Jump to: Predicting Weight Gain What You Can Do
There’s good news and bad news about antidepressant medications and weight gain. The good news is not every antidepressant causes weight gain and not everyone who takes an antidepressant gains weight. The bad news: If you do start gaining weight when you first begin taking antidepressants, you may just keep piling on the pounds over time and ultimately find it hard to lose that excess weight. But you can turn bad news into good by working with your healthcare provider to monitor both your mood and medication on a regular basis and stop weight gain before it gets out of hand.
The antidepressants most likely to cause weight gain include amitriptyline (Brand name: Elavil), mirtazapine (Remeron), paroxetine (Paxil, Brisdelle, Pexeva), escitalopram (Lexapro), sertraline (Zoloft), duloxetine (Cymbalta), and citalopram (Celexa). Tricyclic antidepressants such as amitriptyline and tetracyclic antidepressants such as mirtazapine are linked to the most weight gain. Other antidepressants, like fluoxetine (Prozac, Sarafem) and bupropion (Wellbutrin, Aplenzin, Forfivo, Zyban) are likely to have no effect on weight or might even cause some weight loss. (1, 2, 3)
It’s not always possible, however, to choose a specific type of antidepressant simply because of its effect on your weight. When choosing the most appropriate and effective medication, or switching from one type of antidepressant to another, psychiatrists and medical doctors who prescribe these medications must consider other factors based on individual needs. You may find that one type of antidepressant works better to alleviate depression than another, or that one type gives you other unacceptable side effects, regardless of the effect on your weight.
There are many theories but not much hard evidence showing exactly why so many people gain weight when taking antidepressants, and many factors may come into play. A state of depression, in and of itself, can contribute to weight gain if your condition is causing you to overeat or you can’t work up the motivation to participate in any physical activity.
Article continues below
- Best antidepressant for anxiety according to our readers
- Bupropion Only Antidepressant Linked to Weight Loss
- How can antidepressants affect weight gain?
- How can I lose weight while on antidepressants?
- How to Avoid Weight Gain When Taking Antidepressant Medication
- Ariel Winter Shared that Her Antidepressants Had Made Her Gain Weight — Why Does That Happen?
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On the other hand, you may not feel like eating when you are depressed and initially lose weight, but then gain back your lost weight, and then some, when your medication kicks in and you are feeling better. Antidepressant medications may cause weight gain more directly by interfering with brain chemistry as well as your body’s normal metabolism and regulation of sugar and fat. A family history of obesity could also make you more generally susceptible to weight gain. 3,4
Predicting Weight Gain
One study followed 260 patients suffering from major depressive disorder who were not overweight when antidepressant medication was first prescribed for a major depressive episode. The researchers found that those who experienced at least a 3% weight gain during the first month of antidepressant therapy were at higher risk of long-term gain than those who did not gain any significant weight in the first month.5 These findings suggest that careful monitoring of weight throughout the first month of taking antidepressant medications can help predict who is likely to gain a significant amount of excess weight over the course of treatment and signal the need for preventative measures.
A 3% weight gain in someone who initially weighs 125 to 130 pounds is approximately 3 1/2 to 4 pounds. So, if that person gains more than 3 pounds after just one month of taking antidepressant medication, they may be at especially high risk of gaining even more weight. When that’s the case, a medication may be changed to one less likely to promote weight gain and further steps can be taken to control body weight, such as watching one’s diet and getting more exercise.
Not only were the study patients at higher risk of gaining weight, data gathered from the same study indicated that those who gained excess weight were also at higher risk of developing metabolic syndrome during the 6-month treatment period.6 Metabolic Syndrome is a group of unhealthy conditions that occur at the same time—excess abdominal fat, elevated blood pressure, blood sugar, and cholesterol. Having metabolic syndrome puts you at higher risk of developing heart disease, diabetes, and stroke.
What You Can Do
Psychiatrist and addiction expert Michael McGee, MD, agrees that weight gain is a real problem with many of the medications he prescribes. “Women get especially concerned about it,” admits Dr. McGee, who is also the chief medical officer at the Haven Treatment Center in California and the author of The Joy of Recovery. Some patients can eventually go off antidepressants by adopting evidence-based lifestyle interventions to prevent weight gain, he says.
