Can Antidepressants Cause Weight Gain? with Josh Maline, PharmD, BCPP

Podcast Transcript

John Horton:

Hey there, and welcome to another Health Essentials Podcast. I'm John Horton, your host.

Antidepressants can help ease symptoms of stress, anxiety or other mental health issues. But the medications also can bring added pounds, a reality that sometimes convinces folks to stop taking antidepressants even if they're working. That is not an ideal solution. So, what are your options? That's a good question for board-certified clinical pharmacy specialist, Josh Maline. He's one of the many experts at Cleveland Clinic who visit our weekly podcast to explain matters of health. Now, let's find out what can be done when the results of antidepressant medications show up on your scale.

Welcome back to the podcast, Dr. Maline. Glad to see you back on the guest list.

Dr. Josh Maline:

Thanks for having me back. It was a pleasure last time, and great to be here.

John Horton:

Well, we love having you. You make medication just absolutely come alive for us.

So as we start talking today about antidepressants, I know it seems like every medication comes with a whole list of potential side effects, as anyone who is listening to the warnings at the end of one of those drug commercials understands. So with antidepressants, today, we're looking specifically at weight gain, which is an issue that comes up with it. So, how common is that?

Dr. Josh Maline:

Yeah, this is definitely something that gets brought up in a lot of conversations I have with patients on a daily basis. And then, it's a great question to address, especially in a world where we spend a lot of time and focus on the number on the scale.

So weight changes can happen when people start taking antidepressants, but it's not the case for everyone. And from my experience, it is actually relatively uncommon, though it can really depend on a number of different factors.

John Horton:

What are some of the things that might play a role then in whether or not you might put on a few lbs.?

Dr. Josh Maline:

Yeah. So I think the first one would be the type of medication or antidepressant someone might be on, as well as just someone's individual body chemistry and genetics. As well as lifestyle definitely plays a big role in how active and how healthy one's nutrition is.

John Horton:

So, what kind of weight are we talking about here? Is it just a few pounds or are we talking about some sort of massive swing?

Dr. Josh Maline:

It really kind of depends on the individual. But kind of what we've seen in research and studies, that it's actually about roughly about 3 pounds or so over two years.

John Horton:

Wow. Three pounds. I put on that on a weekend sometimes.

Dr. Josh Maline:

Right. Yeah. So yeah, it's not really that big of a change, or at least that's what we've seen in the studies. It's really, again, 3 pounds or so over two years. But at the same time, I've definitely read and talked with patients who have gained significantly more weight on antidepressant medication. So, it really kind of just depends.

John Horton:

Yeah, I was going to say, I think I've put on more than 3 pounds in the last two years. And I got to find something else I can blame it on.

Dr. Josh Maline:

Well, it's not going to be antidepressants.

John Horton:

It's not for me, so I'm going to have to point to something else, I guess. Perhaps it's my diet, but that's a whole different podcast, and we do those, too.

So we talked about whether the medications themselves can lend itself to a little weight gain. But are there other reasons that might come into play as you start taking an antidepressant that can lead to a few pounds?

Dr. Josh Maline:

Yeah. I think, just kind of looking at it from the beginning here, when someone is depressed or anxious, one's appetite can either increase or decrease — and really, change one's eating patterns that can result in weight gain or weight loss, depending on what change they had there. And then, once somebody starts taking an antidepressant and, hopefully, there's improvements in their depression symptoms or anxiety, those sorts of normal appetite or eating patterns may come back to where they're starting to gain a little bit more weight just from normal patterns returning.

John Horton:

Well, and you can kind of see that. I mean, a lot of times, you hear when people are depressed, maybe you're not eating or you're skipping meals. So if you start taking an antidepressant and your mood improves, you might all of a sudden be eating a little bit more and a couple pounds might come on.

Dr. Josh Maline:

Yeah, exactly. And especially with maybe how long maybe that depressive episode has been going on, if it's been a couple of months, but possibly a couple of years, yeah you can really see drastic changes in weight significantly, once one's mood improves.

John Horton:

Now, is there a point where, if you put on a bunch of weight right away, and I don't know, 5, 10 pounds within a week or so … I mean, I take it that's something that maybe should be a little alarming, and you want to check in with your healthcare provider.

Dr. Josh Maline:

Yeah. So with that data and studies that we've seen with the minimal to no weight gain, potentially, I would say it's something that we may be overly sort of fixated on. But if one was gaining, I would say 2 to 3 pounds a day or maybe 5 pounds in a week, that would maybe be a situation to talk to your healthcare provider about. Or if there's sorts of situations, if you've seen rapid or unintentional weight gain or loss, that would also be a situation to seek medical attention.

John Horton:

Now, we've been talking about the weight gain side of it, but as I understand it, the opposite effect, weight loss, has also been seen. Correct?

