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 Using health records from one New England healthcare system,
researchers studied 19,244 adults treated with antidepressants,
recording their weights over the course of a year.
The results showed that people taking citalopram (Celexa), from a
class of antidepressants known as selective serotonin reuptake
inhibitors, or SSRIs, gained more than two and a half pounds, on
average.
Other SSRIs were associated with weight gain similar to citalopram,
with people taking fluoxetine (Prozac) gaining on average a pound
and a half and those taking sertraline (Zoloft) gaining nearly two
pounds, the authors write in JAMA Psychiatry.
On the other hand, people taking bupropion (Wellbutrin) lost on
average nearly half a pound. The tricyclic antidepressants
nortriptyline and amitriptyline were also linked with significantly
less weight gain than the SSRIs.
“Our study provides more support for the idea that if weight is a
major concern, Wellbutrin is a good option,” senior author Dr. Roy
Perlis told Reuters Health. Perlis is a psychiatrist at Harvard
Medical School and director of the Center for Experimental Drugs and
Diagnostics at Massachusetts General Hospital in Boston.
“There’s no question we see less weight gain with Wellbutrin,” he
said. “But in absolute terms, the difference is rather small.”
On average, people taking antidepressants “will gain a very modest
amount of weight . . . between half a pound and perhaps two pounds
if they stayed on the medicine for about a year,” he said. But some
people will gain much more, he said.
About one in 10 Americans takes antidepressants, according to the
Centers for Disease Control and Prevention (CDC). Use of the drugs
rose 400 percent over the past two decades, making them the most
frequent prescription for Americans ages 18 to 44.
At the same time, the obesity rate has swelled, with more than
one-third of U.S. adults now considered obese.
“We in practice have long since watched the effect of
antidepressants on weight,” Dr. Anne Peters told Reuters Health.
“The key to this medicine is don’t overmedicate; don’t use drugs
unless there’s a good reason.”
Peters directs the University of Southern California Clinical
Diabetes Program in Beverly Hills and was not involved in the
current study.
In addition to depression, a substantial percentage of study
participants were prescribed antidepressants for anxiety or pain or
as an aid to quit smoking. People who take antidepressants for
reasons other than depression and are prone to weight gain may want
to consider alternatives, Peters said.
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“We’ve got to individualize this and not keep people on
antidepressants forever,” she said. “People shouldn’t stay on these
drugs if they’re contributing to their weight gain and they’re no
longer needed.”
On the other hand, she said, “Nobody wants to gain weight, but I
sure don’t want to see people depressed.”
More than 60 percent of Americans taking antidepressants have been
on them for two years or longer, and 14 percent have taken the drugs
for 10 years or more, according to the CDC.
Peters noted that Wellbutrin can agitate anxious people and
therefore may be a poor match for some people with depression.
Wellbutrin affects different brain chemicals than do SSRIs, and some
of those chemicals may play a role in appetite. Researchers don’t
know all the reasons why some antidepressants appear to cause weight
gain and others do not, Perlis said.
Some people gain weight and others lose weight as a result of
depression. Consequently, researchers have trouble untangling the
effects of medication and the effects of depression on weight,
Perlis said.
The new study also can’t prove the antidepressants were responsible
for weight gain.
“A one-size-fits-all solution isn’t right,” Perlis said. “We
desperately need newer, better antidepressants in terms of
effectiveness.”
Perlis and one of his co-authors have consulted for and received
funding from numerous antidepressant drug manufacturers. But Perlis
said all the drugs he studied are now available as generics.
SOURCE: http://bit.ly/1p2CpwS
JAMA Psychiatry, online June 4, 2014.
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