Elavil and weight gain. Antidepressants and Weight Gain: Understanding the Connection and Managing Side Effects

13.08.202312.06.2023 by alexxlab

Which antidepressants are most likely to cause weight gain. How does long-term use of SSRIs affect body weight. What are some antidepressants associated with less weight gain. How can patients manage weight gain while on antidepressant medication.

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Common Antidepressants Associated with Weight Gain

Weight gain is a potential side effect of many antidepressant medications. While individual responses to these drugs can vary, certain classes and specific medications are more frequently linked to increases in body weight. Understanding which antidepressants are more likely to cause weight gain can help patients and healthcare providers make informed decisions about treatment options.

Tricyclic Antidepressants (TCAs)

Tricyclic antidepressants, also known as cyclic antidepressants or TCAs, were among the first drugs approved to treat depression. Although they are prescribed less frequently today due to newer options with fewer side effects, TCAs can still be effective for patients who don’t respond to other antidepressants. However, weight gain is a common side effect that often leads to discontinuation of treatment.

TCAs associated with weight gain include:

Amitriptyline (Elavil)
Amoxapine
Desipramine (Norpramin)
Doxepin (Adapin)
Imipramine (Tofranil-PM)
Nortriptyline (Pamelor)
Protriptyline (Vivactil)
Trimipramine (Surmontil)

Monoamine Oxidase Inhibitors (MAOIs)

MAOIs were the first class of antidepressants developed. While they are now prescribed less frequently due to potential side effects and safety concerns, they can be effective when other treatments fail. MAOIs associated with weight gain include:

Phenelzine (Nardil)
Isocarboxazid (Marplan)
Tranylcypromine (Parnate)

Of these, phenelzine is most likely to result in weight gain. However, a newer MAOI formulation, selegiline (Emsam), which is applied as a transdermal patch, has been shown to result in weight loss during treatment.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs are the most commonly prescribed class of antidepressants. While some SSRIs may initially cause weight loss, long-term use (over six months) is generally associated with weight gain. SSRIs linked to weight gain include:

Paroxetine (Paxil, Pexeva, Brisdelle)
Sertraline (Zoloft)
Fluoxetine (Prozac)
Citalopram (Celexa)

Among these, paroxetine is most commonly associated with weight gain in both short-term and long-term use.

Other Antidepressants

Mirtazapine (Remeron), a noradrenergic antagonist, has been consistently shown to increase appetite and cause weight gain more frequently than other antidepressants. However, it generally causes less weight gain than TCAs and has fewer side effects compared to other antidepressants.

Antidepressants Less Likely to Cause Weight Gain

Not all antidepressants are equally likely to cause weight gain. Some medications have been associated with less weight gain or even weight loss in some cases. These include:

Escitalopram (Lexapro, Cipralex) – an SSRI
Duloxetine (Cymbalta) – a serotonin-norepinephrine reuptake inhibitor (SNRI)
Bupropion (Wellbutrin, Forfivo, Aplenzin) – an atypical antidepressant
Nefazodone (Serzone) – a serotonin antagonist and reuptake inhibitor
Venlafaxine (Effexor) and venlafaxine ER (Effexor XR) – SNRIs
Desvenlafaxine (Pristiq) – an SNRI
Levomilnacipran (Fetzima) – an SNRI
Vilazodone (Viibryd) – a serotonergic antidepressant
Vortioxetine (Trintellix) – an atypical antidepressant
Selegiline (Emsam) – a transdermal MAOI

Additionally, when used for less than six months, the following SSRIs are less likely to cause weight gain:

Sertraline (Zoloft)
Fluoxetine (Prozac)
Citalopram (Celexa)

Understanding the Mechanism of Antidepressant-Induced Weight Gain

The exact mechanisms by which antidepressants cause weight gain are not fully understood, but several theories exist. These medications may affect metabolism, appetite regulation, or energy expenditure in various ways:

Altered Metabolism

Some antidepressants may slow down the body’s metabolic rate, leading to fewer calories burned throughout the day. This can result in weight gain even if caloric intake remains constant.

Increased Appetite

Certain antidepressants, particularly mirtazapine, may increase appetite and food cravings. This can lead to higher caloric intake and subsequent weight gain.

