How to overcome weight gain caused by common medications like antidepressants and steroids. Discover effective solutions to shed unwanted pounds and reclaim your health.

Understanding Medication-Induced Weight Gain

Many people living with chronic conditions, from autoimmune diseases to mood disorders, rely on powerful medications to manage their symptoms. However, some of these common drugs, such as antidepressants and corticosteroids, can have an unintended side effect – weight gain. In fact, a significant percentage of individuals taking these medications report experiencing unwanted pounds. This weight gain can be a frustrating and disheartening consequence, but there are effective strategies to combat it.

The Link Between Medications and Weight Gain

Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like Prozac, Zoloft, and Lexapro, are among the most common culprits when it comes to medication-induced weight gain. These drugs can lead to increased appetite and changes in metabolism, contributing to the accumulation of extra pounds. Corticosteroids, such as prednisone, also have the potential to disrupt the body’s electrolyte and water balance, as well as metabolism, resulting in weight gain, often concentrated in the abdominal area, face, and neck.

Strategies for Tackling Medication-Related Weight Gain

If you’ve experienced weight gain due to necessary medications, don’t lose hope. There are several effective steps you can take to combat this unwanted side effect and regain control of your health.

1. Manage Sodium Intake

Avoiding excessive sodium is crucial, especially for those on steroids or antidepressants. Steer clear of processed foods, canned goods, and fast food, as these are often high in sodium. Learn to read nutrition labels and aim to keep your daily sodium intake within the recommended range of 2,300 mg or less.

2. Focus on Nutrient-Dense, Low-Calorie Foods

Adopt the same healthy eating strategies you would use to manage weight, regardless of medication use. Choose fresh fruits and vegetables, fiber-rich complex carbohydrates, and stay hydrated by drinking plenty of water. These nutrient-dense, low-calorie options can help you feel full and satisfied without packing on extra pounds.

3. Engage in Regular Exercise

Physical activity is a powerful tool in the fight against medication-induced weight gain. Incorporate a mix of cardiovascular exercise, strength training, and flexibility routines into your weekly routine. Not only can this help you burn calories, but it can also boost your mood and overall well-being.

4. Consider Medication Adjustments

If weight gain becomes a persistent issue, talk to your healthcare provider about the possibility of switching to a different medication that may have a lower risk of this side effect. They may be able to recommend an alternative treatment option that can provide the desired therapeutic benefits without the unwanted weight gain.

5. Prioritize Stress Management

Chronic stress can contribute to weight gain, and it’s often a factor for those dealing with chronic health conditions. Implement stress-reducing practices, such as meditation, yoga, or other relaxation techniques, to help minimize the impact of stress on your body and mind.

6. Get Adequate Sleep

Proper sleep is essential for overall health and can play a role in weight management. Aim for 7-9 hours of quality sleep each night to support your body’s natural processes and prevent the negative effects of sleep deprivation, which can include increased appetite and weight gain.

7. Seek Support and Guidance

Navigating the challenges of medication-induced weight gain can be daunting, but you don’t have to go it alone. Consider working with a registered dietitian or a healthcare professional who specializes in weight management to develop a personalized plan that addresses your specific needs and concerns.

Reclaiming Your Health and Confidence

Experiencing weight gain due to necessary medications can be frustrating, but with a proactive and strategic approach, you can regain control and achieve your health and wellness goals. By implementing these proven strategies, you can effectively combat the unwanted side effects of your medications and reclaim your confidence and overall well-being.

7 Ways to Lose Weight Gain Caused by Medication

Antidepressants and steroids like prednisone often lead to extra pounds. If you’re experiencing weight gain from drugs like Lexapro or prednisone, there are choices you can make with regard to meals and exercise that can help.

People living with issues like autoimmune diseases, from Crohn’s to rheumatoid arthritis (RA), or mood disorders like depression have powerfully effective medications out there to help minimize or eliminate their symptoms so that they can live comfortably.

Yet some of the common drugs for these issues — like prednisone and other corticosteroids, and paroxetine (Paxil) and other antidepressants — have less-than-desirable side effects. One major side effect of these drugs is weight gain.

And while you should go easy on yourself — you’re battling an illness, after all — it can be a frustrating adverse effect.

Read on to find out the best ways to lose unwanted pounds brought on by medication you need.

Antipsychotic drugs, antidepressants, and mood stabilizers are common drugs that have the most potential to increase weight gain. All 12 of the leading antidepressants, including fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), make gaining weight more likely.

