Anxiety and depression are very common psychiatric disorders. Antidepressants can benefit both of them and are typically the first medication prescribed.
All medications have side effects. One common side effects of antidepressants is weight gain. Sometimes, this results in patients stopping the medication. Also, weight gain carries some health risks.
Researchers wanted to know which of certain common first-line antidepressants are likely to cause greater weight gain. Patimer and colleagues published their results in the Annals of Internal Medicine on July 2, 2024.
They chose sertraline (Zoloft) as the antidepressant for comparison to the others they studied.
The likelihood of gaining weight within 6 months was the same as sertraline (Zoloft) for fluoxetine (Prozac).
However, weight gain was greater for citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil), duloxetine (Cymbalta), and venlafaxine (Effexor).
There was less weight gain for bupropion (Wellbutrin) than all of the others.
The likelihood over 2 years of gaining 5% or more weight greater than the weight before starting the medication compared to sertraline (Zoloft) was 10 to 15% more for escitalopram (Lexapro), paroxetine (Paxil), and duloxetine (Cymbalta). In contrast, bupropion (Wellbutrin) had a 15% lower risk.
In summary, sertraline and fluoxetine have the same level of risk for weight gain within the first 6 months. However, citalopram, escitalopram, paroxetine, duloxetine, and venlafaxine all had a higher risk of weight gain. Bupropion had the lowest risk.
The bottom line is that there are differences in the risk of weight gain within this group of medications commonly prescribed for anxiety and depression.
However, weight gain from these medications may not be due entirely to drug side effects. Anxious and depressed patients often lose their appetite and lose weight. When they take a medication that helps their mood disorder, their appetite returns to normal, so they regain weight.
Also, while weight gain is an important consideration in choosing an antidepressant, it is not the only factor that must be taken into account.
For example, has a particular antidepressant worked well and been tolerated in this patient in the past? If so, it is usually a good choice.
Another example would be certain contraindications, e.g., a history of seizures is a contraindication to bupropion.
Peter M. Hartmann, MD
Family Medicine & Psychiatry
