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11 October 2010

Weight gain and antidepressants

Are you on antidepressants and gaining weight? Research has shown that weight gain can occur in up to 25% of patients taking antidepressants. DietDoc looks at this complex problem.

Many of Health24's users ask me if the antidepressants they are taking, could be linked to weight gain. A recent article on “Weight gain caused by antidepressants” by Dr Ian Westmore which was published in the August Edition of the Medical Chronicle, sheds more light on this tricky question.

On the one hand, patients suffering from severe depression require medication to assist them to cope with their problem and to prevent extreme reactions such as suicide, while on the other hand many of these medications can cause pronounced weight gain which will in turn contribute to increased depression and lack of self confidence in the affected patients.

In some cases, patients using SSRIs may actually lose a small amount of weight at the start of their treatment (usually only about 0,5 kg), but then go on to gain, rather than to lose weight.

  • seeking comfort in food which leads to overeating
  • the effects of antidepressants such as TCAs. One study showed that TCAs stimulated appetite and increased carbohydrate cravings causing gains varying between 0.57 to 1.37 kg per month during treatment.

  • stimulation of appetite (TCAs)
  • increased carbohydrate cravings (TCAs)
  • interference with central nervous system functions that regulate energy balance
  • changes in the Resting Metabolic Rate (TCAs, SSRIs, MAOIs)
  • interaction with a genetic predisposition to weight gain
  • counteracting the action of the 5-HT2 receptors, which will then increases appetite 
  • interference with the production of noradrenaline

  • Always discuss any changes you notice in your body weight when you are being treated with antidepressants with the prescribing doctor. The doctor may be able to adjust your dosage or change your prescription to another antidepressant which is better suited to your unique metabolism and requirements.
  • If you are turning to food as ‘comfort’, ask your doctor to refer you to a clinical psychologist who will teach you better methods of coping with your depression.
  • Consult a registered dietitian to assist you with a balanced slimming diet that is tailored to your needs.
  • Do as much cardio or aerobic exercise as possible. This type of exercise will not only help you control your weight and promote weightloss by stimulating your metabolism, but it has a strong positive effect on your psychological makeup. Doing daily exercise is also an expression of taking back control of your life despite being depressed, which can be an empowering experience.

  • Never stop your antidepressants without first discussing this step with the medical doctor who is treating you for your depression. It can be dangerous and even fatal to stop taking antidepressants if you suffer from severe depression because the danger of suicide is increased if you should abruptly stop your medication.
  • Do not take over-the-counter slimming pills or fat-burners or any other herbal or pharmaceutical product that is advertised as a ‘sure-fire solution to rapid weightloss’ because many of these herbal products can interfere with your antidepressant treatment and even counteract the effect of your antidepressants leading to serious side-effects.
  • Do not use starvation diets to try and achieve rapid weightloss because very-low-energy diets have been linked to an increase in depression.
  • Never take antidepressants for the sole purpose of losing weight. Some of my Readers have reported this disturbing practice which should be prevented at all costs.

  • Low-fat dairy products (milk, yoghurt, cottage cheese, maas) are our best source of readily available calcium in the diet. Calcium is essential for bone health and nerve impulse conduction. Have 3 servings a day. 1 serving = 1 cup of milk/yoghurt/maas; ½ cup cottage cheese.
  • Fresh fruit and vegetables are rich in phytonutrients and dietary fibre which protect us against a variety of diseases and keep your digestion regular. Have at least 5 servings a day. 1 serving = ½ to 1 fruit, ½ cup cooked vegetables/salad.
  • Low-GI grains and cereals (e.g. low-GI breads, high-fibre breakfast cereals, wholewheat crackers, brown rice and wholewheat pasta) are low in fat and high in fibre and vitamin B complex (the latter vitamins are essential for your nervous system). Have 4-5 servings a day. 1 serving = 1 slice of bread; ½ cup dry or cooked cereal/rice/pasta; 3 crackers.
  • Lean meat, fish, eggs and legumes (dry, cooked or canned beans, peas, lentils and soya) are rich in protein and minerals like iron (to prevent anaemia) and zinc (to boost immunity). Have 2-3 servings a day. 1 serving = 30g meat/fish; 1 egg; ½ cup cooked legumes.
  • “Good” fats and oils like soft margarine (sold in tubs, not bricks!) made with mono- or polyunsaturated fats, and oils rich in monounsaturated and omega-3 fatty acids (olive, canola, flaxseed and avocado oils) are beneficial to the nervous system and prevent heart disease. Have 2 servings a day. 1 serving = 1 tablespoon. 

 
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