With approximately 13 percent of Americans currently taking antidepressants — and without medication options that don’t cause fluctuations in weight — a lot of people can’t avoid being put at higher risk for unhealthy weight gain.

Steroids like prednisone may also have similar effects. Alanna Cabrero, MS, a registered dietician at NYU Langone Health’s IBD Center, says steroids are often “used to tackle inflammatory conditions like IBD, Crohn’s, arthritis, lupus, and osteoarthritis.”

For some of these medications, nearly 70 percent of users reported weight gain as a side effect.

You might assume that you’d notice the pounds sliding on right away if your body is sensitive to this side effect. But a recent study found that isn’t the case. People taking antidepressants are most at risk for weight gain two to three years into treatment.

Medications that cause weight gain include:

• Antidepressants, such as:
  • selective
    serotonin reuptake inhibitors (SSRIs), including fluoxetine
    (Prozac), sertraline (Zoloft), escitalopram (Lexapro), citalopram (Celexa), and paroxetine (Paxil)
  • serotonin-norepinephrine
    reuptake inhibitors,
    including duloxetine (Cymbalta) and venlafaxine
    (Effexor)
  • tricyclic antidepressants (TCAs), including desipramine
    (Norpramin)
• Corticosteroids, such as:
  • budesonide, including Pulmicort
    and Symbicort
  • prednisone
  • methylprednisolone
• Drugs commonly
  prescribed for bipolar disorder and schizophrenia, such as:
  • olanzapine
  • risperidone
  • quetiapine

Drugs like corticosteroids alter the body’s electrolyte and water balances, as well as metabolism.

“Drugs like steroids decrease the body’s flushing out of sodium,” explains Cabrero.

Many people taking steroids report increased fat in the abdomen, face, and neck. Even if you can control the steroid-driven weight gain, it’s possible to look heavier because of redistributed fat.

Antidepressant-induced weight gain is tied to appetite changes. “With medications for depression, increases in appetite occur. Generally, then, anything becomes a little bit more appetizing — and our cravings usually don’t fall under fruits and vegetables,” Cabrero points out.

If you want to lose a few extra pounds that you’ve put on since taking a weight gain-inducing medication, you’re already on the right track.

“If you know that these medications have the potential side effect of weight gain, you can take the appropriate steps to be prepared,” says Cabrero.

Here are seven ways she recommends you take off — or fight off — unwanted pounds.

Avoiding too much sodium in your diet is smart for anyone looking to eat healthier. But patients on steroids or antidepressants might want to consider paying extra close attention.

That means avoiding processed foods, canned foods, and fast foods, since they’re often packed with sodium.

“Eight percent of our sodium intake comes from these foods,” says Cabrero. “The general population in the U.S. has 3,300 to 3,500 mg of sodium per day, when it should fall more around 2,300 mg. Reduce these foods that have naturally a ton of sodium.”

Cabrero recommends you learn how to read nutritional labels in order to understand what’s in your food.

To curb weight, use the same strategies you’d use to
control weight with or without the added effects of medication. Choose
low-calorie foods like fresh fruits and vegetables, eat fiber-rich and
slow-to-digest complex carbohydrates, and drink lots of water.

People taking antidepressants should also be aware of hyponatremia, which is low sodium in the blood. This is especially important in the first 28 days of starting antidepressants, as low sodium levels can lead to more severe health problems.

If you’ve been newly prescribed an antidepressant, your doctor should monitor you for signs of hyponatremia, including:

• dizziness
• nausea
• lethargy
• confusion
• cramps
• seizure

Your doctor can help you avoid hyponatremia.

Eating a potassium-rich diet is great for people who are looking to lose weight gained because of medication — potassium flushes out sodium. And a potassium-rich diet is linked to other health benefits, such as reduced blood pressure, protection against stroke, and osteoporosis prevention.

Potassium-rich foods include:

• bananas
• sweet potatoes
• avocados
• coconut water
• spinach
• black beans
• edamame
• potatoes
• beets

Managing your condition is a priority, so there may not yet be any options that cause little to no weight gain.

Still, ask your doctor if there are any alternative medications or treatments that would maintain your health without the extra pounds.

For people on steroids, ask if going on the shortest, most effective dose is a possibility.

If you’re taking antidepressants, bupropion (Wellbutrin) may be less likely to cause weight gain.

Your appetite can increase while taking specific medications, so you may be tempted to eat more.

Instead of having three massive meals throughout the day, breaking up your food into smaller, more frequent meals can make you feel like you’re consuming more calories because you have little time between snacks to be hungry.

