- Why Do I Gain Weight On Antidepressants?
QUESTION:
Dear Dr. Heller,
I have depression and much-reduced BPD (it was a bigger problem in my teens and twenties). My problem is that though medication helps me a lot, I can’t handle the weight gain. I don’t believe that my anxiety level gets worse on SSRI’s. Can you help?
I am 42. About 8 years ago I experienced a 50 pound weight gain with a tri-cyclic amines antidepressant, which I then became aware was not unusual. After getting off it for about a year, and readily losing about 25 pounds, I took Prozac which helped me immensely psychologically. I had no side effects of feeling more anxious. It relieved my anxiety, agitation, and depression. However, I put on another 35 pounds. Then I got off Prozac (after about 3 years) and tried Paxil. Once again I gained lots of weight (added another 10 pounds on my maximum weight).
My sense is that I lose the ability to know when I am full – that I don’t get a sense of being “done” or even feeling “stuffed”. I have trouble controlling my intake, and I also feel that even at the beginning there is a metabolism shift. It feels if my skin is crawling. Is this common, and is there a medication that is known to consistently avoid this effect?
Thank you very much.
ANSWER:
Tricyclic antidepressants can cause weight gain, and can be used to stimulate appetite in those who are underweight or have lost their appetite. In my experience, the most common cause for weight gain with the SSRI’s in an individual with the BPD is the generalized anxiety disorder (GAD). Many individuals interpret their anxiety level as meaning the GAD, but actually the GAD is a genetic trait with primarily persistent worry, or the mind never shutting down. Those with the BPD and GAD treated with an SSRI get some anxiety relief from the SSRI, yet at the same time their GAD is actually increased. The increased GAD causes an increase in BPD dysphoria (anxiety, rage, depression and despair) – which can result in the skin crawling sensation and is often “self-medicated” with food. Since the food is being used to “treat” dysphoria, there is no satiety effect. I go into the GAD/SSRI/BPD phenomenon at length in “Biological Unhappiness.” Many studies have been done on SSRI’s and weight gain/loss with no consistent findings. I recommend looking at the screening test.
