Will weight be gained from taking depression medication?
Potential
weigh gain is a very real concern for many patients. The answer to this
question is not so straight-forward. As a group, the older
antidepressants have been classically associated with weight gain
(tricyclics, MAOIs). When the SSRIs first entered the market, they were
believed to have no associated weight gain as a group, and some even were
found to cause weight loss (e.g., Prozac). If the side-effect profiles
are looked up in the Physicians' Desk Reference, weight gain is not noted
for most of the SSRIs. Keep in mind that side-effect profiles are
typically developed from the early studies of medications, which are
conducted over the short term (i.e., several weeks). In the short term,
for example, fluoxetine use can result in weight loss. In clinical
practice, however, many physicians have found that SSRIs can be
associated with weight gain over the long term. Although clinical trials
have typically found that weight gain does not differ significantly from
placebo, uncontrolled studies have noted weight gain over the long term.
Paroxetine appears to be more associated with weight gain clinically than
the other SSRls. Citalopram has been reported to have early weight gain.
There may be an increase in carbohydrate craving associated with SSRIs as
a possible mechanism.
It is certainly plausible that weight gain over the long term may be
independent of SSRI use in some people. Obesity has become an epidemic in
many countries regardless of medication use. More long-term controlled
studies are needed to compare weight gain over time between
antidepressant users and those who are not. Keeping in mind the potential
for weight gain, good nutrition and exercise should be part of the
treatment.
Although data are not conclusive regarding weight gain with SSRIs, there
are data supporting weight gain potential from the anticonvulsants that
are prescribed for bipolar conditions and mood instability in general.
Also, atypical antipsychotics and benzodiazepines as classes of
medications are associated with weight gain as well.
When deciding what medication to use in treatment of depression,
discussions about side effects should be undertaken with your doctor. The
risk for weight gain needs to be balanced against the risk for untreated
depression. Bupropion is one antidepressant that does not have weight
gain associated with it and can be considered as one treatment option.
Nefazodone also does not have weight gain associated with it, but because
of recent concerns about liver toxicity, it is no longer a first-line
treatment for depression.
