalopram and paroxetine users had a 10 to 15 percent higher risk.
Weight Change by Antidepressant at Six Months
Sertraline was designated as the “reference” drug in the study because it is the most commonly prescribed antidepressant, serving as the baseline for comparing weight changes with other medications.
- Bupropion (Wellbutrin): -0.48 lbs
- Fluoxetine (Prozac): -0.15 lbs
- Citalopram (Celexa): +0.26 lbs
- Venlafaxine (Effexor): +0.37 lbs
- Duloxetine (Cymbalta): +0.75 lbs
- Paroxetine (Paxil): +0.81 lbs
- Escitalopram (Lexapro): +0.90 lbs
The study authors emphasize that these differences in weight gain are important for both clinicians and patients to consider when selecting an antidepressant. Weight gain can significantly impact patients, potentially affecting medication adherence and overall treatment success.
Antidepressants and Weight Gain
The study notes that antidepressants are “among the most commonly prescribed medications in the United States.” With millions of Americans relying on these medications to manage mental health conditions such as depression and anxiety, the side effects, including weight gain, are a significant concern.
Numerous studies have highlighted the potential for weight gain among antidepressant users. A
2018 BMJ study reported that people taking antidepressants were 21 percent more likely to experience a weight gain of at least 5 percent of their body weight compared to those not on the medications.
The study also indicated that the increased risk persisted for at least six years, suggesting a long-term link between antidepressant use and weight gain.
“Widespread utilisation of antidepressants may be contributing to long-term increased risk of weight gain at a population level,” wrote the authors of the BMJ study. “The potential for weight gain should be considered when antidepressant treatment is indicated.”
Weight gain is not inevitable for everyone on antidepressants,
according to Dr. Daniel Hall-Flavin, a psychiatrist at Mayo Clinic. “Weight gain is a possible side effect of nearly all antidepressants. However, each person responds to antidepressants differently. Some people gain weight when taking a certain antidepressant, while others don’t.”
Research shows that weight gain from antidepressants can be due to various factors, including changes in brain chemistry and behavior. Many antidepressants boost serotonin levels, a neurotransmitter that influences appetite and metabolism, resulting in increased cravings, higher food intake, and, ultimately, weight gain.
“All of these medications increase serotonin levels in the brain. Serotonin regulates mood and affects appetite,”
writes Dr. Chika V. Anekwe, an obesity medicine physician at Massachusetts General Hospital Weight Center.
Additionally, as patients start feeling better on antidepressants, their appetite often returns, and they may eat more as a result. “Some people lose weight as part of their depression,” writes Dr. Hall-Flavin. “In turn, an improved appetite associated with improved mood may result in increased weight.”
Strategies for Maintaining Weight While Improving Mental Health
Managing weight while on antidepressants can be challenging, but with a proactive approach, it is achievable. Dr. Anekwe
emphasizes optimizing lifestyle and daily habits to minimize weight gain. Here are actionable tips she recommends to help maintain a healthy weight and support mental health.
Adopt a Healthy Diet
Focus on eating a diet rich in whole foods, such as fruits, vegetables, lean proteins, and whole grains. Limiting processed foods and added sugars can help control weight and improve overall health. A balanced diet provides the nutrients to support physical and mental well-being.
Stay Physically Active
Regular physical activity is crucial. Not only does it help counteract potential weight gain, but it also has significant mental health benefits. Exercise releases endorphins, which can improve mood and reduce stress.
Manage Stress
High stress levels can lead to emotional eating and weight gain. Techniques such as mindfulness, meditation, and yoga can help manage stress effectively.
Ensure Adequate Sleep
Quality sleep is essential for maintaining a healthy weight and supporting mental health. Lack of sleep can disrupt hormones that regulate appetite, leading to increased cravings and weight gain.
Cognitive and Behavioral Strategies
Working with a psychologist to develop cognitive and behavioral strategies can be beneficial. These strategies can help manage increased cravings for sweets and carbohydrates, which are common side effects of many antidepressants.