“I recommend the Mediterranean Diet because it has antidepressant qualities and I encourage good eating habits like eating slowly and mindfully, avoiding ‘red light’ foods with lots of added sugar or foods that are overly processed,” he explains, adding that it’s also important for patients to make friends with hunger. “Accepting that a little hunger is OK and is necessary to maintain weight.” Dr. McGee also recommends spending time in nature, becoming involved in a spiritual community and connecting with others through volunteer work or by socializing with friends.
Be sure to voice your concerns with your physician. Ask your prescribing doctor if there is more than one option and if they can recommend an antidepressant that isn’t associated with weight gain. If your doctor feels the most effective medication is one that has been found to cause weight gain in some people, start taking preventative steps right away.
For additional support, ask your physician to refer you to a cognitive behavioral therapist, motivational counselor, and/or a registered dietitian or licensed nutritionist before switching to a different antidepressant or prescribing additional medication to control weight gain.7
You may not be able to fully prevent medically-induced weight gain, but you can take these steps to help keep it under control:
- Skip fad diets and quick weight-loss schemes. Instead, base your food choices on a proven healthful eating plan, such as a Mediterranean-style diet, the DASH diet designed to control blood pressure or a Flexitarian Diet. These are all plant-based diets that don’t necessarily eliminate meat and other animal foods but put more emphasis on fresh vegetables and fruits, whole grains, nuts, and legumes.
- Increase your protein intake, if necessary, to boost your metabolism.
- Increase the fiber in your diet, if necessary by eating more complex carbohydrates by including more beans, lentils, whole grains, fruits, and vegetables at every meal and also when you snack.
- Eliminate or cut way back on low-fiber, simple carbohydrates such as bread and pastries made with only white flour, sugary desserts, candies, sodas, and soft drinks.
- Drink more water, and eat more watery foods, like plain low-fat yogurt, fresh fruits, and vegetables.
- Walk more often and incorporate muscle-building techniques (no special equipment needed for moves like pushups, planks, and lounges) in addition to aerobic exercise. Healthy muscle is necessary to efficiently burn excess fat.
- Don’t forget mind-body exercises, like yoga, tai chi, and meditation, that help reduce any stress that may be contributing to overeating and weight gain.
- Make sure you get enough sleep every night. Good sleep habits can also help regulate weight.
Article Sources Last Updated: May 7, 2019
Best antidepressant for anxiety according to our readers
Most respondents—78 percent—received medication for their depression or anxiety, reflecting the tremendous growth of the use of antidepressant drugs in the past 15 years. According to IMS Health, a group that monitors drug sales, U.S. doctors prescribed $9.9 billion worth of antidepressants in 2009, a 3 percent growth over the previous year. They’re the third most prescribed class of drugs in the country, after cholesterol-lowering drugs and codeine-based painkillers, thanks at least in part to years of aggressive marketing.
Drugmakers spent almost $300 million in 2009 on ads for two newer antidepressants alone: duloxetine (Cymbalta: “When you’re depressed, where do you want to go? Nowhere.”) and desvenlafaxine (Pristiq: “I feel like I have to wind myself up just to get out of bed.”).
Reflecting national trends, most recipients of medication in our survey got an SSRI (selective serotonin reuptake inhibitor) such as fluoxetine or sertraline; many others got an SNRI (serotonin and norepinephrine reuptake inhibitor) such as venlafaxine or duloxetine. The drugs alter the levels of certain brain chemicals, or neurotransmitters, that carry signals between nerve cells. The Food and Drug Administration has approved SSRIs and SNRIs as standard first-line treatments for depression and anxiety disorders.
Forty-seven percent of respondents got their prescription from a psychiatrist; the rest obtained it from their primary-care physician, whom they saw separately or as an adjunct to talk therapy with a mental-health professional. That’s consistent with national data that show primary-care doctors, not psychiatrists, prescribe the majority of SSRIs and SNRIs and have done so for at least the last five years.
One size doesn’t fit all
Some SSRIs and SNRIs are promoted for particular types of anxiety, such as social anxiety or obsessive-compulsive disorder. But clinical evidence shows that they work equally well for each major form of anxiety. And individuals don’t all react the same way to these drugs, so it can take some trial and error to find the one that works best for you. Among respondents who took medication for anxiety or depression, the median number of drugs tried was three. Respondents who tried three medications had slightly better outcomes than those who tried fewer or more, suggesting that trial and error is an important part of pharmaceutical treatment.
