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Antidepressant Medications

The prescription drugs listed below are used for many problems other than depression, including:  insomnia, obsessive-compulsive disorder, fibromyalgia, and anxiety.  It is important to understand why you have been prescribed these medications and to be assertive with your caregivers if you feel you are having complications that outweigh the benefits of using them.  There may be another medication that offers more benefits with fewer side effects--before completely stopping the medication, ask about other possibilities.

The comments in the third column are a work in progress.  The information included is by no means all-inclusive, but it does provide an idea of what kind of interactions with food and weight have been scientifically observed and recorded in the National Library of Medicine PubMed database.  All references are included below the chart.

We limited studies reported to double-blind designs, which means that neither the subjects nor the researchers knew during the study who was receiving the real drug and who was receiving the placebo.  This is a research design that helps to reduce bias in reporting results.  Weight gain after starting a medication regime is typically one of two kinds:  (1) regain of weight that was lost due to anxiety/depression (this may actually be a positive sign of restored health) and (2) weight gained over and above any weight change experienced before the onset of anxiety/depression (this may be a sign of a negative medication side effect).  Simply reporting that weight gain occurs with the use of a medication is not enough.  A double-blind design is needed to more accurately evaluate which kind of weight gain a particular medication is prone to cause, and whether or not this is cause for concern.

Need more information?  

1.  Our Nutritional Implications of Psychotropic Medications CD summarizes the neurophysiological, hormonal (with emphasis on diabetic/PCOS potential), and nutritional (weight/appetite) aspects of 58 psychotropic medications in the antidepressant, anxiolytic, mood stabilizing, antiepileptic,  antipsychotic, anti-Parkinson's, Alzheimer's, and psychostimulant categories. 

--Which psychiatric medications interfere with fertility

--Which psychiatric medications are associated with diabetes and metabolic syndrome

--Which medications affect vitamin and mineral metabolism

--Off label uses for these medications

 

We surfed thousands of Pub Med abstracts so you don't have to!

 

Click here for a sample report and more information

 

2.  New!  This Is Your Brain On Psych Drugs is our brand-new consumer publication that provides an introduction to psychotropic medications and their nutritional perspective.  It provides a summary of the most popularly linked information on our sister blog, presented in user-friendly language.

 

Click here for ordering information

 

3. Because this page received so much traffic and because the format in the above resource did not allow for me to write about many important aspects of psychiatric medications, I started a new blog.  Please visit! 

 

www.thisisyourbrainonpsychdrugs.blogspot.com

 

4. Krause's Food & Nutrition Therapy by Mahan and Escott-Stump, 12th Edition, contains more information about nutrition and mental health.  Click here for ordering information. 

 

Have you tried omega-3 fatty acids? 

This nutritional supplement is quickly gaining credibility as a complementary treatment for mental health issues.  Click here for more information on omega-3 fatty acids; click here for more information on an omega-3 supplement After the Diet has had a part in developing.

Want to learn more? 

If you feel that your weight gain and your depression are related, it is possible that you have metabolic syndrome.  In women, this can manifest as polycystic ovary syndrome.  After the Diet is very actively working to educate both medical professionals and women with this disorder about nutritional options for managing both weight and depression. Please check out our web page on PCOS--and if you happen to live in the Phoenix or Los Angeles areas, please consider attending our brand-new inCYST™ programs to learn more.

 

THIS CHART LAST UPDATED MAY 26, 2007. 

 
Trade Name Generic Name

Research Comments on

Weight /Nutrition/Appetite Interactions
Celexa® citalopram

  • Reduces appetite for sweets (1).

  • Significantly reduced binge eating episodes (2).

  • Effective in the treatment of binge eating disorder (3, 4).

  • Meta-analysis suggests weight loss effect (5).
Cymbalta® duloxetine

  • In rats, observed to decrease food intake in the 2 to 8 hour period following administration (6).

  • In 1159 subjects, reduced weight by an average of 0.2 kg (7).

  • In a study of 128 individuals, weight modestly increased over a 2 year period (8).

  • In a study of 1279 patients, average weight gain after a year was 2.4 kg (9).
Effexor® venlafaxine

  • Useful in the treatment of binge eating disorder (10).

  • Reduces food intake (11).

  • Weight loss has been reported (12).

