What Is the Best Antidepressant for Weight Loss?

Wellbutrin or Prozac may be sensible options for avoiding weight gain

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Many people with depression have worked hard to treat their disease by attending therapy and taking their antidepressants, only to find that now the numbers on the scale are rapidly moving up and their clothes are not quite fitting like they used to. 

With that, you may feel better emotionally and mentally, but maybe you are discouraged by your physical appearance and/or health.

Antidepressants and Weight Gain

Weight gain while taking an antidepressant is a conundrum that can leave many people scratching their heads, even doctors.

If a person gains weight, it's sometimes unknown whether the weight gain is from a side effect of the antidepressant itself or from the fact that a person is feeling better, and he or she is eating more. 

For example, in melancholic depression, which is a subtype of major depressive disorder, a person experiences a loss of interest or pleasure in nearly all daily activities, intense hopelessness and guilt, and often significant weight loss. So, in this instance, weight gain with an effective antidepressant therapy would be expected and positive.

On the flip side, if a person has atypical depression (another subtype of major depressive disorder), weight gain is common. In this instance, with antidepressant treatment, further weight gain may indicate failed treatment or it could be medication-induced—a tricky, but extremely critical distinction.

To further complicate the picture, while many people associate antidepressant use with weight gain, there is actually limited scientific evidence to back this up.

In fact, research shows weight gain is mostly linked only to three antidepressants:

  • The selective serotonin reuptake inhibitor Paxil (paroxetine)
  • The tricyclic antidepressant Elavil (amytriptyline)
  • The atypical antidepressant Remeron (mirtazapine)

Weight gain associated with other antidepressants, if it does occur, is usually short-lived.

In addition, individual factors seem to play a role—in other words, it's hard to predict who will gain weight on certain antidepressants, as so may variables are at play.

Antidepressants and Weight Loss

You may be surprised to learn that there are two antidepressants linked to weight loss. Remember, a link implies a statistical association, so it does not predict individual results. These include:

  • The selective serotonin reuptake inhibitor Prozac (fluoxetine)
  • The atypical antidepressant Wellbutrin (Bupropion)

Prozac (fluoxetine) is a selective serotonin reuptake inhibitor, or SSRI, which means it increases the levels of serotonin in the brain. Selective serotonin reuptake inhibitors (SSRIS) are generally first-line treatment for depression.

Wellbutrin (bupropion) is an antidepressant that does not change serotonin levels in the brain. Rather, it uniquely alters other chemicals in the brain like noradrenaline and dopamine and is associated not only with weight loss, but also improved sexual functioning.

This all being said, Wellbutrin may not be appropriate for all people, especially those with a history of seizures or an eating disorder like anorexia or bulimia, which could put you at greater risk for having a seizure while using it.

Like all antidepressants, Wellbutrin and Prozac carry a black box warning regarding its potential for increased risk of suicidal thoughts and actions in children, teens, and young adults during the early stages of treatment.

Proceeding With an Antidepressant

Treating your depression is paramount to your mental health and well-being. Of course, though, your physical appearance and health is also important, and your doctor would not want weight gain to affect your adherence to your depression therapy.

Please have a candid discussion with your doctor about depression treatment, as there are a lot of options out there.

It's important to remember, too, that weight gain is not inevitable with antidepressant therapy, and if it does occur, it's usually transient.

A Word From Verywell

Treating your depression may take some patience and resilience on your part as you navigate and find the right plan, but it can be done. You can optimize both your physical and mental health—in fact, they often feed off one another. Be kind to yourself—you deserve it. 

Sources:

Hirsch M, Birnbaum RJ. Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects. In: UpToDate, Roy-Byrne PP (Ed), UpToDate, Waltham, MA. 

Patel K, Allen S, Hague MN, Anfelescu I, Baymeister D, Tracy DK. Bupropion: a systematic review and meta-analysis of effectiveness as an antidepressant. Ther Adv Psychopharmacol. 2016 Apr;6(2):99-144.

Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010 Oct;71(10):1259-72.

Viewweg WV. Psychotropic drug considerations in depressed patients with metabolic disturbances. Am J Med. 2008 Aug;121(8):647-55.

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