Expect some side effects
As with all drugs, antidepressants have side effects. But our findings suggest they can be a lot more common than what’s reported in the package inserts you get when you fill your prescription. For example, 31 percent of people we surveyed who took SSRIs and 36 percent of those who took SNRIs reported a decrease in sexual interest or ability (see Readers Rate Antidepressants). That’s more than double the rate reported in studies sponsored by drug companies, which can carefully choose their participants and tend to pick those least likely to experience adverse effects.
Interestingly, men reported more sexual side effects than women, while women complained more often about weight gain. It may be a true physiological difference, or women may simply be more bothered by weight gain and men by sexual difficulties.
The sexual side-effect rates from the current survey are lower than those we found in 2004, when up to 53 percent of respondents reported them. “It’s possible that health-care providers are either prescribing antidepressants that are less likely to cause these problems, such as bupropion (Wellbutrin and generic) or are adding another drug in as an antidote to help counteract the sexual side effects,” said Anita Clayton, M.D., a professor of psychiatry and obstetrics and gynecology at the University of Virginia.
For many respondents, side effects proved more than mere annoyances: Of those who’d stopped taking an antidepressant, 33 percent said they did so because of intolerable side effects. Still, the drugs helped a lot for about half of the people who took them and at least somewhat for another 30 percent. And people who took the drugs in conjunction with talk therapy fared especially well.
Use tranquilizers selectively
For the 58 percent of respondents who experienced anxiety, we also asked about benzodiazepines, an older class of anti-anxiety drugs that includes alprazolam (Xanax and generic) and lorazepam (Ativan and generic). About one-quarter had tried a benzodiazepine; of those, 57 percent said it helped “a lot.” The drugs can cause dizziness and drowsiness, though, and unlike SSRIs and SNRIs, their daily use can lead to dependence. Our medical consultants say they’re best for short-term “rescue” situations, such as quelling a panic attack or helping a fearful flyer board a plane.
What to do
Consumer Reports Best Buy Drugs, a public education project that generates drug recommendations based on safety, efficacy, and price, says that generic bupropion, citalopram, fluoxetine, and sertraline are among the best initial options to consider for depression. Ask your doctor whether you can start at the lowest dose possible. If the first drug hasn’t helped within six to eight weeks, talk with your doctor about increasing the dose or switching to a different drug. Don’t take bupropion if you have a history of seizures, since it carries a risk of seizures at high doses. Discuss with your doctor the potential side effects and how long you’ll probably need to take the drug (most respondents had been taking theirs for at least two years). Don’t stop taking an antidepressant suddenly, which could cause withdrawal symptoms.
Bupropion Only Antidepressant Linked to Weight Loss
Bupropion is the only antidepressant associated with modest long-term weight loss, but only among nonsmokers, according to a new retrospective cohort study published recently in the Journal of Clinical Medicine.
“We found that bupropion is the only antidepressant that tends to be linked to weight loss over 2 years,” study leader David Arterburn, MD, Group Health Research Institute, Seattle, Washington, said in a Group Health Research Institute news release. “All other antidepressants are linked to varying degrees of weight gain.”
“Our study suggests that bupropion is the best initial choice of antidepressant for the vast majority of Americans who have depression and are overweight or obese,” he added.
Only Nonsmokers Lost Weight With Bupropion
Dr Arterburn and colleagues studied the relationship between antidepressant choice and weight change over 2 years among adults with a new prescription for antidepressant therapy.
“Because one of the most commonly prescribed antidepressants, bupropion, is also used as an adjunct to smoking cessation, and smoking cessation is strongly associated with weight gain, we sought to examine the effects of this antidepressant on weight gain among smokers and nonsmokers separately,” the authors write.
They conducted a retrospective electronic health record–based cohort study of adult patients who began monotherapy with second-generation antidepressant treatment between 2005 and 2009. They used fluoxetine as the reference treatment and included citalopram, bupropion, paroxetine, sertraline, trazodone, mirtazapine, venlafaxine, and duloxetine.
The researchers adjusted for potential confounders present at baseline, including age, sex, history of anxiety disorder, bipolar disorder, sleep disorder, schizophrenia and schizoaffective disorders, and smoking status at the time of beginning antidepressant treatment.
