Why some antidepressants can promote weight gain and how to deal with it

  • Why some antidepressants can promote weight gain and how to deal with it

There is a frequent question or complaint in the consultation of people with anxiety and/or depression and it is about the weight gain they experience.

In many cases, the answer that is obtained is that it is caused by a higher intake, particularly when anxiety is an important constitutive part of the picture and that they must control this.

However, this would not be, according to recent research, what justifies this increase and is in correlation with the statement, also very frequent, that even limiting intake, people experience weight gain.

In other cases, this is associated with the observation, verified and real, that some patients present an increase in their weight with certain antidepressants in particular.

The concrete thing is that the issue of weight gain, anxiety and/or depression is part of the problems that are found daily in the consultation and the drawback is that they do not help the patient in his self-esteem, a constitutive part of the picture, but neither in adherence and maintenance of treatment.

With which abandonment is experienced or the search for magical solutions, in many cases risky. In this regard, patients, out of desperation, resort to supposedly natural medicines but which end up being magisterial preparations in which amphetamines predominate.

The anxiety/obesity/depression correlation has been studied and known for a long time. Beyond empirical verification, scientific papers that have statistics on large groups and rigorous methodology are those that provide concrete data and not speculation, and this is what counts in science.

A study from May of this year on a large population explores the incidence of hormonal disorders, depression and anxiety; as well as the comorbidity between them.

The conclusions of the study in which the obesity and overweight factors were separated on the one hand, and depression and anxiety (within this, severe anxiety) on the other, made it possible to obtain some important conclusions for the understanding and treatment of this obesity/ anxiety Depression.

On the one hand, they found something that might be expected and that was that weight gain and obesity occurred more in patients with anxiety plus depression than in those with lower levels of anxiety or only depression.

On the other hand, from the measurement of biological variables, they found alterations in the parameters that evaluate thyroid function such as thyroid-stimulating hormone (TSH), free thyroxine (T4) and free triiodothyronine (T3), as well as antibodies (thyroglobulin, peroxidase ) in a high percentage of cases, mainly in those in which anxiety was more severe and slightly higher in the overweight population, versus those with the greatest weight gain, that is, obese. In relation to this, they found a similar response in other variables such as glucose or lipids.

They verify the correlation between thyroid disorders and obesity, obviously known, but not proven in these cases of anxiety-depressive pathology. On the other hand, they highlight the significant role played by anxiety.

To these findings we must add the known effects of certain types of antidepressants and, in particular, when their use is indiscriminate, without control in quantity or duration of treatment.

For some time now, the rebound phenomenon has been evaluated based on the duration of treatment, that is, on the body mass index (BMI), which measures the weight-height correlation, in patients who started taking antidepressants without a precise indication, but with the weight loss goal.

We know that overweight and obesity are associated with the specific type of depression, the degree of comorbid anxiety, and with the response to antidepressant treatment. The mechanisms underlying these associations are complex and multifactorial, and may include stress, dysfunctional eating behaviors, and neuroendocrine abnormalities. All must be considered.