  • In rats, observed to decrease food intake in the 2 to 8 hour period following administration (6).
Elavil® amitryptiline

  • In a sample of 144 patients treated over a course of 8 weeks, significant weight gain was observed (13).

  • In a systematic review of antidepressants, had the highest incidence of weight gain (14).
Ludiomil® maprotiline

  • Weight gain has been reported (15).

  • In a systematic review of antidepressants, had "intermediate potential" for weight gain (14).
Nardil® phenelzine sulfate

  • Weight gain has been reported (16).

  • Reduces symptoms of bulimia (17).
Norpramin® desipramine

  • No weight gain reported in a 4 week study in individuals with depression (18).

  • May have therapeutic benefit in reducing symptoms of bulimia (19).
Parnate® tranylcypromine sulfate

  • Decreases appetite (20).

  • Reduces symptoms of bulimia (21).
Paxil® paroxetine hydrochloride

  • In a study of 32 elderly patients treated for 8 weeks, those who gained the most weight were the ones who had lost the most weight prior to using medication. Degree of weight loss associated with depression was correlated with the severity of depression (22).

  • A total of 96 patients with major depressive disorder were given paroxetine and compared to similar groups on sertraline and fluoxetine.  The patients were treated for 26-32 weeks.  A significantly greater number of patients receiving paroxetine than those on the other two drugs gained 7% of their original weight or more during the course of treatment (23).

  • In a sample of 144 patients treated over a course of 8 weeks, no significant weight gain was observed (13).

  • 3% of a sample of approximately 100 subjects lost weight over 8 weeks of treatment with an average dose averaging 25.5 mg per day (14a).

  • Less weight gain when compared to mirtazapine in a 6 week study of 123 patients averaging a dose of 22.9 mg/day (24).

  • A review of over 1800 research subjects with generalized anxiety disorder did not show any significant increase in weight (25).

  • A marked association between general and abdominal obesity has been reported (26).
Prozac® fluoxetine hydrochloride

  • Reduces food intake and is associated with weight loss in depressed and otherwise healthy individuals (23, 27-30).

  • Weight changes are dependent on weight at onset of use; weight loss is observed in persons whose weight is classified as "overweight," "ideal" weight persons gained some weight, and "underweight" persons showed now significant weight trend (31).

  • Fluoxetine plus behavior modification therapy resulted in greater weight loss than fluoxetine alone.  Protocol did not appear to help with binge eating (32).

  • Significant reduction in body weight in women with bulimia who used the drug in combination with intensive psychotherapy (33).

  • Improved symptoms of bulimia, including:  depression, carbohydrate craving, and dysfunctional eating attitudes and behaviors (34, 35, 36, 37).

  • A modest but insignificant number of 44 patients receiving treatment for 26 to 32 weeks gained more than 7% of baseline weight (23).

  • 11.88% of a sample of approximately 100 subjects lost weight over 8 weeks of treatment with an average dose averaging 27.5 mg per day (14a).

  • Helps to lose weight in obsessive-compulsive disorder (38).
Remeron® mirtazapine

  • Weight gain reported on doses of 15-60 mg over 8 weeks of treatment (39).

  • Weight gain reported on average dose of 32.7 mg over 6 weeks of treatment (40).

  • Weight gain in 50% of individuals receiving an average of 18.3 mg over 8 weeks (41).

  • Weight gain averaged 1.4 kg over 40 weeks of treatment on a dose of 15-45 mg (42).

  • No weight gain reported with an initial dose of 15 mg (increased to 30 mg when needed) over 4 weeks of treatment (43).

  • More weight gain when compared to paroxetine in a 6 week study of 127 patients averaging a dose of 32.7 mg/day (24).

  • In 147 patients treated with mirtazapine, the average weight gain was 0.8 lbs. (38).
Sinequan® doxepin

  • Trend toward increased appetite and weight (44).
Tofranil® imipramine

  • Increased a preference for sweets in 15% of a test sample (45).

  • Weight gain has been reported (46, 47).

  • Perception of weight change altered with treatment; a 5 lb. weight change was more problematic during recovery than during depression (48).

  • Reduces binge duration in obese bingers (13, 14a); adding this drug to nutrition and psychological counseling helps with weight loss even for at least 6 months off of medication (14a).

