Many women are understandably concerned about the risk of weight gain associated with antidepressants. It is difficult to advise them as to which antidepressants are less or more likely to cause weight gain, as there are no head-to-head comparisons.

In a recent electronic health record study including data from 22,610 individuals, 19,244 of which were antidepressant-treated patients, the researchers observed statistically significant differences in trajectory of weight gain over a 12-month period for multiple antidepressants:

  • Bupropion and the tricyclic antidepressants (TCAs) nortriptyline and amitriptyline demonstrated significantly less weight gain than citalopram.
  • SSRIs were similar in terms of weight gain; escitalopram, the S-enantiomer of citalopram, did not differ significantly from the racemic mixture of citalopram.
  • Mirtazapine and paroxetine were associated with the greatest weight gain.
  • While not statistically significantly different from citalopram, the serotonin-norepinephrine reuptake inhibitors, more so duloxetine than venlafaxine, yielded somewhat less weight gain.

There are some limitations to this study. For instance, it is possible that the indication for which these medications are taken may influence the risk of weight gain. Because depression itself may be associated with weight changes, it may make the data somewhat more difficult to interpret. Nonetheless, this study gives us a better sense of how antidepressants affect weight.

Ruta Nonacs, MD PhD

An Electronic Health Records Study of Long-Term Weight Gain Following Antidepressant Use (JAMA Psychiatry Online First)