It’s recommended to stave off hunger by eating six small meals a day versus
three large ones.

Cabrero suggests you try to integrate nonstarchy veggies, or what she calls “volume-rich foods,” into your diet. “They’re nutritious and don’t have a lot of calories,” says Cabrero. Experiment beyond cut-up carrots: try veggie soups and salads.

Staying active is important for overall health as well as weight loss or maintenance. Depending on your level of health or current symptoms, you may want to consult your doctor first.

“Depending on what other symptoms are going on, physical activity is something to be sure to do,” says Cabrero. “You might not be as active as you were before, but light yoga, walking, or something along those lines helps to keep you mobilized and improves overall health.”

For people who have come off medication, intermittent fasting can be an effective way to lose weight, provided it’s recommended by your doctors.

“I usually suggest a gut rest. This is a 12-hour window when you don’t eat, which should start about 2 to 3 hours before bed,” says Cabrero. “A lot of times after dinner we end up snacking on foods that are not nutritious, nor are even related to hunger.”

A good night’s sleep can do wonders when you’re trying to lose weight, especially if you’re taking steroids for any condition.

“With steroid use, patients find that they won’t sleep well, and that increases your appetite for sugary foods because you need that energy burst,” says Cabrero.

Here are 10 ideas for natural ways to sleep better.

Meagan Drillinger is a travel and wellness writer. Her focus is on making the most out of experiential travel while maintaining a healthy lifestyle. Her writing has appeared in Thrillist, Men’s Health, Travel Weekly, and Time Out New York, among others. Visit her blog or Instagram.]

Does Prozac cause weight gain or loss?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on Feb 17, 2023.

Initially, you may lose a small amount of weight, about 1 kg (2.2 lb) on average, when you first start taking Prozac, but over the long-term you may gain that weight back or even add on extra weight up to 6 kgs (13.2 lbs). Studies suggest this may be due to a recovery of your appetite after your symptoms subside. Weight changes may vary between patients, but in general Prozac is not usually associated with serious weight gain (over 7%).

In Prozac studies, weight loss has been reported in about 2% of patients (2 out of every 100), but patient self-reports of weight gain have been much higher, up to 37% in one survey.

Selective serotonin reuptake inhibitors (SSRIs) available in the U.S. include:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Prozac (fluoxetine)
• Fluvoxamine (generic only)
• Paxil (paroxetine)
• Zoloft (sertraline)

Of all of the SSRIs, Prozac (fluoxetine) appears to be associated with the least chance for weight gain and Paxil (paroxetine) with the greatest chance. Paroxetine has been shown to lead to up to a 3.6% weight gain in about 6% of patients in one study. Other antidepressants, such the tricyclic antidepressants (TCAs) or mirtazapine can be associated with significant weight gain.

Why do weight changes occur with Prozac?

Weight gain

It is not fully clear if longer-term weight gain with selective serotonin reuptake inhibitors (SSRIs) is due to a drug side effect, the recovery of appetite after symptom recovery, or a mix of both. Short-term Prozac treatment for up to 3 months usually leads to little weight change, but most patients need medication for longer periods. Other reasons for weight gain with SSRIs may include genetic differences and increased carbohydrate cravings.

Weight loss

Weight loss during early treatment with Prozac may also be due to stomach (gastrointestinal) side effects. All SSRIs can cause some degree of short-term nausea and digestive tract discomfort when starting therapy or increasing the dose.

Over time, these common side effects tend to improve for most patients, but can include:

• loss of appetite (4% to 17% of patients)
• diarrhea (8% to 18% of patients)
• nausea (12% to 29% of patients)

Patients with diabetes may have trouble with low blood sugar levels while taking Prozac, but blood sugar levels may increase when treatment is stopped. Your healthcare provider may need to adjust your dose of diabetes medications.

Other common side effects with SSRIs include sexual dysfunction, insomnia, headache, dry mouth, sedation, sweating, tremor, agitation and orthostatic hypotension (low blood pressure, dizziness when standing). Serious side effects like suicidal thoughts, bleeding, abnormal heart rhythms can also occur with SSRIs.

Studies: Weight Changes with Prozac

In studies looking at weight changes with Prozac (fluoxetine), weight loss has ranged from about 0.2% of body weight to a gain of about 1%.

Study 1

In a one-year randomized study, patients whose depressive symptoms had subsided after 12 weeks of treatment with fluoxetine 20 mg/day received either fluoxetine or a placebo (an inactive treatment) for 38 weeks. Weight changes were assessed during the initial 12 weeks of treatment and after 14, 26, and 38 weeks (for a total of 50 weeks).

