June 6, 2014
News Review From Harvard Medical School -- Study: Weight Gain with Antidepressants Small
Although some pills for depression can spur weight gain, a new study finds that the long-term amount gained is small. Most prior studies have lasted only a few months. The new study was based on electronic records for more than 19,000 adults with depression. They had been treated with at least 1 of 11 different antidepressants. After 12 months, they had gained an average of 1 to 2 pounds. Weight gain was smallest for those who took bupropion (Wellbutrin and generics), amitriptyline and nortriptyline. But differences between average weight gains for different drugs were small. The journal JAMA Psychiatry published the study. HealthDay News wrote about it June 5.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
The treatment of depression has improved a great deal in the last couple of decades. Many medicines are now available. That's the good news. However, only one-half of adults treated for depression show some response to the first antidepressant prescribed. Only one-third get satisfactory relief from their symptoms with the first drug.
There is also the problem of side effects. Even when a drug is working, side effects may limit a person's desire to stay on it. One of those unwanted side effects is weight gain.
Prior studies have looked at short-term weight changes related to antidepressant drugs. Most people gain some weight after starting any of the antidepressants. But the amount of weight gain varies a great deal. Some people even lose weight.
These researchers looked at longer-term weight gain from antidepressants. They compared weight changes of 11 different drugs over 12 months. The study included more than 19,000 adults who were prescribed an antidepressant. On average, they found that long-term weight gain was small.
The researchers chose citalopram as the reference drug. Prior studies suggested that citalopram (Celexa and generics) caused a roughly similar amount of weight gain as other antidepressants, on average. And the median weight gain in this study for people taking citalopram was about one to two pounds.
The researchers compared the average amount of weight gain in people taking the other 10 drugs vs. people prescribed citalopram. The differences were small. People taking bupropion (Wellbutrin and generics) had the least amount of weight gain, close to none. Two others that appeared to have less weight gain were amitriptyline and nortriptyline.
Amitriptyline and nortriptyline are older drugs. Because so many newer drugs have fewer side effects, they are prescribed much less often. In addition, most studies other than this one suggest that weight gain is a common side effect of amitriptyline. Actually, doctors sometimes prescribe a low dose to stimulate an appetite for underweight people.
What Changes Can I Make Now?
Based on results of this study, concern about weight gain should not influence the choice of antidepressant for most people. However, a small number of people have a condition called atypical major depression. Instead of the more usual problems of decreased appetite and difficulty sleeping, their depression causes an increased appetite and sleeping too much. This leads to weight gain even without drug treatment. If possible, they should avoid adding a drug that causes even more weight gain.
Antidepressants generally have similar effectiveness. So choosing which one to try first is determined mainly by cost and potential side effects.
Many of these drugs are available as generics. Therefore, they are lower in cost. The generics work as well as the brand names.
Here are some tips for choosing a treatment based on common side effects:
- Sexual side effects, such as difficulty having an orgasm. Bupropion may be less likely to cause this side effect. It's also linked with the least amount of weight gain.
- Insomnia. Consider an antidepressant that makes you sleepy and take it before bed. Trazodone is the most sedating. Paroxetine might also be a good choice, but it has a slightly higher risk of weight gain.
- Decreased energy level. None of these drugs is clearly more stimulating. Perhaps bupropion or fluoxetine could be the first choice.
If you start taking an antidepressant, don't expect major improvement right away. It often takes 6 to 8 weeks to see a response. And don't give up if the first one doesn't work. If the first choice does not relieve symptoms, you can switch or add a second drug.
Another option to consider is psychotherapy, especially if the first drug doesn't work. People who do not respond to the first antidepressant can often do as well with talk therapy as they would with another drug.
What Can I Expect Looking to the Future?
It's reassuring that on average there is minimal weight gain from antidepressants. However, some people may start to gain a lot of weight when they take an antidepressant. For those people, it will be a very good reason to consider a change in therapy.