Changes in Neurotransmitter Activity

Antidepressants affect neurotransmitters in the brain, which can influence appetite and food intake. For example, increased serotonin levels may lead to carbohydrate cravings in some individuals.

Fluid Retention

Some antidepressants may cause fluid retention, leading to a temporary increase in weight that is not related to fat gain.

Managing Weight Gain While on Antidepressants

While weight gain can be a concerning side effect of antidepressant treatment, it’s important to remember that not everyone will experience this issue. For those who do, there are several strategies to manage weight while continuing necessary treatment:

1. Discuss Medication Options with Your Healthcare Provider

If weight gain becomes a significant concern, talk to your doctor about potentially switching to an antidepressant less likely to cause weight gain. However, never stop or change your medication without professional guidance.

2. Adopt a Healthy Diet

Focus on consuming a balanced diet rich in fruits, vegetables, lean proteins, and whole grains. Limit processed foods, sugary snacks, and high-calorie beverages.

3. Increase Physical Activity

Regular exercise can help counteract potential weight gain and has additional mood-boosting benefits. Aim for at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous-intensity aerobic activity per week.

4. Monitor Portion Sizes

Be mindful of portion sizes, especially if you experience increased appetite. Use smaller plates, measure servings, and practice mindful eating techniques.

5. Stay Hydrated

Drinking plenty of water can help manage appetite and may reduce fluid retention associated with some medications.

6. Get Adequate Sleep

Poor sleep can affect metabolism and appetite regulation. Aim for 7-9 hours of quality sleep each night.

7. Consider Cognitive Behavioral Therapy (CBT)

CBT can help address emotional eating patterns and develop healthier coping mechanisms for stress and anxiety.

The Importance of Balancing Mental Health and Physical Well-being

When considering the potential for weight gain with antidepressant use, it’s crucial to weigh the benefits of improved mental health against the possible side effects. In many cases, the positive impact of effectively treating depression or anxiety outweighs the concerns about moderate weight gain.

However, significant weight gain can lead to additional health problems and may negatively impact self-esteem and overall well-being. This is why open communication with healthcare providers is essential to find the right balance between managing mental health symptoms and maintaining a healthy weight.

Individualized Treatment Approaches

Every patient responds differently to antidepressant medications. What causes weight gain in one person may not affect another. Healthcare providers often need to try different medications or combinations to find the most effective treatment with the least problematic side effects for each individual.

Monitoring Progress and Adjusting Treatment

Regular check-ups and open discussions about side effects, including weight changes, are crucial parts of antidepressant treatment. Providers may recommend adjusting dosages, switching medications, or adding supplementary treatments to address both mental health needs and weight concerns.

Emerging Research and Future Directions

As the prevalence of both depression and obesity continues to rise globally, researchers are increasingly focusing on the relationship between antidepressant use and weight gain. Several areas of study show promise for improving treatment outcomes:

Pharmacogenetics

This field examines how genetic factors influence an individual’s response to medications. Future developments in pharmacogenetics may allow healthcare providers to predict which patients are more likely to experience weight gain with specific antidepressants, enabling more personalized treatment plans.

Novel Antidepressant Formulations

Pharmaceutical companies are working on developing new antidepressants with improved side effect profiles, including reduced potential for weight gain. Some of these medications aim to target specific neurotransmitter systems more precisely or utilize new delivery methods to minimize systemic effects.

Combination Therapies

Research is ongoing into combining antidepressants with other medications that may help mitigate weight gain. For example, some studies have explored adding metformin, a diabetes medication, to antidepressant regimens to help manage weight.

Lifestyle Interventions

More research is being conducted on the effectiveness of structured lifestyle interventions, including diet and exercise programs, specifically tailored for individuals taking antidepressants. These interventions aim to prevent or minimize weight gain while supporting mental health treatment.

Conclusion: Balancing Efficacy and Side Effects in Antidepressant Treatment

The relationship between antidepressant use and weight gain is complex and varies significantly among individuals. While certain medications are more commonly associated with weight gain, it’s important to remember that not everyone will experience this side effect. The decision to start, continue, or change antidepressant medication should always be made in consultation with a healthcare provider, taking into account the individual’s mental health needs, overall health status, and personal preferences.