• During the initial 4 weeks of treatment, an average weight decrease of 0.4 kg (0.9 lb) was observed for all patients. After 50 weeks, weight increases were similar between the Prozac and placebo-treated groups. An average weight gain of 3 kg (6.6 lb) was observed over the entire 50-week period in the fluoxetine group, compared to 3. 2 kg (7 lb) for the placebo group.
• Weight gain was associated with a poor appetite at the beginning of treatment and an improved appetite after depressive symptoms cleared. Weight gain was not associated with the patient’s body weight at the start of the study.
• No patients stopped Prozac treatment due to weight gain.

Study 2

In another study in 284 patients with major depressive disorder, long-term weight changes with Prozac were assessed when compared to paroxetine (Paxil) or sertraline (Zoloft), other commonly used SSRIs. Patients were evaluated for a total of 26 to 32 weeks.

• Researchers looked at the average change in weight in each group and the number of patients with at least a 7% increase in weight from the start of the study.
• Patients treated with paroxetine (Paxil) had a significant increase in weight, and those with a 7% or greater weight increase were highest in this group. Patients receiving fluoxetine (Prozac) or sertraline (Zoloft) had a modest but nonsignificant weight increase.

Bottom Line

• Prozac is associated with a low amount of weight gain over the long- term compared to many SSRIs. Early in treatment, during the first few weeks it can cause a slight weight loss, but usually only about a pound or so.
• It appears weight loss may be due to adverse stomach side effects like nausea or loss of appetite in the short-term, while weight gain may occur over the longer-term due to improved appetite and social functioning with improved mood.
• If you are concerned about weight gain or loss with any antidepressant treatment, speak with your healthcare provider. There are many options to treat depression, some that have fewer side effects like weight gain. Do not stop treatment on your own without speaking to your healthcare provider.

This is not all the information you need to know about Prozac (fluoxetine) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.

References

• Michelson D, Amsterdam JD, Quitkin FM, et al. Changes in weight during a 1-year trial of fluoxetine. Am J Psychiatry. 1999 Aug;156(8):1170-6. doi: 10.1176/ajp.156.8.1170. 
• Fava M, Judge R, Hoog SL, et al. Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry. 2000 Nov;61(11):863-7. doi: 10.4088/jcp.v61n1109. 
• Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry. 2010 Oct;71(10):1259-72. doi: 10.4088/JCP.09r05346blu. 
• Anagha K, Shihabudheen P, Uvais NA. Side Effect Profiles of Selective Serotonin Reuptake Inhibitors: A Cross-Sectional Study in a Naturalistic Setting. Prim Care Companion CNS Disord. 2021 Jul 29;23(4):20m02747. doi: 10.4088/PCC.20m02747. 
• Hirsch M (author). Selective serotonin reuptake inhibitors: Pharmacology, administration, and side effects. Up to Date. https://www.uptodate.com/contents/selective-serotonin-reuptake-inhibitors-pharmacology-administration-and-side-effects
• Prozac Weekly. Professional. Prescribing information. Accessed Dec. 8, 2022 at https://www.drugs.com/pro/prozac-weekly.html#s-42231-1

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Medical Disclaimer

Hormones and their effect on weight

The effect of hormones on weight regulation in women is known to many. This is especially true for middle-aged women. Today, when hormone tests have become publicly available, it has become possible to identify any hormonal disorders that can lead to excess weight.

So, the main hormones that affect weight are: estrogens, progesterone, testosterone, DHEA, prolactin, cortisol, insulin and thyroid hormones.

Estrogens

There are three types of estrogen in our body: estradiol, estrone and estriol. These three types are not interchangeable, as they have a decisive influence on the female body in middle age.

Estradiol – the dominant estrogen in the human body – is produced by the ovaries, and during menopause, its formation completely stops. Estradiol increases insulin sensitivity, increases energy, induces a good mood, promotes clarity of thought, good memory, ability to focus, normal blood pressure, optimal bone density, improved sleep, sexual desire and a normal, active metabolic process.

Decreased estradiol levels in middle age lead to reduced release of serotonin. The loss of serotonin leads, in turn, to depression, irritability, anxiety, increased sensitivity to pain, indigestion, obsessions, and disturbed sleep patterns. Each of these factors can slow down the metabolism, and therefore reducing the amount of estradiol leads to the problem of excess weight and difficulty in dropping it.