Bupropion was the only medication associated with a significantly different estimate of weight loss at 2 years when compared with fluoxetine, and this finding was seen only in nonsmokers.
After adjustment for confounders, nonsmokers who began treatment with bupropion lost, on average, 7.1 pounds compared with nonsmokers who used fluoxetine (P < .01).
The results were different in those who smoked, however. Smokers who used bupropion gained, on average, 2.1 pounds compared with smokers who used fluoxetine, although this difference was not significant (P = .33).
Those who used mirtazapine gained, on average, an estimated 11.6 pounds compared with those who used fluoxetine (P = .12). This difference was not statistically significant, probably because of the small number of patients who began mirtazapine.
And with the exception of sertraline, the remaining antidepressant-drug weight-change estimates did not differ significantly from fluoxetine. Those who used sertraline gained, on average, 5.9 pounds compared with those who used fluoxetine (P = .02).
Choose Bupropion for Nonsmokers With Obesity and No Contraindications
“Obesity and depression…commonly occur together, and adults with both conditions may have even greater health risks. The causal pathway is probably bidirectional — obese adults are at greater risk of depression and vice versa,” the authors write.
But bupropion is not appropriate for all patients, including those with a history of seizure disorder, they note.
“In conclusion, we find that bupropion is the only antidepressant associated with long-term weight loss (although this effect is limited to nonsmokers).”
“Given similar efficacy for improvement in depressive symptoms across bupropion and other second-generation antidepressants, bupropion may be considered the first-line drug of choice for overweight and obese patients unless there are other existing contraindications,” they surmise.
Coauthor Gregory Simon, MD, Group Health, Group Health Research Institute, and University of Washington School of Medicine, Seattle, agrees, commenting in the news release: “A large body of evidence indicates no difference in how effectively the newer antidepressants improve people’s moods.”
“So it makes sense for doctors and patients to choose antidepressants on the basis of their side effects, costs, and patients’ preferences — and, now, on whether patients are overweight or obese,” Dr Simon concluded.
The authors have disclosed no relevant financial relationships.
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J Clin Med. Published online April 13, 206. Article
How can antidepressants affect weight gain?
The following antidepressant medications may be more likely to lead to weight gain:
Tricyclic antidepressants (TCAs)
Share on PinterestWeight gain is be a potential side effect of some types of antidepressants.
Also known as cyclic antidepressants, TCAs are some of the earliest forms of antidepressant medications.
They are not as commonly prescribed as more modern forms of antidepressants, as they can cause more side effects, including weight gain. Older research suggests that excessive weight gain caused many users to quit TCA treatment.
However, cyclic antidepressants can be effective, especially for some people who do not respond to other treatments.
Examples of TCAs are:
Monoamine oxidase inhibitors (MAOIs)
MAOIs are another early class of antidepressants and have generally been replaced by newer antidepressant drugs. Although effective, they tend to cause weight gain and several other adverse reactions.
In addition, people who take MAOIs may need to restrict their diets, as these drugs can cause elevated blood pressure levels when taken with some foods and medications.
However, MAOIs help relieve depression in some people who do not see improvements with other drugs.
Types of MAOIs that may lead to weight gain include:
- isocarboxazid (Marplan)
- phenelzine (Nardil)
- tranylcypromine (Parnate)
One type of MAOI called selegiline (Emsam), a topical treatment that is applied to the skin as a patch, has been associated with weight loss in some users.
Selective serotonin reuptake inhibitors (SSRIs)
The most commonly prescribed form of antidepressant medication, selective serotonin reuptake inhibitors (SSRIs) have been associated with weight loss in short-term use, but may cause weight gain when used long term.
Commonly used SSRIs include:
- citalopram (Celexa)
- fluoxetine (Prozac)
- paroxetine (Brisdelle, Paxil, Pexeva)
- sertraline (Zoloft)
However, weight gain associated with SSRIs depends on the length of time they are taken, as well as the type. For example, paroxetine is the most likely to lead to weight gain, while sertraline is least likely.
According to a 2017 study, SSRIs were associated with weight gain when users engaged in “unhealthy behaviours,” such as eating a standard Western diet, lack of exercise, and tobacco use.
One type of atypical antidepressant called mirtazapine (Remeron) has been linked to both increased appetite and weight gain. It is less likely, however, than TCAs to cause weight gain.