Dr. Josh Maline:

Yeah, it's definitely not as common as the weight gain. The antidepressant that really comes to mind where we see a little bit more weight loss is actually Wellbutrin™ or bupropion. It actually comes in a combination medication with naltrexone that is prescribed for weight loss.

John Horton:

So it's actually designed for that, or it's kind of an intentional side effect.

Dr. Josh Maline:

Yeah potentially, when it is used in that combination with the other medication. But even with Wellbutrin by itself, it potentially has some appetite-suppressing properties. So individuals may see a little bit of weight loss with that medication.

John Horton:

All right. So with all of these weight changes, is that a big health concern after you start taking an antidepressant? Or is this just something that we fixate on because we are very much of a scale-watching world?

Dr. Josh Maline:

Yeah, I think it kind of goes back to the scale-watching world, what we see on social media with these fitness creators and things like that. I think that really sort of catches our gaze to really watching the scale and paying attention more to weight gain and things like that. The studies really have shown minimal to no weight gain with our antidepressant medications that we've seen.

John Horton:

Yeah. Well, I'd imagine, too, if somebody is taking an antidepressant, you also don't want it to become a situation where they're watching the scale, and all of a sudden, they're maybe getting fixated on those numbers and considering dropping the medication or things like that just because of what they're seeing on the scale.

Dr. Josh Maline:

Yeah, exactly. I mean, I think if you've seen a couple pound changes, I think trying to implement those lifestyle modifications — maybe exercising more, eating a healthier diet — and I think overall, just trying to focus on why one may be taking the medication in the first place. We want to try to improve our mood and maybe improve anxiety, things like that. And that's really kind of what these medications are about.

John Horton:

So it sounds like maybe someone should look at it like … look at exactly why you're taking it. Like I said, if you're feeling better, if your mood improves, deal with that first. And then, if there are a couple pounds that come on, it might be something you can deal with afterward when you kind of get your medication all straightened out and you kind of know the track that you're on.

Dr. Josh Maline:

Yeah, exactly. I think it's kind of treating the underlying issue first, then we kind of handle those things after we start feeling better.

John Horton:

And speaking of that, so when you hit that point and you've put on a couple pounds, you've taken these antidepressants, what kind of things can you do just to start maybe taking those off?

Dr. Josh Maline:

Yeah. I think again, maybe talking with your doctor, too, if you have seen a significant weight change, just reaching out to your provider to maybe see if there's other medical conditions going on that you may be unaware of that could be contributing to that. They could definitely give you a recommendation or referral to maybe a dietitian.

Or again, yeah, just trying to hit the gym, getting the exercise routine, getting a healthier diet. All those things are definitely going to be beneficial. As well as getting adequate sleep. That's a huge one that I think people don't realize, is making sure we get adequate and restful sleep can definitely play a role in our metabolism.

John Horton:

And do you find, with the antidepressants, does that usually help people sleep a little bit?

Dr. Josh Maline:

Yeah. So with depression, with someone who's experiencing depression symptoms, they may have troubles getting to sleep or falling asleep. And antidepressants can definitely help improve one's sleep. So as one's mood improves, hopefully, we start to see improvements in sleep as well.

John Horton:

Wow. Well, that definitely would help. I think all the things you mentioned, if you're taking antidepressants and you're having these issues, like you said, a little more exercise, dietary changes, making sure you're sleeping better, maybe working out some stress relief. These all sound like doable and really just healthy options.

So I guess as we look to wrap things up here, what's the most important piece of information that someone should take away from this discussion?

Dr. Josh Maline:

So while I would say weight gain can be a side effect of antidepressants, it's not something that we should overly fixate on. Obviously, that's a little bit easier said than done. But I think the most important thing is that the medication is helping with those symptoms of depression or anxiety. And kind of our goal really is to always try to balance where both mental and physical health are supported.

And then lastly, if you are experiencing troubling weight changes, make sure you talk to your healthcare provider before making any medication changes or stopping your medication.

John Horton:

Yeah, it sounds like that's something you don't want to do on your own — you don't want to play your own pharmacist.

Dr. Josh Maline:

Right. That's what we're here for.

John Horton:

Well, Dr. Maline, I appreciate you being here for us today. And thank you again for coming in, and I look forward to having you back on.

Dr. Josh Maline:

Looking forward to it. Thanks, John.

John Horton:

Taking antidepressants can sometimes lead to weight gain, and that's perfectly normal. But if that change is rapid, extreme or causing you concern, talk to your healthcare provider about your options. In the meantime, though, don't stop taking your medication on your own.

If you liked what you heard today, please hit the subscribe button and leave a comment to share your thoughts. Until next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. This podcast is for informational purposes only, and is not intended to replace the advice of your own physician.