  • Reduces symptoms of bulimia (24).
Wellbutrin® bupropion

  • Is currently under investigation as a potential component of obesity treatment (49, 50).

  • Meta-analysis suggests weight loss effect (5).

  • Associated with weight reduction (50).

  • Reported to decrease food intake and weight (54).
Zoloft® sertraline hydrochloride

  • A modest but insignificant number of 48 patients receiving treatment for 26 to 32 weeks gained more than 7% of baseline weight (23).

  • Inhibits food intake and decreases weight without affecting locomotion (51-53).

  • In individuals with obsessive-compulsive disorder, an average weight gain of 4.5% was experienced during a 2 year period of using this medication (54).

References
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4.  McElroy SL, Hudson JI, Malhotra S, Welge JA, Nelson EB, Keck PE Jr.  Citalopram in the treatment of binge-eating disorder; a placebo-controlled trial.  J Clin Psychiatry 2003 Jul; 64(7):  807-13.
5.  Li Z, Maglione M, Tu W, Mojica W, Arterburn D, Shugarman LR, Hilton L, Suttorp M, Solomon V, Shekelle PG, Morton SC.  Meta-analysis: pharmacologic treatment of obesity.  Ann Intern Med. 2005 Apr 5;142(7):532-46.
6.  Jackson HC, Needham AM, Hutchins LJ, Mazurkiewicz SE, Heal, DJ.  Comparison of the effects of sibutramine and other monoamine reuptake inhibitors on food intake in the rat.  Br J Pharmacol 1997 Aug; 121(8):  1758-62.
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8.    Wohlreich MM, Mallindkrodt CH, Prakash A, Watkin JG, Carter WP.  Duloxetine for the treatment of major depressive disorder:  safety and tolerability associate with dose escalation.  Depress Anxiety 2007; 24(1):  41-52.
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19. McCann UD, Agras WS.  Successful treatment of nonpurging bulimia nervosa with desipramine: a double-blind, placebo-controlled study.  Am J Psychiatry 1990 Nov;147(11):1509-13.  
20.  Leibowitz SF, Brown LL.  Histochemical and pharmacological analysis of noradrenergic projections to the paraventribular hypothalamus in relation to feeding stimulation.  Brain Res 1980 Nov 17; 202(2):289-314.
21.  McElroy SL, Keck PE Jr., Pope HG Jr., Hudson JI.  Pharmacological treatment of kleptomania and bulimia nervosa.  J Clin Psychopharmacol 1989 Oct; 9(5):  358-60.
22.  Weber E, Stack J, Pollock BG, Mulsant B, Begley A, Mazumdar S, Reynolds CF3rd.  Weight change in older depressed patients during acute pharmacotherapy with paroxetine and nortriptyline: a double-blind randomized trial.  Am J Geriatr Psychiatry 2000 Summer;8(3):245-50.
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24.  Benkert O, Szegedi A, Kohnen R.  Mirtazapine compared with paroxetine in major depression. J Clin Psychiatry 2000 Sep;61(9):656-63.
25.    Rickels K, Rynn M, Iyengar M, Duff D.  Remission of generalized disorder:  a review of the paroxetine clinical trials database.  J Clin Psychiatry 2006 Jan; 67(1): 41-7. 
26.    Raeder MB, Bjelland I, Emil Vollset S, Steen VM.  Obesity, dyslipidemia, and diabetes with selective serotonin reuptake inhibitors:  the Hordaland Health Study.  J Clin Psychiatry 2006 Dec; 67(12):  1974-82. 
27.  Levine LR, Enas GG, Thompson WL, Byyny RL, Dauer AD, Kirby RW, Kreindler TG, Levy B, Lucas CP, McIlwain HH, et al.  Use of fluoxetine, a selective serotonin-uptake inhibitor, in the treatment of obesity: a dose-response study (with a commentary by Michael Weintraub).  Int J Obes 1989;13(5):635-45.
  
28. Pijl H, Koppeschaar HP, Willekens FL, Op de Kamp I, Veldhuis HD, Meinders AE.  Effect of serotonin re-uptake inhibition by fluoxetine on body weight and spontaneous food choice in obesity.  Int J Obes 1991 Mar;15(3):237-42.
  