Progesterone

Progesterone prepares the body for pregnancy and childbearing, so the woman begins to eat for herself and for the baby. Progesterone levels are high in the second half of the cycle, which explains the appetite during this period. Other changes – fluid retention and breast enlargement – are also explained by the work of progesterone in preparation for pregnancy.

Progesterone slows down the movement of food through the digestive tract, which allows the female body to absorb more nutrients. In times of famine, this should serve pregnant women well. (That’s why a woman can feel “bloated” during this period of her cycle.) Progesterone also affects the brain, which has a calming effect, but for many women, this leads to decreased activity and weight gain.

Testosterone

The female body has testosterone (in a tiny amount compared to the male body), and its content decreases with age. With the onset of menopause, testosterone in the female body begins to be produced 2 times less, but this can also happen at a younger age. Testosterone contributes not only to healthy sex drive, but also plays an important role in weight regulation. This hormone is anabolic, i.e. , it promotes the growth of muscle mass, and uses fats as fuel, which, in turn, helps to reduce weight.

I’ll cover this in more detail in Part 2, where you’ll learn that estradiol, along with testosterone, has a strong impact on weight and can help you achieve a healthy balance of muscle mass and less fat. Since women lose up to 95% of estradiol and over 50% of testosterone when the ovaries stop functioning normally, it is not surprising that in middle age they are forced to struggle with being overweight. After all, they lose a huge amount of hormones that promote muscle growth, prevent the deposition of fat and speed up metabolism.

DHEA

DHEA is another “male” hormone produced by the adrenal glands and also by the ovaries before menopause. DHEA has been touted as a weight loss hormone, but is only effective for men. Modern research has proven that women who take this hormone gain weight and experience many side effects – hair loss and their appearance on the face, acne, cravings for sweets, restless sleep and irritability. Medicines containing DHEA are widely available, but because the doses of the hormone in them are too high for women, unwanted side effects are often encountered.

Thyroid hormones

T3 and T4 are the main thyroid hormones produced by the thyroid gland. These are the main regulators of the metabolic process, since they regulate the use of energy and its reproduction in all cells and tissues of the body. Metabolism depends on the normal functioning of thyroid hormones and the chemical reactions they cause at the cellular level. With a decrease in thyroid hormones, especially when the functioning of ovarian hormones is disrupted, women gain weight very easily, even if they begin to consume low-calorie foods. Sometimes, in cases of excessive amounts of thyroid hormones, women gain weight in the first half of the cycle due to increased appetite associated with the activity of these hormones.

Cortisol

Cortisol is known as the stress hormone, the level of which rises in the presence of one second or prolonged stimulation. Short and strong stress also causes the release of adrenaline. However, due to both short-term and long-term reactions to stress and irritants, fat in the waist and entire abdomen is deposited rather than split. Why? After acute stress, you feel hungry due to the release of adrenaline into the bloodstream, this leads to a desire to eat, especially sweets, and as a result you eat more than you need. Chronic stress leaves you overworked, completely exhausted and craving “soothing food” – sweets.

Insulin and glucagon

Insulin and glucagon affect the amount of glucose (“sugar”) in the blood, as well as the ratio of fat to muscle mass. They are called counter-regulatory hormones because they have the opposite effect on blood sugar (glucose). Insulin lowers glucose levels by causing it to move from the blood to muscle cells, where it is burned for energy, or to fat cells, where it is stored. The rate and amount of insulin formation depends on the foods we consume, their combination and the time they enter the body. The action of glucagon is opposite to that of insulin. When the brain becomes aware that the amount of sugar in the blood is decreasing, glucagon causes the liver to “push” the glucose out of the fats into the bloodstream, where it enters the cells and is burned. Insulin production is influenced by ovarian hormones, and vice versa. At high level insulin with resistance to it (insulin resistance) the woman’s waist begins to gain weight. A similar violation of the response to insulin is observed with polycystic ovaries and with a reduced amount of estradiol.

Prolactin

Prolactin is produced by the pituitary gland, and in large quantities it causes excess weight. Prolactin regulates milk production during breastfeeding. In men and non-pregnant women, its amount is less than 15-20 ng / ml, but in the last trimester of pregnancy, the level of prolactin rises to 300 ng / ml. In the first few months after childbirth, its level drops, even when the mother continues to breastfeed.

When the level of this hormone exceeds 15-20 ng / ml, the menstrual cycle becomes irregular, the formation of estradiol is suppressed. With prolonged release of a large amount of prolactin, menstruation may stop (amenorrhea), and milk will begin to flow from the breast (galactorrhea). This is clear evidence of high prolactin levels, which are associated with other problems often overlooked by doctors – weight gain, breast enlargement, headaches and depression.

