Antidepressants can be a seemingly contradictory drug class. They all aim to accomplish the same primary goal (the reduction of depression or anxiety symptoms), but their mechanisms of action can be quite different. As such, their effects on body weight can differ equally.
Some antidepressant users are horrified to find they’ve put on a decent bit of weight after they’ve been on the medication for a while. I certainly could relate when I hit my all-time heaviest, after gaining 50 pounds in just a few short months after beginning Fluoxetine for the first time.
For those dealing with depression, this can be a very sensitive subject since body weight is very closely tied to self-esteem and associated levels of depression. Simply put: The less people are satisfied with or acceptant toward their current body weight, the less likely they are to be depressed.
Untreated depression can directly cause weight gain. For some people, this extra body fat can worsen depression symptoms even more, contributing to an endless cycle. Likewise, many people can become less dependent on their antidepressants after losing weight. Some become able to take a lower dose, and some eventually manage to taper off the drug completely (with their doctor’s supervision).
Needless to say, if you’re looking to begin taking or switch antidepressants – and looking for one that helps you lose weight rather than gain it – it helps to have a list of your best options are.
This guide will help give you some ideas to discuss with your doctor, and prepare you for your appointment with drug-category-specific details.
Note: This article is for informational and discussion purposes only. Don’t start or stop any medication until gaining approval from your doctor.
The Typical SSRIs
Weight Loss Friendliness Rating: 3 of 10
The SSRI (Selective Serotonin Reuptake Inhibitor) is, by far, the most popular first-line treatment for depression in modern medicine. Common examples of these drugs are Citalopram (Celexa), Fluvoxamine, Escitalopram (Lexapro), Paroxetine (Paxil), Sertraline (Zoloft), and Fluoxetine (Prozac).
These drugs often produce similar benefits to older, less selective drugs, without as many side effects (or at least much less severe ones).
The effect of SSRIs on weight gain is complicated, and varies somewhat from one drug to the next. Typically, these medications will follow a pattern of initially encouraging weight loss. As your receptors readjust (which can take anywhere from a couple of weeks to well over a month), your response to an SSRI is likely to change. It’s for this reason that doctors usually insist you try an antidepressant drug for several weeks before ruling it ineffective.
Despite a possible encouragement of weight loss up front, long-term SSRI treatment usually doesn’t help you lose weight. After your body adjusts, they often increase cravings for unhealthy carbohydrates and can stimulate the appetite.
For this reason, many SSRI patients get “hooked in” thinking the drug won’t cause much harm based on the benefit it provides during the first few weeks. Then, a few months later, after they’ve stopped worrying about weight gain, they step on the scale to be shocked by the most drastic weight gains of their lives.
Everyone is different, so talk to (and listen to!) your doctor before you decide SSRIs aren’t right for you. Overall, though, most people don’t consider them the best tool for weight loss.
Weight Loss Friendliness Rating: 6 of 10
Trazodone is a drug that, similar to the SSRIs mentioned above, works via your serotonin receptors. It’s not an SSRI, though. It’s in another class called an SARI (Serotonin Antagonist and Reuptake Inhibitor).
This drug affects serotonin in a different way than regular SSRIs. As a result, it’s not known for commonly causing weight gain or an increase in perceived appetite. Also unlike SSRIs, Trazodone is very helpful for promoting sleep.
Overall, Trazodone would be ideal to discuss with your doctor if you want to try something that won’t likely affect your weight, and especially if you might benefit from improved sleep at night.
Weight Loss Friendliness Rating: 8 of 10
Serotonin-Norepinephrine Reputake Inhibitors (SNRIs) provide similar benefits to SSRIs, but by also increasing norepinephrine (a neurotransmitter closely related to adrenaline) they become more stimulating than SSRIs. Examples of this relatively new class of drug include Venlafaxine (Effexor) and Duloxetine (Cymbalta).
This additional mechanism of action appears to not only be effective in reducing the weight gain symptoms of its serotonergic actions, it also seems to promote weight loss instead.
Indeed, the activating nature of SNRIs means they tend to encourage you to get up and do physical things throughout the day, which helps expend energy and lose fat. They also tend to reduce your cravings for food and make it easier to eat less food in one setting.
As a result, this antidepressant class might be something worth discussing with your doctor.
Wellbutrin / Bupropion
Weight Loss Friendliness Rating: 9 of 10
Bupropion (Wellbutrin), an atypical antidepressant, can also be considered. This drug works on norepinephrine like the SNRIs mentioned above, but instead of effecting serotonin, it instead effects dopamine.
