Which antidepressants are less likely to cause weight gain?

[Picklemeyellow]

I need antidepressants.
I have suffered for decades with anxiety, depression, ocd , issues with weight and food, intrusive thoughts, bad dreams and basically unbalanced thinking etc.
My mental health has never been great but I’ve limped on by with endless cbt, exercise, healthy eating, no alcohol and caffeine and just ‘trying my best’.

But I’ve got to face up to the fact that it’s not working. I have some health issues (IBS, endometriosis and adenomyosis). The latter two will need more investigating and operations this year which is already raising my anxiety levels. Add into the fact I am in peri and caring for a parent with dementia and needless to say I’m ready to break.

However, many people I know have gained so much weight on antidepressants including my sister who has gone from a size 10 to 16. I know people will say they’d rather be bigger and happy than slim and miserable and I understand this as I long to feel happier but for most of my life I’ve been dealing with food issues and I love being slim, it’s my identity. The thought of weight gain makes me feel so miserable. I know that is hard for some people to understand but the possibility of any weight gain as a side effect to medication very much holds me back.

I have tried Citalopram, nortriptyline (Was told this has less digestive side effects so wouldn’t exacerbate my daily gut issues) and sertraline but I’ve never gotten past the initial side effect weeks and the fear or weight gain.

Are there anxiety/depression meds which are less likely to cause weight gain? And if the weight gain is due to increased appetite how do you deal with that (I have never had much of an appetite)?

Trazodone is a slight appetite depressant and a slight libido stimulant. Those side effects do tend to wear off once you’ve been on the drug for a while. It also has a sedative effect so aids sleep but that can mean you get a degree of brain fog in the morning.

Mr daughter is on sertraline, this has caused weight gain. She also takes quitiepine (not sure of spelling) for complex PTSD. I think I’ve read that the way it works is that it can slow your metabolism down. So far no extra weight gain.

It’s so upsetting putting weight on due to medication, I myself have been reluctant to take medication due to this possible side effect. Although I must say before taking HRT I was putting on weight, especially around the midriff. Since being on estrogen, progesterone and the all important testosterone I’ve managed to lose it.

There's a school of thought it's not the AD's that make you gain weight more that the AD's are making you feel more happy and relaxed and you have more of an appetite

Thanks everyone.

I have an appointment next week with my MH worker, I will go back through all of my options with her.

Maybe putting weight on wouldn’t be such an issue if I were happier and more contented? Maybe I need those meds to get me to that place?

I tend to eat if I'm depressed for comfort, so if I eat more on anti-d's, it's not that much more when I factor in I'd be binge-eating junk food anyway.

Your response to a medication would be quite personable to you and your circumstances in the rest of the world

I was put on quetiapine (antipsychotic) in 2012 and this is notorious for 1+ stone weight gain. My weight stayed stable until I turned 30 and suddenly jumped half a stone. I lost a lot of weight in pregnancy due to pregnancy sickness and then proceeded to lose a lot of weight afterwards due to pnd and a very limited diet due to breastfeeding an allergy baby.
During this time I stayed on the quetiapine now at the highest dose I had been prescribed and variations of mirtazapine, sertaline, escitalopram and very briefly venlaflaxine. I was close to my lowest anorexic weight.
I went on lithium, I stopped breastfeeding and started comfort eating probably due to the 18 months of a very limited diet because of the pregnancy sickness and breastfeeding diet. In 4-6 weeks I went from very underweight to normal and then I have continued to slowly gain weight. I am at my highest weight outside of pregnancy but still in the "normal" category and have gone up 0.5-1 dress size.

This is just my experience of medication side effects. I do have to be mindful of portions but generally over the last 12 years I haven't had to give it too much consideration. More recently I am having to be more careful but I also know what foods I am eating beyond what I would consider typical for me and that these do fairly frequently come with weight gain. I think I might have just reached the age where I can no longer eat what I like or binge without consequence.

Without the medication I wouldn't have finished my undergrad or PhD. I wouldn't have been well enough to stay in my job that allowed me to buy a house and gain some stability with life. I wouldn't have been able to care for my daughter nor be the daughter, sister, partner and friend that I am. The medication allows me to enjoy seeing a rainbow and autumn leaves. I get to enjoy cooking food and engaging in exercise both of which allow me to manage my weight. Also, if I was able to tell 18 or 21 or 25, or even 30 year old me that I could still be happy with my clothes appearance at this weight they would not have believed you. In the right clothes I truly feel beautiful. I'm still working on the naked and in everything. I am choosing to just buy more clothes than make me feel beautiful for now.

I put on 20lb in sertraline. I think it's because a) I was no longer too anxious to eat and B) it made me feel very sluggish.

It got me through an awful time though. Just wish the weight would come off as easy as it went on.

If you’re struggling, I’d give it a go, OP. I’m diagnosed with GAD and went through a rough time 3-4 years ago, having panic attacks, etc. Escitalopram really helped me overcome the anxiety and think more clearly, I felt much better after just three weeks on it. Good luck with whatever you decide. 💐

I have been on sertraline, fluoxetine (Prozac), and venlafaxine and all three caused me major weight gain -- more than 2 stone. Despite the doctors constantly saying SSRIs don't. In fact, when I got fed up and went poking round the medical databases I found several scientific studies that confirmed my experience: most SSRIs cause a tiny amount of weight loss in the first few weeks (probably because nausea is a common early side effect, but it wears off). But in long term use (over 18 months) all of those studied did on average cause weight gain, and more in women than in men. And, most annoying of all, it tends to sit on the belly. Similarly, and probably related, SSRIs tend to raise cholesterol levels. The bad news is that regulators don't require drug makers to test for long periods, like a lifetime: it's impractically slow.