How can I lose weight while on antidepressants?
I am exercising and eating well and still can’t seem to shed the pounds. I am on antidepressants. What can I do?
Losing weight is often a struggle, especially when a person is also living with a mood disorder. The causes are multiple. Increased appetite and carbohydrate craving, along with reduced activity level, are common symptoms of depression. And yes, certain antidepressants and other medications may increase appetite. However, most medications do not alter metabolism, per se. Thus, weight loss can still occur when attention is given to other factors, including the composition and timing of dietary intake.
Eating more frequently and smaller amounts, increasing the relative amount of protein eaten (people generally feel more “full” when eating high protein content foods), reducing breads and starches, eating a healthful breakfast, and avoiding large meals or snacks late in the evening can provide a more balanced diet throughout the entire day.
If one believes their current efforts to lose weight should be more productive, a consultation with a nutritionist may be helpful. If that isn’t possible, keeping a written log of one’s consumption may provide clues to problem areas and reinforce better dietary habits. In particular, check out the nutritional content of commonly eaten foods and foods believed to be “healthy”.
Several readily available websites and phone apps list nutritional information for prepared and restaurant food items, and provide logs for recording consumption. We are often unaware of the hidden calories in many foods we eat. Even so-called “low fat” or “no fat” foods may be loaded with empty carbohydrates. Soft drinks, sport drinks, energy bars, restaurant salads and salad dressings may contain excessive amounts of sugar. Alcoholic beverages such as wine and beer are also loaded with carbohydrates and are a source of excessive calorie intake for some individuals.
Another critical ingredient for weight loss is exercise. Increasing both aerobic exercise and strength training, ideally four times a week for a minimum of 30 to 45 minutes, can increase muscle tone and metabolism and reduce fat stores. Regular exercise has also been shown to reduce risk for depression relapse when combined with a stable medication regimen. If one is already exercising regularly, changing up your routine and challenging your body in novel ways with repeated bursts of exertion can make your work-outs more efficient.
Chronic, low-grade sleep deprivation is another contributor to obesity. Skipping sleep leads to persistently elevated levels of the body’s stress hormone, which can cause elevated blood sugar levels and increased fat stores. Staying up late may also make one more prone to late night snacking.
Lastly, a person carefully tending to all the above yet still gaining weight should consult their physician. Certain medical conditions such as thyroid abnormalities can cause weight gain as well as complicate depression.
How to Avoid Weight Gain When Taking Antidepressant Medication
In all, 4094 patients, or about 1 in 4 of those in the study, were taking at least one psychiatric medication. Most were taking an antidepressant, although about 11% took both. The aim of the study was to compare weight loss for those taking the medications and those not taking them. Data was collected from 2008 to 2017.2
The men and women were, on average, in their late 40s or early 50s. Their average body mass index or BMI was about 39 or 40.2 The program stresses effective, personalized lifestyle changes, Dr. Wharton says. Patients answered questions about family medical history, weight management history, and other health information. Then, a trained weight management educator gave suggestions regarding eating and physical activity to help avoid weight gain.2
In general, participants were taught to cut out 500 calories a day from their usual intake, and they returned to the clinic for ongoing dietary guidance every 3-4 weeks.2
Over the average of 16 months of clinic attendance, on average, patients lost about 7.5 pounds, or 2.9% of their body weight. That translated to 27.6% of patients losing 5% or more of their baseline weight and 10.1% losing twice that amount or more.2
You may be saying….a 2.9% weight loss is not such a big deal…but according to Dr. Wharton, these results correlate with those of other weight loss interventions and, this number indicates an average, meaning some lost more, some lost less.
More importantly, Dr. Wharton tells EndocrineWeb, contrary to past beliefs, the findings from this study suggest that weight gain is not inevitable when taking psychiatric medications. Also, weight loss is achieved in direct contrast to the expectation that everyone would gain weight when taking an antidepressant or antipsychotic medication.2
Men who were taking antidepressants lost slightly less than people in the other groups, but it wasn’t a big difference,2 says Ms. Christensen. While the researchers can’t explain the reason for this finding, they believe it could be that the other patients were feeling better mentally so they were a bit more successful with their weight loss goal but this would require further testing to gain a clear answer.
