Mental Health

I need a new wardrobe with my medication

Aside from sexual dysfunction, weight gain is another side effect that becomes problematic for patients who need long-term antidepressant therapy. Many patients stop antidepressant therapy on their own, without notifying the physician (”noncompliance”) due to undesirable side effects that further impact their self image or normal daily functioning.

Most Psychotropics Cause Weight Gain

The effects of antidepressant therapy on weight, particularly those within the SSRI (selective serotonin reuptake inhibitors, such as fluoxetine, sertraline, paroxetine, or citalopram) class, have been often debated. Often, early during treatment, SSRI’s have been associated with weight loss due to increased agitation in some patients. However, in the long run, the patient may gain weight due to mechanisms that are still not well understood. Atypical antidepressants such as nefazodone (brand name Serzone) and bupropion (brand name Wellbutrin) are not associated with weight gain, although bupropion appeared to be linked with weight loss. The atypical antidepressant mirtazapine (brand name Remeron) is associated with significant weight gain, which may be an advantage for elderly patients who are often dangerously underweight.

Weight gain may also be a “natural” part of recovering from depression. If a patient loses appetite due to depression and stops eating, recovery will include a desire to eat and therefore regaining of lost weight. Some antidepressants may change appetites or metabolism, and these mechanisms warrant further study.

Many have complained of cravings certain foods (such as carbohydrates) while on antidepressant therapy or mood stabilizers. While patients may not stop therapy due to weight gain, clinicians are beginning to realize that weight gain is not simply a cosmetic issue. Patients who gain a large amount of weight may be less likely to keep complying with therapy (keep taking medication as directed) and their self image will not improve. Recently, weight gain associated with medication therapy had taken on a more insidious nature - accompanied by increased risk for heart disease or diabetes.

Although new drugs in the pipeline for treating depression and mood disorders may have improved side effect profiles and minimize weight gain, for the time being, physicians do not have a many options for treating weight gain cause by medication therapy, other than changing medications or stopping the medication therapy.

Psychological v. Physiological Craving

With my own treatment-induced weight gain experience, my cravings weren’t due to hunger. I would often be full, and still crave sweets. Gorging on sweets was comforting. It was easy to lose control with a gallon of ice cream or a whole pizza pie. I saw this as a psychological side effect rather than being hungry. Since people react to medications differently, what made me gain weight may easily make someone else lose too much weight. Therefore, even testing medications that will help your symptoms improve without too many side effects remains an individual trial and error.

I have been free of antidepressant therapy for many years. I was able to take off most of the extra weight through good old fashioned “eating smaller portions” and exercise. I still have carbohydrate cravings - these seemed to not go away. However, a high protein, low carbohydrate diet seemed to help take the edge off the cravings.

In addition, I also get adequate sleep. Studies have shown that lacking sleep can actually contribute to weight gain and obesity, plus other health problems associated with sleep deprivation.

Drinking water and keeping yourself hydrated throughout the day is a simple yet important way to keep your body working properly.

Incorporating weight- or resistance training with regular aerobic exercise is an excellent method to increase metabolism. Muscles require energy and you are able to burn fat even while not aerobically exercising. For women, please do not worry about “buffing up” too much. Unless you were genetically programmed for bulk, regular weight training will tone muscle, not build bulk.

Finally, when the cravings are clearly psychological - when you’re bored, when you’re stressed - keep a list of things to do to distract you from your cravings, or simply remove yourself with a walk down the block or in the park.

I know these aren’t clear-cut solutions, especially if you are still on an antidepressant for managing your depression. Trying many different methods - especially non-medication methods - can maximize your chances of controlling treatment-related weight gain.

© 2008 by Jane Chin, Ph.D. (email) All Rights Reserved.
Abstract logo images by Asif Akbar