By staying informed about potential side effects, maintaining open communication with healthcare providers, and adopting healthy lifestyle habits, many individuals can successfully manage their mental health while minimizing unwanted weight gain. As research in this field continues to advance, we can look forward to more targeted and personalized approaches to antidepressant treatment that optimize efficacy while minimizing side effects.

16 Antidepressants That Cause Weight Gain

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Medically reviewed by Alan Carter, Pharm. D. — By Jacquelyn Cafasso — Updated on April 18, 2019

Overview

Weight gain is a possible side effect of many antidepressant drugs. While each person responds to antidepressant treatment differently, the following antidepressants may be more likely to cause weight gain during your treatment.

Tricyclic antidepressants, also known as cyclic antidepressants or TCAs, may cause weight gain. These drugs include:

amitriptyline (Elavil)
amoxapine
desipramine (Norpramin)
doxepin (Adapin)
imipramine (Tofranil-PM)
nortriptyline (Pamelor)
protriptyline (Vivactil)
trimipramine (Surmontil)

TCAs were some of the first drugs approved to treat depression. They aren’t prescribed as often anymore because newer treatments cause fewer side effects.

Weight gain was a common reason people stopped treatment with these types of antidepressants, according to a 1984 study.

Still, TCAs can be effective in people who don’t respond to other types of antidepressant drugs, despite the unwanted side effects.

Monoamine oxidase inhibitors (MAOIs) were the first class of antidepressants to be developed. MAOIs that cause weight gain include:

phenelzine (Nardil)
isocarboxazid (Marplan)
tranylcypromine (Parnate)

Doctors prescribe MAOIs most often when other antidepressants don’t work due to certain side effects and safety concerns. Of the three MAOIs listed above, phenelzine is the most likely to result in weight gain, according to a 1988 review.

However, a newer formulation of an MAOI known as selegiline (Emsam) has been shown to result in weight loss during treatment. Emsam is a transdermal medication that’s applied to the skin with a patch.

SSRIs are the most commonly prescribed class of depression drugs. Long-term use of the following SSRIs may cause weight gain:

paroxetine (Paxil, Pexeva, Brisdelle)
sertraline (Zoloft)
fluoxetine (Prozac)
citalopram (Celexa)

Although some SSRIs are associated with weight loss at first, long-term use of SSRIs is mostly linked to weight gain. Long-term use is considered treatment that lasts longer than six months.

Of the SSRIs listed above, paroxetine is most commonly associated with weight gain with both long-term and short-term use.

Mirtazapine (Remeron) is a noradrenergic antagonist, which is a type of atypical antidepressant. The drug has been shown repeatedly to be more likely to cause weight gain and to increase appetite than other drugs.

Mirtazapine is less likely to make people gain weight compared with TCAs.

It also doesn’t result in as many other side effects as other antidepressants. However, it can cause:

nausea
vomiting
sexual dysfunction

Other antidepressants have been associated with less weight gain as a side effect. These antidepressants include:

escitalopram (Lexapro, Cipralex), an SSRI
duloxetine (Cymbalta), a serotonin-norepinephrine reuptake inhibitor (SNRI), may cause modest weight gain with long-term use
bupropion (Wellbutrin, Forfivo, and Aplenzin), an atypical antidepressant
nefazodone (Serzone), a serotonin antagonist and reuptake inhibitor
venlafaxine (Effexor) and venlafaxine ER (Effexor XR), which are both SNRIs
desvenlafaxine (Pristiq), an SNRI
levomilnacipran (Fetzima), an SNRI
vilazodone (Viibryd), a serotonergic antidepressant
vortioxetine (Trintellix), an atypical antidepressant
selegiline (Emsam), a newer MAOI that you apply to your skin, which may lead to fewer side effects than MAOIs taken by mouth

Weight gain is also less likely to occur with the following SSRIs when they’re used for less than six months:

sertraline (Zoloft)
fluoxetine (Prozac)
citalopram (Celexa)

Not everyone taking an antidepressant will gain weight. Some people will actually lose weight.

