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Exploring the Limited Impact of Antidepressants on Weight Gain

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Antidepressants have proved to be a lifeline for millions of individuals, paving the way for clarity amidst the suffocating darkness of depression. However, concerns about potential side effects, such as weight gain, often lead some individuals to discontinue their medication. In an effort to shed light on this matter, researchers from Massachusetts General Hospital's Center for Experimental Drugs and Diagnostics conducted an extensive study involving over 19,000 men and women to explore the correlation between antidepressant use and weight gain.

Unraveling the Complexities:

Past studies that connected antidepressant usage to weight gain were generally limited in scope and duration. In stark contrast, this study encompassed individuals who had taken an antidepressant for at least three months, presenting a more comprehensive assessment. The researchers meticulously analyzed electronic health records and identified various commonly prescribed antidepressants, such as amitriptyline (Elavil), bupropion (Wellbutrin), citalopram (Celexa), duloxetine (Cymbalta), escitalopram (Lexapro), fluoxetine (Prozac), mirtazapine (Remeron), nortriptyline (Pamelor), paroxetine (Paxil), venlafaxine (Effexor), and sertraline (Zoloft). To create a comparative baseline, they also included a control group of 3,400 individuals using alternative non-depression medications. Each participant's weight was meticulously tracked every three months for a year.

The Impact of Different Antidepressants:

Within the study, citalopram was chosen as a reference due to previous indications that it exhibited an "average" propensity for weight gain. Findings indicated that individuals taking citalopram experienced an average weight gain of one to two pounds. In comparison, the weight gain associated with other antidepressants was relatively minimal. Notably, bupropion demonstrated an association with the least weight gain, with negligible effects. Additionally, amitriptyline and nortriptyline, two older antidepressants, appeared to have relatively lower weight gain rates. It's worth mentioning that newer drugs are often favored as they tend to have fewer side effects, resulting in a reduced prescription rate for amitriptyline and nortriptyline. Conversely, citalopram exhibited the highest weight gain among the evaluated antidepressants. However, it is important to note that the overall differences in weight gain between the drugs were insignificant. The findings of this groundbreaking study were published in JAMA Psychiatry.

Individual Variances:

While weight gain was observed in some individuals taking antidepressants, it is crucial to recognize that not everyone experienced this side effect. In fact, some individuals actually lost a few pounds while on medication.

Tips for Choosing an Antidepressant

Based on the results of this enlightening study, concerns about weight gain should not significantly impact the choice of antidepressant for the majority of individuals. The overall effectiveness of each antidepressant tends to be relatively similar. Instead, factors such as cost and potential side effects should guide the selection process.

Considering Common Side Effects:

1. Sexual side effects, such as difficulty having an orgasm, may be less likely with bupropion. Furthermore, bupropion showed minimal weight gain association, making it a compelling option.

2. Sleepiness can be a side effect of certain antidepressants. If you struggle with falling asleep or staying asleep, it may be advisable to take medications like trazodone or paroxetine before bed.

3. Decreased energy levels can be mitigated by antidepressants that provide a stimulating effect. Bupropion or fluoxetine might be the ideal initial choices in such cases.

It is essential to remember that the effects of antidepressant medication may not be immediately evident. It often takes around 6 to 8 weeks to observe a response. Moreover, if the first antidepressant prescribed does not yield the desired results, it is crucial not to lose hope. Trying an alternative medication or considering psychotherapy can lead to a significant breakthrough in treatment outcomes.

Lastly, it is worth noting that a small number of individuals may experience atypical major depression, which differs from the more common symptoms such as decreased appetite and difficulty sleeping. Instead, individuals with atypical depression may encounter an increased appetite and excessive sleep, resulting in weight gain irrespective of the prescribed drug. For such cases, it is advisable to steer clear of antidepressants that may exacerbate weight gain further.

William H. McDaniel, MD

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School.

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