I put up with this for nearly 15 years because my depression really, really needed help and other ADs cause even more weight gain (ie the old MAOIs and tricyclics, not to mention lithium which is mainly for bipolar disorder).

My good news for you: when I stopped taking the medication, I immediately started losing weight very fast, without changing anything else like diet or exercise. The bad news is I also got depressed again. So now like you I am hesitating over what to do.

It is true that SNRIs (like venlafaxine) are somewhat less likely to cause weight gain and cause less gain on average, so maybe try that one first and see if it helps. But if you do gain weight, don't let anyone gaslight you that it's your own fault and not the medication.

I gained on sertraline, duloxetine and mirtazepam, oh and trazadone. ( and quetiapine but that’s anti psychotic.
neutral on lamotrogine (mood stabiliser ), Prozac and citalapram.
lost on venaflaxine then stabilised (still on venaflaxine). I went from a size 12 to 18 on mirtazepine and now size 8.

I am on seroxat. Initially I gained weight not because of the medication but because I was eating better because I was happy. I soon got a grip and am back to my usual weight and have been for the last few years. It’s not the tablets, it’s the calories and when you are content you tend to eat more

That is so amazing @Superscientist

I’ve been on nearly all of them.

The only ones that didn’t make me gain weight were Agomelatine and Trazadone. The rest were non stop eating.

Currently on Venlafaxinewhich is bearable. They all make me crave sugar and carbs, and it’s really hard to fight. Really hard.

Same.

athingofbeauty yes to the weight gain around the middle. I started them with a 26-27" waist, when I stopped taking them it was 36". I looked like a barrel! But the weight came off my middle really quickly once Istopped them and all the withdrawal symptoms went.

Again though, the benefits I got from them really outweighed (ha!) the negatives for me.

I completely understand where you’re coming from. The fear of weight gain can be a huge mental barrier when starting antidepressants, especially when you’ve struggled with food and body image for so long. But at the same time, it sounds like you’ve been carrying so much on your shoulders, and you deserve to feel better.

From what you’ve said, you need an antidepressant that’s effective for anxiety, depression, and OCD but with minimal impact on weight. Based on research and personal experience, here are some options that might work for you:

• Wellbutrin (Bupropion) – This is actually known for causing weight loss in some people rather than gain. It’s also stimulating, so it might help with energy levels, but it’s not always the best for anxiety.
• Zoloft (Sertraline) – I’ve been taking Zoloft for quite a while now, and it has helped me tremendously. I personally haven’t noticed any weight gain at all, and honestly, I don’t have any side effects now that my body has adjusted. The first few weeks were a bit rough, but after that, it’s been smooth sailing. If you ever want to try it again, I usually order mine from this pharmacy topsup24.com/?product=zoloft, because I know for sure the quality is good.
• Lexapro (Escitalopram) – It’s similar to Zoloft but sometimes better tolerated with fewer digestive issues. Weight gain varies, but many people don’t experience much.
• Effexor (Venlafaxine) – Less likely to cause weight gain for many, but it can be hard to come off.
• Trintellix (Vortioxetine) – Known for being weight-neutral and can actually help with cognitive symptoms like brain fog.

If weight gain is due to increased appetite, the best way to manage it is to be mindful of your eating habits from the start. Since you naturally don’t have a big appetite, you might not even notice this issue, but if you do, sticking to a structured meal plan and focusing on nutrient-dense foods can help. Also, regular exercise (which you’re already doing!) can keep things in balance.

I really think you shouldn’t let the fear of weight gain hold you back from getting the help you need. Mental health struggles are exhausting, and with everything you’re dealing with—IBS, endo, peri, caregiving—you deserve some relief. Maybe a low-dose start of a weight-neutral antidepressant could be a good middle ground?

You don’t have to suffer through this alone. 💛

Thank you so much, that is really helpful.

I take Escilatropram, and apart from very minor nausea in the first few days, I have had no side effects at all, including no weight gain.

Panickyanicky that is really good to know. My GP has prescribed me 10mg and as she knows I am so anxious about starting them she has suggested I cut them in half and go in low and slow. I am still anxious though 😬

Some antidepressants like Wellbutrin (Bupropion) and Prozac (Fluoxetine) are less likely to cause weight gain. But everyone reacts differently, so it’s best to talk to a doctor to find the right option.

@Picklemeyellow Mine did the same, I did 5mg for 7 days then upped it to 10mg, very very slight nausea for couple of hours after taking them when upping it to 10mg at which point I switched from taking them in the morning to taking them at night and that solved it. GP thought it was probably because I don't eat breakfast so I was taking them on an empty stomach.

I’ve only taken sertraline and currently Escitalopram, neither have affected my weight at all , Mirtazapine is the one most associated with weight gain

I don't eat breakfast either so may try and take them in the evening to try to avoid the nausea especially as I already suffer from gut issues.