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Sunday, July 31, 2011

Weight and antidepressants – what's the connection?

Depression in the US is widespread, increasing gradually since WWII. More than 30 million Americans are thought to have depression, with two thirds of them women. Not surprising in the age of an economic crisis.

Many Americans with depression are now taking antidepressant medication, such as Celexa, Prozac, Wellbutrin or Elavil, to name a few.

Obesity in the US is even more widespread, with 70% of adults classified as overweight, and half of them classified as medically obese. The harmful consequences of obesity are well known; no need to repeat them here.

Does the use of antidepressants affect your weight? For many, this is a valid health question. For others, especially women (but not limited to women), it's also a social issue, a body-image issue, and many times a reason for refusing to use medically-necessary antidepressant medication.

Many patients on antidepressants gain weight. Is it a direct effect of the antidepressant, or is it that some patients begin to enjoy life more, and "celebrate" it with more eating.

Others lose weight. Is this a direct effect of the medication, or is it that these patients can now better deal with the realities of life and better control their eating habits and exercise?

While the jury is still out on this question, some answers begin to emerge. A meta-analysis (a statistical analysis of related research) that appeared in October of last year in the respected Journal of Clinical Psychiatry indicates that the antidepressants Amitriptyline (Elavil) and Mirtazapine (Remeron) and Paroxetine (Paxil) are associated with weight gain, while the antidepressants Ffluoxetine (Prozac) and Buproprion (Wellbutrin) are probably associated with weight loss.

The pressure to treat overweight in both depressed and non-depressed patients has become so urgent that some antidepressants are now used "off label" for weight loss, either alone or in combination with prescription appetite suppressants.

So, if you're taking or contemplating the use of an antidepressant, and weight loss or weight gain is an issue for you, don't forget to discuss the specific pros and cons related to your situation, with your doctor.

In our office, we have the ability to make a very reliable estimate of your daily caloric requirements (we do this by measuring your actual oxygen consumption while at rest), and use that as a guide in treatment when a combination of depression and obesity exists.

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