Elevated prolactin levels affect weight by stimulating the breastfeeding mother’s appetite, causing her to consume more calories – for herself and her baby. But if you’re not breastfeeding, you don’t need to eat for two, and as a result, excess food gets stored in your body. Prolactin also affects weight by suppressing the work of the ovaries, which produce estradiol and testosterone, which are responsible for active metabolic processes, regulation of the ratio of insulin and glucose, and promote muscle and bone growth. Bone erosion leading to premature osteoporosis also points to an undertreated case of high prolactin levels.

With age and during menopause, the amount of this hormone increases, which affects the acquisition of excess weight in middle age. Its increased amount can also be caused by stress, exhausting workouts, hypothyroidism, nipple stimulation and a variety of common medications, such as Prozac, Paxil, Zoloft, Celexa, Luvox, tricyclic antidepressants – pamelor, amitriptyline and others, tagamet, pepsid, neuroleptics ( navan, haldol, mallaril and others). Some growths in the pituitary gland that produce a lot of prolactin can cause vision loss because these growths, even though they are benign in nature, put pressure on the optic nerve. If you suspect that you have high prolactin levels, your health care provider will suggest a simple blood test. For a more accurate result, the test should be performed from 7 to 8 in the morning.

All these studies are available to you in the OLIMP laboratory network, where they are performed on modern high-tech equipment, and the results of most analyzes are ready within a day.

whether they help, cure or relieve symptoms, cause addiction, gain weight

Checking myths

11/14/22

Daniil Davydov

medical journalist

Author profile

In 2017, 3.4% of the world’s population suffered from depression, i.e. 264 million people.

At the same time, the cures for this disease are surrounded by many myths. Antidepressants are accused of ineffectiveness and severe side effects, but often the problem is not with the drugs themselves, but with their misuse.

We collected 8 myths about antidepressants and found out how close they are to the truth.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don’t write prescriptions, we give recommendations. Relying on our point of view or not is up to you.

Myth 1

Antidepressants almost never help

Most likely, this myth arose due to the fact that antidepressants do not work in all patients – so even some doctors and scientists doubt their effectiveness. However, antidepressants cannot be called ineffective, there are just important nuances in the use of these drugs.

Antidepressants are a class of drugs that normalize the level of neurotransmitters, that is, chemicals that help nerve cells in the brain exchange information.

What are Antidepressants – International Drug Database RxLis

What Medications Help with Clinical Depression in Adults – International Primer for Physicians UpToDate

How Antidepressants Help Pain – Mayo Clinic Bulletin

All antidepressants that used to treat depression in Adults Working – The Lancet

Who Antidepressants Work and Who Don’t – Clinical Guidelines for British PhysiciansPDF, 141KB

These medicines help people whose problems are due to a deficiency or excess of neurotransmitters. Antidepressants reduce symptoms of depression, obsessive-compulsive disorder, generalized anxiety disorder, post-traumatic stress disorder, and bipolar affective disorder.

There is evidence that antidepressants are effective for chronic pain. Antidepressants increase the amount of neurotransmitters in the spinal cord, which reduces pain signals.

Most specialists have no doubts that antidepressants work. For example, according to the British Royal College of Psychiatry, 50-65% of people with depression who take antidepressants feel better – compared with 25-30% of those who take a placebo.

However, there are situations where the benefit of antidepressants is questionable. For example, antidepressants are good for treating moderate to severe depression, but do not work well for people with mild depression – psychotherapy is more suitable for them.

And there are situations when these medicines were prescribed by mistake. Then antidepressants really won’t help.

When antidepressants don’t help

Sergey Divisenko

psychotherapist

There are three cases when antidepressants most often cause problems.

The antidepressant didn’t work because the doctor prescribed the wrong dose. Minimum doses of these drugs do not help in half of the cases. Then competent doctors increase the doses to those recommended in clinical guidelines, while illiterate ones refuse them.

Sometimes, in order for antidepressants to work, they need to be augmented—i.e., enhanced—with other classes of drugs. For example, second-generation antipsychotics, or normothymics, that is, drugs that stabilize mood. If this is not done, the person taking antidepressants will not feel relief.

The antidepressant didn’t work because the doctor misdiagnosed and was trying to treat a condition that these drugs don’t work for. To help a person, one had to either use other drugs or use non-drug methods of treatment: for example, psychotherapy, transcranial stimulation, or electroconvulsive therapy.

