Antidepressants can raise mood and weight

Though antidepressants are designed to help people feel better emotionally, a pesky potential side effect -- weight gain -- can leave people feeling worse about themselves.

The effect can be significant. But a number of complicating factors make it difficult to predict what will happen to each person, according to Dr. Laura J. Fochtmann, a professor of psychiatry, behavioral science and pharmacological science at Stony Brook University School of Medicine.

"The bottom line is that there are no straightforward answers to the challenges of weight gain with antidepressants," she said.

It's clear, though, that certain antidepressants pose a higher risk for weight gain than others. They include older drugs known as tricyclic antidepressants -- such as amitriptyline (Elavil, Endep, Vanatrip) and imipramine (Tofranil) -- along with paroxetine (Paxil, Pexeva) and mirtazapine (Remeron), Fochtmann said.

Jerry Smaldino, director of pharmacy services for St. Charles Hospital in Port Jefferson, said that drugs that can cause weight gain, such as Remeron, are sometimes prescribed for people who need to eat more, including older people who are depressed or those with eating disorders. Clomipramine (Anafranil), for example, will actually cause the "munchies" and hunger, he said.

Another psychiatric drug, quetiapine (Seroquel), is known to cause weight gain among teenagers who take it. An antipsychotic rather than an antidepressant, the drug may also cause weight gain in adults, Fochtmann said, adding that it, too, can cause the "munchies."

IT'S NOT EXPLAINED

Just why some psychiatric drugs lead to weight gain remains puzzling, though scientists think it might have something to do with how the medications tinker with the brain's chemicals. Others say it's also possible that people simply eat more when they feel better, thanks to the intended effect of the drugs.

The specific effects -- just how much weight a person will gain, if any, or whether the person's weight will settle down over time, for instance -- also may vary, as may people's reactions.

"Each individual has a unique set of symptoms, circumstances and feelings about weight and weight gain," Fochtmann said. "In addition, some individuals have pre-existing disorders, such as diabetes or high blood pressure, that would make additional weight gain more risky for them."

ASK A DIETITIAN

All the uncertainty need not lead to inaction for someone who gains weight while taking an antidepressant. Smaldino recommends against taking diet pills or using caffeine drinks to speed the body's metabolism. It's better to try a different medication, he said, or "use behavioral modification techniques along with nutritional support of a registered dietitian to create good eating habits and positive self-esteem."

Fochtmann agreed that working with a dietitian can help because simply dieting usually isn't effective enough for someone with medication-related weight gain. Dietitians can help people learn new habits, she said, especially if they're experiencing other side effects that also might be affecting their weight.

"For example, many medications can give people a dry mouth," Fochtmann said. "If they respond by drinking calorie-laden fluids, the weight gain can be slowed by a change to water or low-calorie beverages. Or, as people feel less depressed, they may be socializing more and eating out more often, with associated increases in calorie consumption. Increases in appetite with the medication may benefit from a proactive change to snacks such as vegetables or fruit."

One thing's for sure, though: People taking antidepressants or other psychiatric medications should alert their physician or psychiatrist if they notice weight gain, Fochtmann said, to get a conversation started about ways to deal with the issue.