If you’ve ever taken medication to treat certain mental health conditions including depression, anxiety, or OCD (or been prescribed a medication to help with menopause symptoms), you know that it’s a trial-and-error process, and every drug tends to have its own set of often frustrating side effects. While a common side effect for antidepressants is weight gain, a new study proves some drugs are more likely to result in weight changes than others. Published this month in the Annals of Internal Medicine, the study found that people taking certain drugs such as Lexapro, Paxil, Cymbalta, and Effexor XR, saw a 10% to 15% higher risk for gaining at least 5% more of their original weight than those taking Zoloft, for example. Interestingly, those taking the drug Wellbutrin were less likely to gain weight altogether.
“Antidepressants can affect metabolism, appetite, and energy levels, which can lead to weight changes,” Dr. Alison Tarlow, a Licensed Clinical Psychologist and Certified Addictions Professional (CAP) at Boca Recovery Center, tells Flow Space. “They may alter how your body processes and stores fat and influence hormones that regulate hunger and satiety.”
What types of antidepressants are more likely to cause weight gain?
While there are a number of antidepressants currently on the market, they all belong to different classes. Those classes consist of SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors), TCAs (tricyclic antidepressants), MAOIs (monoamine oxidase inhibitors), and NDRI’s (norepinephrine and dopamine reuptake inhibitors).
According to Harvard Medical School, the reason why some antidepressants might cause weight gain could be linked to serotonin levels in the brain. Serotonin is a hormone that regulates mood and affects appetite, and every class of these medications increase serotonin levels. NDRI’s, however, like Wellbutrin, are antidepressant medications that have a much lower risk for weight gain, per research. That’s likely because they contain a slightly stimulant effect, which may not only decrease appetite, but can also assist with symptoms of lethargy that often accompany depressed mood.
It’s important to understand that the amount of time that someone is on these medications also plays a role in whether or not they gain weight. While short-term use of SSRIs, SNRIs, TCAs, and MAOIs reduces impulsivity and increases satiety, long-term use (longer than a year) can cause down regulation of serotonin receptors. This could provoke cravings for fatty foods such as bread, pasta, and sweets that ultimately may lead to weight gain. However, taking antidepressant medication in and of itself is not going to cause weight gain without the accompanying behavior of increased eating, Dr. Tarlow explains.
“While it is possible that an antidepressant medication may increase one’s appetite, this can be combated by maintaining a healthy diet and incorporating regular exercise,” Dr. Tarlow says. “Generally, if weight gain does occur, it will typically be somewhere in the range of 5 to 10 pounds, on average.”
The overprescribing of SSRIs for menopause
Every year, 2.2 million women in the United States enter menopause. Yet, 80% of physicians don’t feel adequately equipped to treat menopause, according to data collected by the menopause telehealth company Evernow. This may help to explain why, despite menopause guidelines that state antidepressants shouldn’t be the first option for addressing the low mood linked with perimenopause and menopause, multiple surveys have shown that menopausal women are on these medications at a significantly higher level than men are.
In fact, a 2022 study from Sweden showed that men report depression more often than women but are prescribed antidepressants to a lesser extent. The study also revealed that women were prescribed antidepressants without reporting depression more often than men, which is possibly a sign of over-treatment; this also may be contributing to a change in weight for some people. In sum, it is important to note that there are a wide variety of antidepressant medications available, and what works for one person may not work for another.
Dr. Tarlow explains that a lot about the antidepressant’s effects will depend on someone’s brain chemistry and how their body reacts to the drug. This includes the experience of side effects. If someone is experiencing side effects that are uncomfortable or bothersome, Dr. Tarlow advises those individuals to speak with their doctor.
“Your doctor can switch you to a different antidepressant if you’re experiencing side effects,” Dr. Tarlow says. “There are many options available, and your doctor will work with you to find a medication that helps with your symptoms while minimizing side effects. They may gradually reduce your current medication while slowly introducing a new one to minimize withdrawal symptoms and adverse effects.”