Anti depressants and weight gain

[Luna6]

I have a history of depression and anxiety and although this improved in later years, since the menopause it has been so bad. I have been waiting for hormones to settle down and it to improve but honestly some days it’s hard to see a light at the end of the tunnel. I’m thinking of asking the dr for ADs again but in the past when I took Prozac I put on so much weight. I wondered if anyone had experienced weight gain with sertraline or other more modern ADs or whether weight has remained the same. Thanks.

I'm on sertraline and have not experienced any weight gain. In the past I have sometimes gained a few pounds when on ADs of one sort or another, but not always.

I think that when I do gain weight while on ADs, it is down to increased appetite, especially for carby foods. I have found that a very low carb diet really helps these cravings to diminish a lot.

So you may well be able to control any small tendency to put on a bit of weight.

Thank you for answering. That’s good to know.

Hi @Luna6 It's worth talking to your GP and not assuming that the drugs you took years ago are the ones you need now. The guide is that HRT is offered, especially if you have other symptoms.

Anti depressants are no longer prescribed as first line treatment for mood in peri and post menopause. NICE guidance said this in 2015 and GPs are supposed to follow the guidance.

You may find it helps to read this which explains it well.

Hope you find a way forward!

https://themenopausecharity.org/information-and-support/symptoms/menopause-and-mental-health/

The suggested treatment is HRT because low mood in peri is related to loss of estrogen. This is from the BMS guide (see point 4, page 2 of the linked info.)

https://thebms.org.uk/wp-content/uploads/2025/04/09-BMS-TfC-NICE-Menopause-Menopause-identification-and-management-%E2%80%93-from-guideline-to-practice-MARCH2025-D.pdf

The guideline recommends that Clonidine or antidepressants should not be routinely offered.

Of the non-hormonal therapies, isoflavones or black cohosh have been shown to be helpful, but consideration should be given to the fact that not all preparations contain the same amount or quality of product.

The guideline recommends that for depressive symptoms with onset around the same time as other symptoms associated with menopause and not meeting the criteria for a diagnosis of depression, HRT should be considered, and cognitive behavioural therapy can be helpful.

@JinglingSpringbells I think the op was looking for human advice not AI

Are you taking HRT? Get thee on it!

I don't follow your thinking. The links are to medical information written by humans. Dr Louise Newson, and the medical specialists of the British Menopause Society who write the guidance.

Just be careful about focusing on the menopause too much, especially since you have a history of depression.
Perhaps the menopause is responsible for it worsening, perhaps not. There are often many other things that can be going on at that time of life that make things hard. For example, teen and young adult children can bring an intense level of worry; so can elderly parents. Plus there is the accumulated exhaustion and stress of parenting, job and marriage over m any years.
I do worry that the focus on menopause has become so much on trend that we are in danger of returning to the bad old days in which women were viewed just as avatars of their hormones. The menopause is one line of investigation of the problem. xx

Thanks for your replies. I can’t actually take HRT so that isn’t an option.

I do sometimes wonder if I am focusing too much on the menopause link. The only reason I am is that it can come and go. I might wake up one day feeling perfectly fine and the next be in the depths of despair. So I thought it was hormone related. When I suffered from depression before there was no let up.

OP - advice from PP is poor. Menopause should be a big consideration, because for many of us (who can take HRT), the fix is swift. I was suicidal without HRT. Dangerously unwell. The shift within a short space of time was miraculous.

That's not to say you can't look at other options, but dismissing hormones would be foolish. If it is them, ADs may not help and you may waste precious time.

Why can't you take HRT?

I didn't 'dismiss' hormones. I just referenced the importance of keeping an open mind., not really because of anything the OP said, but because of other posts on the thread (and the intensely strong tendency on MN as a whole). Of course the menopause needs to be part of the exploration of the problem. But it may or may not be the answer.

Reminder: You suggested the focus on menopause is a 'trend' and that you worry it's damaging the female brand. To a woman suffering who can likely be helped by HRT.

But how on earth can you say that the OP is 'likely' to be helped by HRT? How do you know that? It is one possibility.

Anyway, I will bow out of this strand of the discussion now because this is a derail. The question was about weight gain and ADs. I do absolutely understand that concern, OP. In many cases the benefits of AD are so subtle and hard to feel confident about that there really is the concern that they will be wiped out by increased self-image problems that arise from a few extra pounds of weight. We all know that a few extra pounds is an irrational concern, but that doesn't make it any less relevant or valid - since these irrational self-denigrating thoughts are part of the very depression that the meds are meant to be improving.

Certainly, my GP says that that sertraline doesn't come with a real concern about weight gain, and I have currently been on it for about nine months with zero gain.

@Luna6 If you're willing to say why you can't take HRT, we can point you to the latest advice on it .

A lot of the information you may think applies can be out of date and some GPs aren't up to speed. So unless you've had a recent chat with your GP about it and they are up to date, you could find things have changed.

The main reasons not to use HRT (bearing in mind some rare diseases of which only a specialist can advise, so I'm not saying these are the only ones) , are -

Recent breast cancer
Recent heart attack or stroke/ blood clot
A diagnosed blood clotting disorder.
Some forms of epilepsy
Severe chronic liver disease

If you find you can't actually use it, your GP can refer you to a specialist, or there is advice online from the British Menopause Society on Alternatives to HRT which your GP (and you) can read.

I’m sure it is well meant but I didn’t start this thread for people to try and persuade me that HRT is the best route. I just want to know about weight gain and ADs.