Evidence Based
Weight gain associated with antidepressant medications is a common concern[1] among patients. Because these medications may cause weight changes, there is also concern among healthcare providers that many individuals may avoid or stop using[2] an antidepressant medication altogether. This is a very important problem to address when considering the therapeutic needs of individuals navigating mental health diagnoses.
This has also prompted some prescribers to consider using medications like Ozempic to help counteract the weight gain[3] associated with antidepressant and antipsychotic use.
These issues raise the question, “Which antidepressants cause weight loss?” Alternatively, are there treatment options available for your needs that are less likely to cause weight gain? These are important questions to help promote a better experience with therapy.
Best Antidepressant For Weight Loss
Many antidepressants are associated with weight gain, but several options are more weight-neutral. Some may also be associated with a modest weight loss:
- Bupropion (Wellbutrin).
- Fluoxetine (Prozac).
- Duloxetine (Cymbalta).
- Nortriptyline.
- Amitriptyline.
There are differences between medications and the conditions for which they are most helpful. Your doctor can help you determine whether an alternative antidepressant will continue to maintain your therapeutic needs.
An Overview Of Antidepressants
The term antidepressants is applied to several classes of medications. In addition to being used for depression, many of these medications are also used for a variety of other health concerns. The primary classes of antidepressants are:
- Selective serotonin reuptake inhibitors or SSRIs like fluoxetine or paroxetine.
- Serotonin-norepinephrine reuptake inhibitors, or SNRIs like duloxetine or venlafaxine.
- Tricyclic antidepressants, or TCAs like amitriptyline or nortriptyline.
- Atypical antidepressants like bupropion or mirtazapine.
These medications help regulate levels of the neurotransmitters serotonin, norepinephrine, and dopamine. Over the years,[4] certain medications have become more popular than others because of some observed differences among classes and individual medications. Ultimately, the potential for side effects is weighed against how well the medication will likely work for an individual’s needs.
The potential for weight changes is a commonly monitored side effect. So, what are some of the antidepressant options, and can any of them cause weight loss? Consulting with your doctor can help you maintain your treatment needs while considering alternatives.
Which Antidepressants Cause Weight Loss
There are no antidepressants that are approved for weight loss. A few antidepressants may have the potential to be more weight-neutral or are associated with a small degree of weight loss. When prescription medications are evaluated for weight loss potential, a common goal for therapy is to reduce body weight by at least 5% from baseline.[5]
Because there are no antidepressants that reliably accomplish this, the approach is often to consider treatment options that minimize the potential for weight gain. It is important to remember that some medications, even within the same class, can be more reliably effective for specific mental health diagnoses. While weight management is important, the ultimate goal is to promote a sustainable improvement in overall well-being.
Several antidepressants have been associated with a higher chance of losing weight. Your doctor can help you determine whether these options suit your needs.
Bupropion (Wellbutrin)
Bupropion is a prescription medication that increases the levels of norepinephrine and dopamine in the brain. Like other atypical antidepressants, it works differently than many other antidepressants, focusing more exclusively on either serotonin, norepinephrine, or both.
Depression can manifest in several ways, but it does leave many individuals feeling drained. Many ask, “Are there any antidepressants that give you energy and weight loss?” Bupropion may be among the best options for these needs.
The most compelling evidence for weight loss potential among antidepressants has been associated with bupropion.[6] However, it should be noted that many trials suggest mixed results, including some that ultimately report a slight weight gain.
Interestingly, the follow-up time frame seems to be connected with weight outcomes. Many of the studies evaluating bupropion conducted follow-up after eight weeks. It has been demonstrated that some antidepressants exhibit initial weight loss followed by weight gain[7] when effects are re-evaluated after a longer time frame. As always, individual experiences may vary.
It is also worth noting that bupropion has been approved for weight loss, specifically when provided with naltrexone.[8] Naltrexone provides additional modulation of reward pathways and may help reduce food cravings. This combination product is sold under the brand name Contrave.
Bupropion is often used more specifically for the management of depression symptoms and to help individuals stop smoking. It should be used cautiously[9] if you have a history of:
- Manic episodes.
- Seizures.
- Reduced liver function.
If your doctor feels bupropion will be effective for your needs and safe to use, it may be the best antidepressant for addressing weight loss.
Fluoxetine (Prozac)
Fluoxetine is a member of the SSRI class or selective serotonin reuptake inhibitors. This medication has been used for a wide variety[10] of mental health diagnoses, including forms of anxiety and depression. In a review article[11] compiling data from 19 trials, an average weight loss of 2.7 kg was associated with fluoxetine use compared with placebo.
While generally well tolerated, some of the potential side effects are:
- Dizziness.
- Drowsiness.
- Fatigue.
- Insomnia.
- Nausea.
Some of these side effects may improve over time with consistent medication use. Because bupropion is not typically used for anxiety, some may consider fluoxetine to be the best anti-anxiety medication with its neutral or slight weight loss effects.
Duloxetine (Cymbalta)
Duloxetine is an SNRI[12] or serotonin-norepinephrine reuptake inhibitor. While traditionally used for anxiety and depression, it has also become commonly used for nerve pain and fibromyalgia. While it does appear to support weight loss early in therapy, it may have the potential to contribute to weight gain[7] over a longer time frame.
