Antidepressants and Weight Gain

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Q: I am currently getting counseling for depression. It’s helping, but not enough. My doctor wants to prescribe an antidepressant, but I am concerned about weight gain. Is there an antidepressant that does not have this as a side effect?

A: The short answer is yes, there are antidepressants that do not cause weight gain. But the key questions to consider are: Will those particular medications work for you? And if not, which is more important—avoiding a potential short- or long-term weight gain or getting help to regain your zest for life? That's the key, and that's the balance that must be discussed with your health care provider before selecting your medication.

Treating depression can be complex. Reasons for depression vary, symptoms can change and tolerance for a given medication may be low. Because of these factors, a behavioral and medical treatment plan is tailored to each person’s specific needs. That being said, when the choice is made to add a medication for the treatment of depression, the expectations, side effects and realistic goals need to be made clear. For instance, how will you know the medication is working, how long will it take to improve, and how long will you need to be on the meds? Even if a medication is helping, many people discontinue treatment because of adverse side effects.

OK, so how do we balance patients’ concerns about gaining weight with their treatment for depression? For starters, note that just because a medication has the potential for causing weight gain does not mean that it will. Next, we need to look at time intervals: Will the medication cause weight gain in the short term (six months or less) or in the long term (one year or more)? This matters to many people, as it is an easier pill to swallow knowing the weight gain will be temporary. Other factors to consider are: What are the chances this will occur? What can be done to combat the problem? Are there antidepressants that can help with depression without the added worry of weight gain?

Getting back to your question, there is a category of antidepressants that seek to balance the brain’s naturally-occurring chemicals, serotonin and norepinephrine. These drugs are not likely to cause weight gain in the short term and have a low tendency to cause this problem over the long term. Medications in this category include nefazodone, venlafaxine and duloxetine. A medication that also works with the brain chemical dopamine is bupropion. Bupropion is unlikely to cause weight gain, and in fact, may cause some weight loss. It is also used to help people quit smoking.

However, those medications are not the most commonly prescribed. That distinction belongs to a category of drugs called “selective serotonin reuptake inhibitors,” or SSRIs. These include sertraline, fluoxetine, paroxetine and citalopram, which work to rebalance the naturally-occurring brain chemical known as serotonin. Significant weight gain, or a 7 percent increase in body weight, is less likely to occur with a short-term regimen than with a long-term one. (One note on paroxetine: This fine antidepressant appears more likely to cause weight gain than the other SSRIs. Whether the weight gain is due to an increased appetite, carbohydrate craving or recovery from depression is unclear.)

Less prescribed and also likely to cause weight gain are tricyclic antidepressants, such as amitriptyline and doxepin. This category of medications seems to work on blocking the receptors known as histamine and alpha 1. What this means is the potential to stimulate appetite, slow the metabolic rate and possibly increase carbohydrate cravings. However, weight gain varies depending upon the specific medication (amitriptyline and imipramine may be more likely to cause this side effect), dose and length of time on the medication.

While there are other types of antidepressants beyond the ones I mentioned, my goal here was to let you know there are choices. It is up to you and your health care provider to choose the best medical treatment for your symptoms. Finally, I want to stress the importance of having good communication with your medical professional. This dialogue can make the difference between riding the healing road to recovery and veering off on a bumpy detour in your search for better health.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)