Experts emphasize that worries about gaining weight shouldn’t influence the choice of antidepressant for most people. There are other side effects and factors to consider when choosing an antidepressant.

If you do gain some weight while taking an antidepressant, the drug may not actually be the direct cause of the weight gain. An improved mood while taking an antidepressant, for example, may increase your appetite, leading to weight gain.

Don’t stop taking your drug right away even if you do gain a little bit of weight. You’ll need to work with your doctor to find an antidepressant that helps with your depression symptoms and doesn’t result in unwanted side effects. This may take a little bit of patience.

Your doctor can also give you some tips for preventing weight gain while on antidepressant therapy.

Last medically reviewed on April 18, 2019

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

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Medically reviewed by Alan Carter, Pharm.D. — By Jacquelyn Cafasso — Updated on April 18, 2019

Weight gain. A side-effect of tricyclic antidepressants

. 1984 Oct;7(2):133-8.

doi: 10.1016/0165-0327(84)90031-4.

G H Berken, D O Weinstein, W C Stern

PMID:
6238068
DOI:
10. 1016/0165-0327(84)90031-4

G H Berken et al.

J Affect Disord.

1984 Oct.

. 1984 Oct;7(2):133-8.

doi: 10.1016/0165-0327(84)90031-4.

Authors

G H Berken, D O Weinstein, W C Stern

PMID:
6238068
DOI:
10.1016/0165-0327(84)90031-4

Abstract

Body weight and appetite were evaluated in 40 depressed outpatients from a private psychiatric practice who were receiving low-modest doses of tricyclic antidepressants. Amitriptyline (maximum of 150 mg/day), nortriptyline (maximum of 50 mg/day), and imipramine (maximum of 80 mg/day) were given for an average of 6 months of treatment. There was a mean weight increase of 1.3-2.9 lbs/month, which led to an average total weight gain of 3-16 lbs, depending on drug, dose and duration. These weight increases were linear over time and were accompanied by marked increases in the preference for sweets. Ultimately, excessive weight gain was the most common cause of discontinuation of treatment, occurring in one-half of the patients. Significant weight loss occurred upon discontinuation of drug. These findings show that chronic administration of low-modest doses of tricyclic antidepressants frequently cause considerable weight gain and can significantly interfere with the ability to provide long-term maintenance therapy.

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MeSH terms

Substances

Memorial Sloan Kettering Cancer Center

Adult Medication

Provided by Lexicomp ^® , this document contains all the information you need to know about this medicine, including indications, directions for use, side effects, and when your healthcare provider should be contacted.

Trade names: Canada

AG-Amitriptyline; Amitriptyline-10; Amitriptyline-25; APO-Amitriptyline; Elavil; JAMP-Amitriptyline; Mar-Amitriptyline; PMS-Amitriptyline; PRIVA-Amitriptyline; TEVA-Amitriptyline

Warning

Drugs like this have increased the likelihood of suicidal thoughts or actions in children and young people. This risk may be higher in people who have tried or had suicidal thoughts in the past. All people taking this drug must be closely monitored. If you develop or worsen disorders such as depression, nervousness, anxiety, grouchiness, panic attacks, and changes in mood or behavior, contact your doctor immediately. Contact your doctor immediately if you have suicidal thoughts or suicide attempts.
This drug is not approved for use in children. Consult your doctor.

What is this drug used for?

Used to treat depression.
This drug may also be used for other indications. Consult your doctor.

What should I tell my doctor BEFORE taking this drug?

If you have an allergy to this drug, any of its ingredients, other drugs, foods or substances. Tell your doctor about your allergies and how they have manifested.
If you have recently had a myocardial infarction.
If you have taken medications for depression or Parkinson’s disease in the past 14 days. These include isocarboxazid, phenelzine, tranylcypromine, selegiline, or rasagiline. An episode of very high blood pressure may occur.
If you are taking any of the following drugs: linezolid or methylene blue.
If you are taking cisapride.

This list of drugs and conditions that may interact with this drug is not exhaustive.

Tell your doctor and pharmacist about all medicines you take (both prescription and over-the-counter, natural products and vitamins) and any health problems you have. You need to make sure that this drug is safe for your conditions and in combination with other drugs you are already taking. Do not start or stop taking any drug or change the dosage without your doctor’s advice.

