COMMON Medications that can CAUSE weight gain and obesity
SUPER BRIEF SUMMARY
Common depression / chronic pain medications associated with WEIGHT GAIN:
SSRIs
Fluoxetine (Prozac)
Citalopram (Celexa)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Paroxetine (Paxil)
SNRIs
Duloxetine (Cymbalta)
Venlafaxine (Effexor)
TCAs
Amitriptyline (Elavil)
Nortriptyline (Pamelor)
Atypical Antidepressants
Mirtazapine (Remeron)
Trazodone
Anticonvulants (used for pain)
Gabapentin (Neurontin)
Pregabalin (Lyrica)
Carbamazepine (Tegretol)
Common depression / chronic pain medications associated with WEIGHT LOSS:
Atypical Antidepressants
Bupropion (Welbutrin)
Antivonvulsants
Topiramate (Topamax)
Yep, unfortunately the WEIGHT LOSS list is REALLY short
THE WHOLE TALK
Depression and chronic pain have become ever more present in our society. Methods for trying to help patients with these problems are multifaceted (physical therapy, psychotherapy, counseling, etc.). However, given Western medicine’s general focus on pharmaceuticals, many patients are also taking medications for depression and chronic pain. A recent 2022 article titled “Weight-Centric Treatment of Depression and Chronic Pain” provides an excellent summary [1].
Did you know, many of these potential medications are associated with weight gain?
This can be especially disturbing when you consider the association and codependence between overweight/obesity and depression/chronic pain. Often, there is a real chicken and egg question here. Somebody with depression may become more sedentary, cope with food, develop body image problems. This can lead to weight gain which can then lead to worsening depression [2]. The increased weight gain can cause chronic pain. For example, weight-bearing osteoarthritis is a consequence of obesity, and the decreased mobility secondary to osteoarthritis may contribute to further worsening of obesity [3]. Furthermore, a systematic review and meta-analysis on the effect of intentional weight loss on depression showed that patients with obesity experienced a reduction in symptoms of depression after weight loss trials [4].
Many physicians are either not aware of the weight effects of many medications, or forget to incorporate this into their routine explanation of medications. This is certainly understandable given the multiple competing priorities and requirements within your usual 15 minute visit. There is simply too much to cover in too little time.
Fortunately, we can all educate ourselves and be advocates in our own care (or reach out to your local Medical Weight Loss Doctor or Bariatrician for expert advice). The following is a brief primer on obesogenic (weight increasing) medications vs anorexogenic (weight decreasing) medications used for depression and chronic pain.
DEPRESSION MEDICATIONS
There are multiple classes of medications used for depression. The most common are as follow:
SSRI
SNRI
TCA
MAOI
Atypical anti-depressants
The following table from the Ghusn article organizes this nicely.
In very brief, almost all anti-depressants are associated with weight gain except a few.
Fluoxetine (Prozac) has a short term association with weight loss, but long term association with weight gain
Bupropion (Welbutrin) has a strong association with WEIGHT LOSS
CHRONIC PAIN MEDICATIONS
Similar to antidepressant medications, there are multiple classes of medications used for chronic pain.
Analgesics (think acetaminophen)
NSAIDS (ibuprofen, naproxen, etc)
TCAs
SNRIs
Anticonvulsants
The following table from the Ghusn article once again organizes this nicely.
Once again, a significant number of these very common medications are associated with weight gain.
Topiramate is the only medication in this metaanalysis associated with weight loss.
This is a call for patients, and more importantly, providers to take a weight centric approach to prescribing medications for depression and chronic pain. They are so integrally intertwined and codependent. Considering the potential harm involved with weight gain, it is necessary to take this approach.
Have questions, comments, concerns. Comment below, or feel free to reach out to the Premier Weight Solutions team. We’re here to help!
SOURCES
1. “Weight-Centric Treatment of Depression and Chronic Pain | Elsevier Enhanced Reader.” Accessed July 7, 2022. https://doi.org/10.1016/j.obpill.2022.100025.
2. Luppino FS, et al. Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatr 2010;67(3):220–9.
3. Kulkarni K, et al. Obesity and osteoarthritis. Maturitas 2016;89:22–8.
4. Fabricatore AN, et al. Intentional weight loss and changes in symptoms of depression: a systematic review and meta-analysis. Int J Obes 2011;35(11): 1363–76.
