These Antidepressants Are More Likely to Cause Weight Gain

Summary:  Antidepressant use is more likely to cause weight gain. However, some antidepressants, like bupropion, may rather promote weight loss. Further, one of the latest studies shows that in the short run, escitalopram, paroxetine, and duloxetine are more likely to cause weight gain. However, the risk of weight gain associated with antidepressant use is less common in those who adhere to the therapy for a long. Thus, this weight gain risk is greater at six months but is much less on consistent antidepressant use for one to two years or more.

Obesity and depression are the two most common health issues in the US. About 70% of adults are overweight or obese in the US, and 10-15% are living with major depression/severe depression requiring regular medical treatment.

But that is not all, as both conditions are not mutually exclusive. Obesity increases depression risk, and depression increases obesity risk. Even worse, many medications used to treat depression can cause significant weight gain. 

However,  not taking the medications is also not an option. Moreover, those living with depression do not stick to medical treatment well. So, the only way out of the issue is that doctors prescribe antidepressants that are less likely to cause weight gain. Further, patient awareness is also important.

Not all antidepressants cause obesity. Some do not cause much weight gain, while other commonly used antidepressants are more likely to cause weight gain.

This new study was published in the Annals of Internal Medicine. It examined the data of 183,118 patients who were prescribed antidepressants. The study found that bupropion (brand name Wellbutrin) was least likely to cause weight gain, whereas significant weight gain was seen in those taking escitalopram (Lexapro, Cipralex), paroxetine (Paxil, Seroxat), and duloxetine (Cymbalta).

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The study found that the drugs escitalopram, paroxetine, and duloxetine increased the risk of weight gain by 10-15%. This is not a massive risk, but it is still a considerable one. Moreover, this increase in risk is seen just after 6-months of antidepressant use.

It is quite likely that the risk may be much higher on prolonged use of antidepressants. However, researchers did not analyze the long-term data for some reasons. They found that after six months, adherence to antidepressants declined significantly. In fact, even at six months, just one-third of patients adhered to the treatment. However, this adherence rate declined to 4-5% at 2 years.

However, the study had other interesting findings, such as bupropion, which reduced the weight gain risk by about 15%. These findings are encouraging, showing that this drug may be a good choice for some patients. 

Further, there were some other encouraging findings that it appears that in the long run, patients get used to antidepressants. Thus, those who regularly used escitalopram for 2 years did not show much weight gain. Further, weight gain associated with the use of duloxetine and venlafaxine also declined after two years.

This means that those living with depression must also stick to their treatment. Some drugs are more likely to cause weight gain during the initial few months. However, they are less likely to cause weight gain in the long run.

There could be many explanations for this phenomenon. Firstly, patients need time to get used to the drugs. Secondly, and perhaps more importantly, antidepressants need time to start working. In the long run, antidepressants may not cause much weight gain, as they help keep depression under control.

So, this study shows that with the exception of a few drugs like bupropion, most antidepressants may cause some weight gain. However, this risk is generally seen with the short-term use of these drugs. However, on prolonged use, very few antidepressants cause any significant weight gain. 

These findings highlight the importance of not only choosing the right kind of drugs for depression management but it also shows the importance of ensuring treatment adherence. Regretfully,  data also shows that adherence to antidepressants is really low, especially after six months.

Source:

Petimar, J., Young, J. G., Yu, H., Rifas-Shiman, S. L., Daley, M. F., Heerman, W. J., Janicke, D. M., Jones, W. S., Lewis, K. H., Lin, P.-I. D., Prentice, C., Merriman, J. W., Toh, S., & Block, J. P. (2024). Medication-Induced Weight Change Across Common Antidepressant Treatments. Annals of Internal Medicine. https://doi.org/10.7326/M23-2742