Antidepressants and Weight
Another, less well-documented side effect of antidepressants is weight gain. Go on any health message board and you’ll read accounts of patients disturbed by the amount of weight they’ve gained -- or in a few cases, lost -- since going on an antidepressant.
One of the problems, says Gaynes, is knowing how much of the weight gain or loss can be attributed to the drug and how much can be attributed to other factors, such as a person’s normal behaviors around food.
Yet some reliable medical studies have shown that long-term use of antidepressants can raise the risk of weight gain and related illnesses -- type 2 diabetes and hypertension.
“Weight gain and loss of sexual interest and performance are the main things I hear about,” says Myrna Weissman, PhD, a clinician and epidemiologist at Columbia University. “The new drugs typically claim to have fewer side effects, but I don’t know that the data supports that. Sometimes there are pretty striking weight gains.”
Some studies and anecdotal evidence suggest that bupropion (Wellbutrin), which works on both the serotonin and dopamine chemicals in the brain, may be less likely to cause weight gain than commonly prescribed selective serotonin reuptake inhibitors (SSRIs) like citalopram (Celexa), sertraline (Zoloft), and paroxetine (Paxil).
Antidepressants and Sleepiness
Certain antidepressants are more energizing, which may be right for someone who feels sleepy often. Other antidepressants tend to have drowsiness as a side effect, which may be good for people who are often anxious.
For example, drugs like mirtazapine (Remeron), which can cause weight gain and sleepiness, may be the right drug for patients who have trouble sleeping, or gaining weight.
If you feel sleepy on your antidepressant, talk to your doctor. You have many options.
Antidepressants, Talk Therapy, and Challenges
In addition to physical symptoms, recovering patients may experience new challenges as the wool of depression is pulled from over their hearts and eyes.
“People sometimes get worse in therapy before they get better,” says Gabrielle Melin, MD, clinical psychiatrist at the Mayo Clinic in Minnesota. “Talk therapy takes work. It takes emotional energy. It can be physically draining, too. But sometimes you’ll feel worse in the process of getting to where you want to be and who you want to be.
“Depression can mask a lot of things. You get so wrapped in a fog and feel so awful that you don’t have the energy to deal with real problems. Sometimes depression is self-protective because it limits the energy you have to go to certain places.”
To a lesser extent, even taking a pill can create an environment of new stresses. “You’re feeling better, more aware, more focused – sometimes you’re more able to recognize things you were doing wrong,” says Melin. “Your attention and focus can be profoundly affected.”
When her patients feel better, Melin says, she may encourage them to work on feelings and behaviors in talk therapy. If a drug helps a patient lift the veil of listlessness and hopelessness, he or she will have more energy to work on fixing problems in life and relationships.