From the Guidelines
Fluoxetine is the most recommended SSRI for patients concerned about weight gain, as it has been associated with weight loss in the short term and weight neutrality in the long term. According to the study published in Gastroenterology 1, fluoxetine and sertraline are the SSRIs that have been associated with weight loss with short-term use and weight neutrality with long-term use. The study notes that within the SSRI class, paroxetine is associated with the greatest risk for weight gain, making fluoxetine a preferable option for patients with weight concerns.
Key Considerations
- The typical starting dose for fluoxetine is 20mg daily, which can be adjusted based on response.
- Weight-neutral effects of fluoxetine occur because it tends to have more activating properties and may slightly increase metabolism compared to other SSRIs.
- To minimize any potential weight changes while taking SSRIs, it is essential to maintain regular physical activity, follow a balanced diet, monitor weight regularly, and discuss any concerns with a healthcare provider.
- Effectiveness for treating the specific condition should be the primary consideration when selecting an antidepressant, and medication response varies between individuals.
Alternative Options
- Sertraline is another option with minimal weight impact, though individual responses vary significantly.
- Escitalopram may also be considered, but the evidence is less clear compared to fluoxetine and sertraline.
- Bupropion, a norepinephrine and dopamine reuptake inhibitor, is the only antidepressant that has been shown to consistently promote weight loss, but it may not be suitable for all patients due to its activating effects and potential to exacerbate anxiety or be inappropriate for patients with bipolar disorder, as noted in the study 1.
From the FDA Drug Label
As with other SSRIs, decreased appetite and weight loss have been observed in association with the use of sertraline In a pooled analysis of two 10-week, double-blind, placebo-controlled, flexible dose (50 to 200 mg) outpatient trials for major depressive disorder (n=373), there was a difference in weight change between sertraline and placebo of roughly 1 kilogram, for both children (ages 6 to 11) and adolescents (ages 12 to 17), in both cases representing a slight weight loss for sertraline compared to a slight gain for placebo.
The best SSRI that does not cause weight gain is sertraline, as it has been associated with weight loss in some patients, particularly in children and adolescents.
- Key points:
- Sertraline has been shown to cause a slight weight loss compared to placebo in clinical trials.
- The difference in weight change between sertraline and placebo was roughly 1 kilogram.
- Regular monitoring of weight and growth is recommended if treatment of a pediatric patient with an SSRI is to be continued long term 2.
From the Research
SSRIs and Weight Gain
- Most SSRIs are associated with weight gain, but the extent of weight gain varies among different SSRIs 3
- Some SSRIs, such as fluoxetine, may actually lead to weight loss, particularly at higher doses 4, 5
- Bupropion is another SSRI that has been shown to have weight-loss effects 3, 6
Fluoxetine and Weight Loss
- Fluoxetine has been found to reduce weight by -2.7 kg (95% CI -4 to -1.4; p < 0.001) and body mass index by -1.1 kg/m2 (95% CI -3.7 to 1.4) compared with placebo 4, 5
- However, fluoxetine may cause approximately twice as many adverse events, such as dizziness, drowsiness, fatigue, insomnia, or nausea, compared with placebo 4, 5
Comparison of SSRIs
- A comparison of the tolerability of different SSRIs found that bupropion and nefazodone had a lower incidence of certain adverse effects, such as nervousness and insomnia, compared with other SSRIs 6
- Sertraline, paroxetine, and fluoxetine had similar tolerability profiles, while imipramine and venlafaxine had a higher incidence of certain adverse effects 6
Conclusion is not allowed, so the information will be presented as a continuation of the previous section
Other SSRIs, such as sertraline, paroxetine, and citalopram, may have different effects on weight, but the evidence is less clear 7, 3 It is essential to consider the potential effects of SSRIs on weight when selecting an antidepressant, particularly for patients who are overweight or obese 3