For example, in bipolar disorder, symptoms can be very similar to depression or anxiety. But with bipolar disorder, antidepressants help only if they are used together with other drugs – mood stabilizers. By themselves, they will either work for a short time, or they will not work, or they can cause a phase inversion – that is, a person will switch from a depressive phase to a manic one.

The patient was not helped by a particular antidepressant, but another might. Antidepressants differ in the principle of action – on this basis they are divided into classes. It happens that one antidepressant does not work, but another from the same or another class helps. If the treatment does not work, you should not stop drug therapy, but continue to look for a drug that will help this particular patient.

Myth 2

Antidepressants only relieve symptoms, but do not eliminate the cause of the disorder

In most cases, this is not a myth. However, in some situations, antidepressants act on the cause of the disorder.

Depression is a heterogeneous disease. Experts identify a different number of subtypes of depression – from 4 to 12. But for our purposes, depression can be divided into two large subtypes.

American Criteria for Depressive Disorders – DSM-5PDF, 32MB

Understanding Depression – International Primer for Physicians UpToDate

illness, not associated with depression. Disorders that can be attributed to this group are more common.

If these causes affect a person long enough and he does not understand how to deal with them, depression may develop. In this situation, antidepressants act as drugs that alleviate the symptoms of the disease. To influence the cause of the problem, psychotherapy is needed.

Depression provoked by internal causes. Approximately 7% of people with depression have the correct way of thinking, there are no internal conflicts and injuries, and there are no serious illnesses. In this situation, the cause of depression is the lack of neurotransmitters: serotonin, norepinephrine and dopamine in the synapses of brain nerve cells. In such people, the antidepressant acts precisely on the cause of the disease, that is, it corrects the production of serotonin in neuronal synapses.

Myth 3

As soon as it gets better, you can stop taking the antidepressant

This is also not entirely a myth – it would be more correct to call it a belief that is true only for some, but not for all patients with depression.

It is generally advised to continue taking antidepressants for at least six months after remission. If the duration of the disease is short, that is, the person was ill for about two weeks, then for the onset of remission, one or two months usually need to take medication. If the duration of the disease is long, from several months or years, then more time is required for the onset of remission. It’s impossible to say exactly how much: different people with depression have different recovery times.

Some people have recurrent depression. In this case, the period during which you need to take the medicine depends on how many bouts of depression have already been during your life. If more than three, it is recommended to take antidepressants for several years or for life.

Myth 4

Antidepressants cause addiction

Perhaps the roots of this myth are that some people need to take depression medication for life. And at the beginning of treatment, some patients have to increase the dose. But in fact, antidepressants do not cause either true physical or drug dependence.

True physical dependence on a drug is a situation where a person becomes so addicted to a drug that when it is withdrawn, the symptoms of the disease sharply increase. People who are dependent on the drug have to increase the dosage, otherwise the drug stops helping.

What is True Drug Addiction—Bulletin of the National Institute for the Study of Drug AbusePDF, 7 MB

What is Drug Addiction—Bulletin of the American Psychiatric Association

Drug dependence may include physical dependence on a drug. But this addiction has a unique feature. Dependence can also develop in a healthy person who used the drug not to recover, but to enjoy. But when he tries to quit the drug, he still experiences physical suffering, which is called the withdrawal syndrome. As a result, a person is forced to look for a new dose of a drug.

Although a person who takes antidepressants to treat depression gets better, the drugs themselves are neither pleasurable nor addictive. Taking them as drugs is useless.

Of all the drugs that are used in psychiatry, true physical dependence can only be caused by psychostimulants that activate mental activity and anti-anxiety, that is, benzodiazepine tranquilizers. Antidepressants are not included in this list, because there is no need to increase the dosage of correctly selected drugs from this group.

However, some people who stop taking antidepressants early sometimes experience withdrawal symptoms such as nausea, hand tremors, and some feel “shocks” in the head, similar to the sensations of an electric shock. Depressive symptoms return to patients who need to take the medicine for a very long time.

Antidepressants are sometimes abused, but they cannot cause addiction – Journal of Modern Psychiatry

To avoid unpleasant consequences, stop taking antidepressants only if the attending physician says that they are no longer needed. But even in this situation, it is necessary to cancel antidepressants slowly, that is, gradually reducing the dose. This will help avoid unpleasant side effects.

Myth 5

A person on antidepressants becomes lethargic and loses interest in life

This popular myth is based on real but outdated data.