Weight Gain—Causes Added Worry with Psych Meds
You are not alone in gaining benefit from psychiatric medication—and you aren’t the only one who stresses about the weight gain linked with many of the drugs. As such, this challenge inspired Ms. Christensen to test for a solution that would address this vexing problem. She tells EndocrineWeb that concern about weight gain is both a real and almost universal experience among the patients in her clinic that are prescribed psychiatric medications.2
“The fear of weight gain is sometimes so powerful that people will stop taking their medication,” says Dr. Wharton who is the senior investigator of the study that shows that participating in an organized, medical weight loss programs work.
As if to confirm how common this conundrum is, Michael McGee, MD, chief medical officer at The Haven at Pismo, an addiction treatment center near San Luis Obispo in California, says that he frequently hears about the anxiety linked with medication-related weight gain.
“My patients fear and complain about weight gain, particularly the women, who often do gain weight, but it is not a given,” he tells EndocrineWeb. With years of practice, Dr. McGee has seen many patients who have experienced weight gain, increasing about five to 10% of their starting weight. That means, for example, a 150-pound woman would be facing up to a 15-pound gain in body weight.
Balancing Mental and Physical Health is Often Complicated
Even when not taking a psychiatric medication, some people with mental health disorders may already be battling overweight or obesity, says Dr. Wharton and his colleagues. Research has shown that those with mental health disorders seem to have up to 1.5 times greater odds of having obesity. 2,3
In addition, the weight gain linked with antidepressant and antipsychotic drugs has been well recognized, although the experience varies and is not the same for everyone.4-7
So how much weight gain are we talking about? In another recent study,7 researchers looked at the weight status of 362 patients taking an antidepressant medication for six to 36 months. More than half of them gained weight, with 40% of individuals gaining at least 7% of their starting weight. The only drug of the eight psych medications evaluated in the study not linked with weight gain was fluoxetine (ie, Prozac). The study did not have funding from pharmaceutical companies.7
The links between weight gain and medications have been shown to differ by medication type, says J. Michael Gonzalez-Campoy, MD, PhD, FACE, medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology.
“In general, the use of antipsychotic medications are most often associated with weight gain,” Dr. Gonzalez-Campoy tells EndocrineWeb “In general, the use of antidepressants is associated with more modest weight gain—with the exception of fluoxetine and bupropion (Wellbutrin, others), which appear to be weight neutral.”
Steps to Avoid Weight Gain When Starting a Psych Medication
Asking for a referral to a qualified weight loss program in your area is a good idea, says Dr. McGee. What else?
- Focus on what (ie, choose a Mediterranean approach to eating) and how you eat (eg, seated at the table, with other people, chewing slowly and mindfully)
- Don’t eat for gratification, boredom, or self-soothing or overeat to punish yourself
- Discuss whether weight loss medicines, in addition to the structured weight loss program, may be appropriate, at least to start.
According to Dr. Gonzalez-Campoy, ”along with a prescription for antipsychotic medications and most antidepressants, a concomitant prescription for weight management should be provided .”
And for those on antipsychotics, you should be made aware of the health risks that come with significant weight gain such as the development or worsening of high blood sugar, high blood pressure, and high cholesterol, he says. These are medical issues that should be monitored as well, he says.
The bottom line—For anyone who is taking an antidepressant or antipsychotic medication: “Taking these medications is very important,” Ms. Christensen says. “Don’t be concerned about the potential weight gain because that can be mitigated .”
None of the healthcare practitioners had relevant financial conflicts with regard to this study.
Last updated on 09/19/2019 Continue Reading Dietary Supplements: What’s Best for Weight Loss, Diabetes, and Thyroid Disease View Sources
- Moore TJ, Mattison, DR. Adult Utilization of Psychiatric Drugs and Differences by Sex, Age, and Race. JAMA Intern Med. 2017: 177(2):274-275.
- Wharton S, Kuk JL, Petrova L, et al. Effectiveness of a Community-Based Weight Management Program for Patients Taking Antidepressants and/or Antipsychotics. Obesity. 2019; ahead of print. Available at: https://onlinelibrary.wiley.com/doi/10.1002/oby.22567. Accessed August 28, 2019.
- Simon GE, Von Korff M, Saunders K, et al. Association between obesity and psychiatric disorders in the US adult population. Archives of General Psychiatry 2006;63:824-830.