Duloxetine is generally well tolerated but has been associated with higher rates of some side effects:
- Nausea.
- Dry mouth.
- Constipation.
- Excessive sweating.
Nortriptyline
Nortriptyline is a tricyclic antidepressant. These medications are not used as commonly as contemporary antidepressant drugs like SSRIs or SNRIs for the management of anxiety and depression due to a relatively higher rate of side effects. The most common concern is a higher incidence of dry mouth, drowsiness, and the potential for falls, making them a less attractive option for individuals over 65.
Nortriptyline has shown a relatively low risk of weight gain[13] compared with other antidepressants.
Amitriptyline
Amitriptyline is actually converted to nortriptyline in your body. Because these medications can be used for various purposes beyond supporting mood and have been studied in multiple capacities, your doctor may provide a specific rationale for choosing one over the other. For instance, amitriptyline may be used when sedation[14] is a desired effect.
Similar to other antidepressants, there are some questions related to the quality of evidence related to weight management. Many studies focus on relatively short treatment windows, and these results can change when therapy is continued for longer periods of time. In a study evaluating electronic health records[13] evaluating continuous therapy for 12 months, amitriptyline was associated with a low risk of weight gain.
Can Antidepressants Cause Weight Loss?
There is a lot of potential for variability of individual responses. When studies evaluate the effects of taking antidepressants on weight, there are often numerous studies that indicate weight gain, no effect on weight, or weight loss for individual medications. This is the case even for antidepressants that are generally considered to be more likely to have beneficial effects on weight, like bupropion.
Because of this, antidepressants are often evaluated based on their likelihood of remaining weight-neutral rather than causing weight gain. Using an antidepressant specifically to lose weight would be an unreliable method.
How To Lose Weight While Taking Antidepressants
The best way to avoid weight gain or make progress toward weight loss goals is to incorporate positive lifestyle habits related to diet and exercise. There are a variety of helpful techniques that can help you avoid weight-related side effects.
- Creating a caloric deficit: Burning more calories than you consume will help you shed excess weight. Working with a registered dietitian can help you maintain an appropriate balance of nutrients, avoiding any deficits caused by dietary restrictions. Some helpful strategies include replacing soda with nutrient-infused water or enjoying a healthy smoothie rather than a sugary dessert.
- Cardiovascular training exercises: Running, cycling, and swimming are all great ways to keep your heart healthy and burn more calories. It is also important to ensure you are staying hydrated.
- Stay focused on managing your mental health: Taking steps to prioritize your mental health is central to your overall well-being. It can be difficult to make healthy choices when stressed. Anxiety and depression[15] are also associated with long-term weight gain.
- Over-the-counter vitamins and supplements: There are many options for additional support, but not all options may be safe or helpful for every individual. Consulting your doctor will help you determine whether an over-the-counter supplement may benefit your needs.
It can be tempting to focus on losing weight as quickly as possible, but it is important to maintain balance and set realistic expectations. Losing weight in a healthy, sustainable way can take time, which is okay. Targeting weight loss of about one to two pounds each week will help you avoid any potential imbalances.
Why Do Antidepressants Affect Weight?
It has been difficult to pin down an exact cause of either weight gain or loss associated with antidepressants partially because of the variable response. Diet, our body’s responses to stress, and mental health are intertwined.[16] Imbalances in serotonin, a primary target for antidepressant medications, have been associated with changes in eating behaviors and weight.
Anxiety and depression themselves have also been associated with weight changes.[15] In some instances, individuals report an improved appetite as depression symptoms improve, which can further complicate the picture.
Your individual experiences with mental health may be just as likely to impact your weight as the medications you use to treat it. Taking steps to manage your mental health can help you achieve balance in the long term.
Are Antidepressants Ever Prescribed For Weight Loss?
Antidepressants are not prescribed for weight loss. Medications like bupropion or fluoxetine can be beneficial options for individuals considered overweight. This is because they are less likely to cause weight gain than some alternatives, not because they are likely to provide clinically meaningful weight loss.
Conclusion
Starting medications to improve your mood and gaining weight from them can be a very frustrating experience. This can cause many individuals to give up on taking the medication completely. Managing mental health conditions can be a complex process, but there are options available that may be more likely to provide a positive experience.
Antidepressants are not prescribed specifically to help with weight loss. Some antidepressants may be less likely to cause weight gain, however. In some instances, they have also been associated with modest weight loss.
Ultimately, addressing your mental health and taking steps toward establishing a healthy balance will help you stay on track for the long term.
Frequently Asked Questions
Sertraline,[7] the active ingredient in Zoloft, is more likely to be weight-neutral or associated with slight weight loss compared with other antidepressants. Individual experiences tend to vary.
Many antidepressants are also used to treat anxiety. Among these, fluoxetine[10] may be considered an option most likely to be weight-neutral. Many anxiety medications can slow down your metabolism, which may make losing weight more difficult.
Mirtazapine can stimulate your appetite,[17] which may make it more difficult to lose weight while using the medication. Losing weight while using mirtazapine would likely rely more on creating a caloric deficit.
Mirtazapine is sometimes prescribed specifically as an appetite stimulant.[17] This medication can be helpful for patients who are losing weight unintentionally.
Many studies[6] evaluated changes in weight after using Wellbutrin for eight weeks. These studies suggest a modest weight loss during this time frame.