Dopamine and norepinephrine are both neurotransmitters closely link to weight control. As such, Wellbutrin tends to be very stimulating, and is an ideal antidepressant for many people who want to lose weight.
A clinical study was done to confirm these results when they were first suspected, and the data backs up the theory – Wellbutrin was effective in helping patients lose weight.
Tricyclic Antidepressants (TCAs)
Weight Loss Friendliness Rating: 2 of 10
Tricyclic antidepressants are older medications, and were some of the first drugs of their kind to hit the market. Examples include Amitriptyline, Nortriptyline, and Imipramine. These are notorious for their intense side effect profiles, and they aren’t prescribed often anymore, due to the newer SSRIs and SNRIs being nearly as effective in practice.
Your doctor might have suggested trying a TCA if a few newer antidepressants have failed to perform. Despite the side effects, they can be more effective in some treatment-resistant depressives.
However, the weight loss news isn’t great. They have plenty of anecdotal evidence suggesting they encourage weight gain. A 1984 study of multiple tricyclic antidepressants indicated that these drugs caused an average weight gain of 1.3 to 2.9 pounds per month.
If other drugs have failed to treat your depression, by all means, your doctor likely has a good point if he suggests trying a TCA. Remember: Obtaining satisfactory mental health comes first. You can always manage your weight, on or off of these drugs – but depressed people don’t tend to live healthy lives. In fact, they statistically tend to live many fewer years than their happier counter-parts. Get your health in order first, then deal with the weight using healthy techniques like the ones found on this site.
Monoamine Oxidase Inhibitors (MAOIs)
Weight Loss Friendliness Rating: 3 of 10
MAOIs are another class of older antidepressants that aren’t used as often as SSRIs and SNRIs. They are better for “atypical” depression than “typical” depression, and most MAOIs come with dietary restrictions that discourage their popularity.
If you’re considering an MAOI for weight loss, it’s not all good news: The list of recognized side effects does include weight gain, and the older MAOIs such as Parnate and Nardil both have a tendency to cause weight gain.
EMSAM, a newer antidepressant patch based on the MAO-Inhibitor selegiline, may be a better option. In higher doses, it acts more like the weight-gain-promoting MAOIs, but the lowest dose (of 6 mg / day) acts through a slightly different mechanism and may actually encourage weight loss.
Atypical Antipsychotics as Antidepressants
Weight Loss Friendliness Rating: 1 of 10
Recently, atypical antipsychotics have been increasingly prescribed as antidepressants, or more commonly, as add-on treatments to other antidepressants to improve response. Examples of these drugs include Aripiprazole (Abilify), Quetiapine (Seroquel), and Risperidone (Risperdal).
Unfortunately, this class of drugs seems to encourage significant weight gain.
Add-On Stimulant Medication
Weight Loss Friendliness Rating: 9.5 of 10
This isn’t a highly common scenario, but sometimes prescription stimulants are used to augment more traditional antidepressants. A stimulant such as Adderall, Dexedrine, Ritalin / Concerta, or Modafinil may be added by your doctor to help treat your depression symptoms.
Due to their strength, these would usually be added by a psychiatrist as opposed to a general practice physician, and would be used only in specific situations. However, if you have too many side effects from an otherwise effective antidepressant, yet are left lethargic, unmotivated, or without adequate appetite control, stimulants may be added by your doctor. They may also be used to “boost” an antidepressant that simply isn’t cutting it alone.
Likewise, if you already take a prescription stimulant to treat a condition such as ADHD or narcolepsy, you’ll most likely be prescribed your antidepressant in addition to your existing stimulant.
When used with patients desiring weight loss results, prescribing even a low dose stimulant can have a profound effect on weight loss. Appetite control is increased, metabolism is raised, and many patients experience increased motivation to work out and be active.
Lifestyle Augmentation of Antidepressants
Human body chemistry varies widely, and different drugs can have surprisingly different results in different people. Just because a drug might “commonly cause weight gain” in tests doesn’t mean you will or have to gain weight on it.
The truth is, you can do your part to heavily modify most positive or negative weight-related effects of antidepressants. Most of these weight gain side effects are a result of increased appetite – and, likewise, the weight loss side effects by decreased appetite.
Although nothing is completely guaranteed, creating and sticking to a balanced diet and exercise routine can help mitigate many of these effects.
If you’d like some more help in losing weight (even while on an antidepressant), make sure to subscribe to my weight loss e-course below. It’s free of charge!