29. Goldstein DJ, Rampey AH Jr, Enas GG, Potvin JH, Fludzinski LA, Levine LR.  Fluoxetine: a randomized clinical trial in the treatment of obesity. Int J Obes Relat Metab Disord 1994 Mar;18(3):129-35.
  
30. Lawton CL, Wales JK, Hill AJ, Blundell JE. Serotoninergic manipulation, meal-induced satiety and eating pattern: effect of fluoxetine in obese female subjects. Obes Res 1995 Jul;3(4):345-56.  
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39.  Leinonen E, Skarstein J, Behnke K, Agren H, Helsdingen JT.   Efficacy and tolerability of mirtazapine versus citalopram: a double-blind, randomized study in patients with major depressive disorder. Nordic Antidepressant Study Group.  Int Clin Psychopharmacol 1999 Nov;14(6):329-37.  
40.  Benkert O, Szegedi A, Kohnen R.   Mirtazapine compared with paroxetine in major depression.  J Clin Psychiatry 2000 Sep;61(9):656-63.  
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42. Thase ME, Nierenberg AA, Keller MB, Panagides J. Efficacy of mirtazapine for prevention of depressive relapse: a placebo-controlled double-blind trial of recently remitted high-risk patients.J Clin Psychiatry 2001 Oct;62(10):782-8.  
43.  Carpenter LL, Yasmin S, Price LH.  A double-blind, placebo-controlled study of antidepressant augmentation with mirtazapine.  Biol Psychiatry 2002 Jan 15;51(2):183-8.
44.  Feighner J, Hendrickson G, Miller L, Stern W.  Double-blind comparison of doxepin versus bupropion in outpatients with a major depressive disorder.  J Clin Psychopharmacol 1986 Feb;6(1):27-32.
  
45.  Fernstrom MH, Kupfer DJ.  Imipramine treatment and preference for sweets.  Appetite 1988 Apr; 10(2):  149-55.
46.  Berken GH, Weinstein DO, Stern WC.  Weight gain.  A side-effect of trycyclic antidepressants.  J Affect Disord 1984 Oct; 7(2):  133-8.
47.  Frank E, Kupfer DJ, Bulic CM, Levenson JA.  Imipramine and weight gain during the treatment of recurrent depression.  J Affect Disord 1990 Nov; 20(3):  165-72.
48.  Fernstrom MH, McConaha C, Kupfer DJ.  Perception of appetite and weight change during treatment for depression.  Appetite 1989 Aug; 13(1):  71-7.
49.Gadde KM, Parker CB, Maner LG, Wagner HR 2nd, Logue EJ, Drezner MK, Krishnan KR.  Bupropion for weight loss: an investigation of efficacy and tolerability in overweight and obese women.  Obes Res. 2001 Sep;9(9):544-51.  
50..Croft H, Houser TL, Jamerson BD, Leadbetter R, Bolden-Watson C, Donahue R, Metz A. Effect on body weight of bupropion sustained-release in patients with major depression treated for 52 weeks.  Clin Ther. 2002 Apr;24(4):662-72.  
51.  Lucki I, Kreider MS, Simansky KJ.  Reduction of feeding behavior by the serotonin uptake inhibitor sertraline.  Psychopharmacology (Berl) 1988; 96(3):289-95.
52.  McElroy SL, Casuto LS, Nelson EB, Lake KA, Soutullo CA, Keck PE Jr., Hudson JI.  Placebo-controlled trial of sertraline in the treatment of binge eating disorder.  Am J Psychiatry 2000 Jun; (157(6):  1004-6.
53.  Garattini S, Mennini T, Samanin R.  Reduction of food intake by manipulation of central serotonin.  Current experimental results.  Br J Psychiatry Suppl 1989 Dec; 41-51.
54.    Billes SK, Cowley MA.  Inhibition of dopamine and norepinephrine reuptake produces additive effects on energy balance in lean and obese mice.  Neuropsychopharmacology 2007 Apr; 32(4):  822-34. 
55.    Maina G, Albert U, Salvi V, Bogetto F.  Weight gain during long-term treatment of obsessive-compulsive disorder:  a prospective comparison between serotonin reuptake inhibitors.  J Clin Psychiatry 2004 Oct; 65(10):  1365-71.