What do I need to know or do while taking this drug?

Tell all your health care workers that you are taking this drug. These are doctors, nurses, pharmacists and dentists. You may need to stop taking this drug before certain types of surgery, as told by your doctor. If you stop taking this drug, your doctor will tell you when you can start taking this drug again after your surgery or procedure.
Avoid driving and other activities that require increased attention until you see how this drug affects you.
To reduce the risk of dizziness or fainting, get up slowly from a lying or sitting position. Walking up and down stairs should be done with care.
Do not stop taking this drug abruptly without consulting your doctor. You may be at increased risk of withdrawal symptoms. If necessary, taking this drug should be stopped gradually, in accordance with the doctor’s instructions.
If you have high blood sugar (diabetes), you should check your blood sugar regularly.
Talk to your doctor if you have signs of high or low blood sugar such as fruity breath, dizziness, rapid breathing, tachycardia, confusion, drowsiness, feeling weak, flushing, headache, unusual thirst or hunger, frequent urination, tremors or sweating.
Check with your doctor before using alcohol, marijuana or other forms of cannabis, or prescription or over-the-counter drugs that can slow you down.
Some patients may be at increased risk of eye problems when using this drug. Your doctor may order an eye examination to see if you are at increased risk for these eye problems. Call your doctor right away if you have eye pain, vision changes, swelling or redness around the eye.
You can easily get sunburn when using this drug. Be careful if you will be in the sun. If you get sunburn easily while taking this drug, talk to your doctor.
Caution should be exercised in hot weather and during vigorous activity. Drink plenty of fluids to prevent dehydration.
Some people may develop a serious muscle disorder called tardive dyskinesia. This effect may decrease or disappear after discontinuation of the drug, but may persist. People with diabetes and older age groups, especially older women, are at increased risk. The risk increases with long-term use or high doses, but may also occur with short-term low doses. Call your doctor right away if you experience uncontrolled body movements or muscle disorders of the tongue, face, mouth, or jaw, such as protruding tongue, puffy cheeks, puckered lips, or involuntary chewing movements.
If you are 65 years of age or older, use this drug with caution. You may experience more side effects.
Tell your doctor if you are pregnant, planning to become pregnant, or breastfeeding. The benefits and risks for you and your child will need to be discussed.

What side effects should I report to my doctor immediately?

WARNING. In rare cases, this drug can cause serious and sometimes deadly side effects in some patients. Call your doctor right away or get medical help if you have any of the following signs or symptoms that could be associated with serious side effects:

Signs of an allergic reaction such as rash, hives, itching, red and swollen skin with blisters or peeling, possibly in combination with fever, wheezing or wheezing, tightness in the chest or throat, difficulty breathing, swallowing or speaking, unusual hoarseness, swelling in the mouth, face, lips, tongue or throat.
Signs of high or low blood pressure, such as a very severe headache or dizziness, fainting, or changes in vision.
Signs of liver problems such as dark urine, fatigue, lack of appetite, nausea or abdominal pain, light-colored stools, vomiting, yellowing of the skin or eyes.
Weakness on 1 side of the body, difficulty speaking or thinking, problems with balance, sagging on one side of the face, or blurred vision.
Chest pain, angina pectoris, tachycardia, or abnormal heart rhythm.
Feelings of confusion, inability to concentrate, or changes in behavior.
Obstruction of the urinary tract.
fever, chills, sore throat; the appearance of bruising and bleeding for unexplained reasons; pronounced feeling of tiredness or weakness.
Inflammation.
Shiver.
Seizures.
Hallucinations (a person sees or hears something that is not in reality).
Unusual sensations of burning, numbness, or tingling.
Change in sex drive.
Inability to achieve or maintain an erection.
Swelling of testicles.
Enlargement of the mammary glands or the appearance of discharge from the nipples.
Severe constipation or abdominal pain. These may be signs of a severe bowel disorder.
Absence of sweating during physical exertion or at high ambient temperatures.
Sleep disorders.
Nightmares.
Tinnitus.
Changing the color of the tongue.
Excessive sweating.
Joint pain.
Hair loss.