These mental changes are seen in patients taking first-generation tricyclic antidepressants such as amitriptyline. It has a sedative, that is, a sedative effect. A person who takes high doses of amitriptyline can indeed become sleepy and indifferent to the outside world.

Amitriptyline – Sedative – Drugs.com International Drug Database

SSRIs do not sedate – Drugs.com International Drug Database

Current second-generation antidepressants that are recommended to start treatment with, such as selective serotonin reuptake inhibitors, or SSRIs almost never cause drowsiness and apathy.

On the contrary, in most people with depression they return interest in life.

Sometimes SSRIs do cause drowsiness, but this has not yet been proven

Sergey Divisenko

psychotherapist

It is believed that in rare cases, modern antidepressants can provoke SSRI-induced apathy. But this condition is extremely rare.

And even then psychiatrists still doubt that the cause is precisely in the drugs, and not in the patient’s condition. After all, some people during the time of taking antidepressants may develop other adverse mental states in which apathy occurs: for example, schizotypal disorder, which was not noticed before.

Myth 6

Antidepressants have many side effects

This is partly true: both SSRIs and antidepressants from other groups have side effects. But it is quite possible to deal with them.

At the beginning of treatment, when people first start taking antidepressants, many complain of increased anxiety, dry mouth, nausea, and trouble sleeping. But after a few days or weeks after the start of the course of treatment, these symptoms usually disappear. If the side effects do not stop, it makes sense to consult a doctor – he will replace the antidepressant.

Dealing with antidepressant side effects – tips from the Mayo Clinic staff

Here’s what to do before the side effects go away:

1. take your antidepressant with meals, unless the instructions say otherwise, so the antidepressant will be less annoying stomach;
2. put a bottle of clean water on the desktop – if your mouth is dry, you can take a sip. Unsweetened lollipops and chewing gum also help with dry mouth;
3. take a walk for at least half an hour before going to bed – this will make it easier to fall asleep. If you can’t sleep at all, you can ask your doctor to pick up sleeping pills.

The second most common side effect is an increase in anxiety at the beginning of antidepressant use. To avoid this problem, psychiatrists resort to two effective methods:

1. titrate the dose – that is, start with the minimum dose of the antidepressant, and then gradually increase it;
2. at the beginning of the reception, sedatives – tranquilizers are prescribed together with the antidepressant.

The third common side effect of SSRIs, especially sertraline, known as Zoloft, and escitalopram, better known as Cipralex, is decreased libido. Approximately 20-30% of people taking antidepressants from this group experience a decrease in sexual desire to one degree or another. At the same time, it is difficult to say how much the drugs are to blame, because approximately 35-50% of people with depression have already experienced sexual dysfunction.

Many people with depression experience sexual dysfunction before starting antidepressants – Harvard Medical School Bulletin

Switching to another antidepressant usually helps, but many people prefer to wait until the medication can be stopped. In some cases, psychiatrists prescribe antidepressants from other groups in addition to the libido-lowering antidepressant. Sometimes it helps to regain interest in sex.

Myth 7

Weight gain due to antidepressants

This is not a myth, but a half-truth. There are both antidepressants that contribute to weight gain, and those that do not have a similar effect.

The most common complaint about weight gain during treatment is people taking the tetracyclic antidepressant mirtazapine, which actually increases appetite. Another weight gaining antidepressant is paroxetine, better known by the trade name Paxil. But “Zoloft” and “Cipralex” do not contribute to weight gain.

If a patient feels that an antidepressant is causing them to overeat, it is wise to consult a doctor and discuss a change of drug.

Myth 8

Antidepressants are expensive

True, but not for all patients. Most people can cure depression and not go broke.

Antidepressants from different groups vary greatly in price. There are both very expensive drugs and relatively low-cost drugs among them. At the same time, both of them work equally well. However, there are situations when a cheap antidepressant cannot be dispensed with.

On the left – inexpensive “Zoloft” for 327 R, a drug based on sertraline, on the right – the most expensive antidepressant “Ixel” based on milnacipran for 2453 R

For example, there is a good antidepressant venlafaxine. The maximum dose of venlafaxine can reach up to 375 mg per day. If these are inexpensive tablets of a domestic manufacturer, then a course of treatment for a month costs about 2000 R. But sometimes inexpensive tablets are not very well tolerated: they cause headache, nausea, sweating, tachycardia, that is, rapid heartbeat. In such cases, you need to switch to a prolonged form of venlafaxine – “Venlafaxine Retard”, or “Velaxin XR”.