- Blumenthal SR, Castro VM, Clements CC, et al. An electronic health records study of long-term weight gain following antidepressant use. JAMA Psych. 2014;71:889-896.
- Domecq JJP, Prutsky G, Leppin A, et al. Drugs commonly associated with weight change: a systematic review and meta-analysis. J Clinical Endocrinol Metab. 2015;100:363-370.
- Bowden Calabrese JR, Ketter T, et al. Impact of lamotrigine and lithium on weight in obese and nonobese patients with bipolar I disorder. Am J Psych. 2006:163:1199-1201
- Uguz F, Sahingoz M, Gungor B, et al. Weight gain and associated factors in patients using newer antidepressant drugs. Gen Hosp Psychiatry. 2015; 37(1):46-48.
Ariel Winter Rich Fury/Getty
Ariel Winter opened up about two fraught topics at once on Wednesday: weight loss and mental health.
The 21-year-old Modern Family star answered questions from her fans on Instagram, and after getting tons of questions about her noticeable weight loss over the last year, she explained that it was the result of switching antidepressants.
“For years I had been on antidepressants that caused me to gain weight that I couldn’t lose no matter what I did,” she said. “It was always frustrating for me because I wanted to be able to get fit and feel like the work I was doing was paying off, but it never felt that way.”
Winter said that she had come to accept the additional weight because the antidepressants were solving her mental health issues, but she started feeling “eh” and decided to try out a new combination of medication.
“I started the process again and was able to find a great combination of medication that works for me,” she explained. “The change in medication instantly made me drop all of the weight I couldn’t lose before by just giving me back a metabolism. That was very unexpected.”
Winter’s experience is likely familiar for those on antidepressants. Weight gain can be a frustrating but common side effect of the drugs, explains Dr. Kevin Gilliland, a clinical psychologist and director of Innovation360, an outpatient resource center, and member of PEOPLE’s Health Squad.
“Some of the common side effects of antidepressants are weight gain, decreased sexual performance and dry mouth,” he says. “Those tend to be some of the most common ones. We don’t know for sure exactly why the weight gain occurs, but it definitely occurs and at a far greater rate than it did in the clinical trials when the drugs were first formulated. Some of it may be just the genetic response to the drugs.”
Gilliland says whether or not a person gains weight on an antidepressant completely depends on their body makeup.
“For some people it just continues to increase,” he says. “Some people gain a little bit of weight and then level off. But it varies by drugs and then it even varies individually because there’s just so much genetic difference.”
If someone is concerned about the weight gain, Gilliland first advises looking at their eating and exercise habits.
“First, make sure you’re eating healthy,” he says. “Make sure you’re eating mindfully. Make sure that you’re eating only when you’re hungry. That your physical activity is good. And you go, ‘Okay, then it’s probably associated with the medication, not with user error and not with what you’re doing and eating.’ ”
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If that’s the case, and the weight gain is from the antidepressants, some people decide to deal with the extra pounds in order to stick with medication that improves mental health, as Winter did for several years. But “when your side effects get to be as bad as your depressive symptoms,” it could be time to switch, Gilliland says.
“If you are having the side effect of weight gain and it’s really having an impact on your mood in a negative way, talk about it with your physician,” he says. Keep in mind, though, that it’s going to take trial and error to find a new combination, and there will be a period of about six weeks as the body transitions and adapts to the new drugs.
“There’s an art to medications,” he says. “Psychiatry tends to be one of the more challenging areas to get the right medication. We just don’t have the ability to run tests and pinpoint the right medication just yet. We’re close. So it really takes an art of, ‘I may combine this one and this one so that we don’t have a side effect that’s starting to be as bad as the depressing effect.’ “
In Winter’s case, the new antidepressants helped her “feel better mentally” while also eliminating that extra weight. And in sharing her experience with her nearly 4 million Instagram followers, she helped to normalize the discussion around mental health and medication.
“Antidepressants are one of the top ten medications that get prescribed,” Gilliland says, adding that around 41 million people have anxiety or depression. “When you look at the increasing rates of depression and anxiety, over the past five years it’s only gone up.”
“Antidepressant medications are a lot better than depression,” he adds. “And it’s when medications are used in combination with therapy, which she’s doing, that we see the best outcomes and benefits.”