What are some other side effects of this drug?

Any medicine can have side effects. However, for many people, side effects are either minor or non-existent. Contact your doctor or seek medical attention if these or any other side effects bother you or do not go away:

Constipation, diarrhea, abdominal pain, nausea, vomiting, or decreased appetite.
Feeling dizzy, drowsy, tired or weak.
Dry mouth.
Headache.
Anxiety.
Nervous tension and agitation.
Change in the ability to perceive taste.
Weight gain or loss.
Ulcers in the mouth.

This list of possible side effects is not exhaustive. If you have any questions about side effects, please contact your doctor. Talk to your doctor about side effects.

You can report side effects to the National Health Board.

You can report side effects to the FDA at 1-800-332-1088. You can also report side effects at https://www.fda.gov/medwatch.

What is the best way to take this drug?

Use this drug as directed by your doctor. Read all the information provided to you. Strictly follow all instructions.

When taken once a day, take this medication 30 minutes before bedtime.
Keep taking this drug as instructed by your doctor or other health care professional, even if you feel well.

What if I miss a dose of a drug?

Take the missed dose as soon as you can.
If it’s time for your next dose, don’t take the missed dose and then go back to your regular dosing schedule.
Do not take 2 doses or an additional dose at the same time.

How do I store and/or discard this drug?

Store at room temperature in a dry place. Do not store in the bathroom.
Keep all medicines in a safe place. Keep all medicines out of the reach of children and pets.
Dispose of unused or expired drugs. Do not empty into a toilet or sewer unless instructed to do so. If you have any questions about disposing of medicines, ask your pharmacist. Drug disposal programs may be in place in your area.

General information about medicines

If your health does not improve or even worsens, see your doctor.
Do not give your medicine to anyone and do not take other people’s medicines.
Some medicines may come with other patient information leaflets. If you have questions about this drug, talk with your doctor, nurse, pharmacist, or other health care professional.
A separate instruction for patients is attached to the drug. Please read this information carefully. Reread it each time you refill your supply. If you have any questions about this drug, ask your doctor, pharmacist, or other health care professional.
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Last revision date

2023-03-28

Copyright

Date last updated

Monday, December 12, 2022

The use of amitriptyline in the treatment of children with cancer

Antidepressant

Trademarks:

Elavil®

Often used for:

Depression, prevention of headaches, neuralgia, sleep disorders

Amitriptyline is an antidepressant. It is sometimes prescribed for the prevention of headaches, as well as for neuralgia and sleep disorders.

During the first few months of antidepressant therapy, some children and young adults may become more prone to suicidal thoughts or actions. Tell your healthcare professional if you notice any unusual or sudden changes in mood, behavior, thoughts, or emotional state.

Oral tablets

Increased fatigue
Vision problems (dry eyes, blurred vision or eye pain)
Dry mouth
Drowsiness, dizziness or feeling unsteady
Nausea and vomiting
Constipation or diarrhea
Change in urine volume or frequency
Excitation, nervousness, irritability
Headaches
Skin irritation, rash

Skin sensitization to sunlight
Weight gain or loss
Fever with increased sweating
Change in blood sugar level
Hallucinations
Convulsions
Low blood pressure
Irregular or rapid heartbeat

The listed side effects are not observed in all patients who are prescribed amitriptyline. The most common side effects are highlighted in bold, but others are not excluded. Report all possible side effects to your doctor or pharmacist.

Be sure to discuss these and other recommendations with your doctor or pharmacist.

If you take amitriptyline to treat depression, the drug starts working after a few weeks.
When amitriptyline is taken for the treatment of neuralgia, it takes 5 to 7 days for the effects to appear.
Pregnant, planning pregnancy or breastfeeding patients should notify the attending physician.

Taking amitriptyline at home:

Taking this drug may cause dizziness or drowsiness and increase the risk of fainting. Do not drive or engage in hazardous activities until a drug reaction has been identified.
In most cases, amitriptyline is taken once (1) times a day. Taking at night may help avoid feeling sleepy during the day. If you have problems sleeping during therapy with amitriptyline, take the drug in the morning.