What are the most effective antidepressants for weight loss?

From the Guidelines

Bupropion is the most effective antidepressant for weight loss, with a pooled weight loss of 2.77 kg at 6 to 12 months, as reported in a study published in the Annals of Internal Medicine 1. When considering antidepressants for weight loss, it's essential to prioritize medications that have a positive effect on weight.

• Bupropion has been shown to be effective for weight loss, with a modest weight loss of 2.77 kg at 6 to 12 months, as reported in a study published in the Annals of Internal Medicine 1.
• Fluoxetine has also been studied for weight loss, with a pooled weight loss of 4.74 kg at 6 months and 3.15 kg at 12 months, but the doses used for weight loss are higher (60 mg) than those used for depression (20 mg) 1.
• Other antidepressants, such as sertraline and topiramate, have limited evidence to support their use for weight loss, with only one small study for sertraline and only one published study for topiramate 1.
• It's crucial to note that antidepressants should never be prescribed primarily for weight loss, but rather for the treatment of depression or anxiety, with weight effects being a secondary consideration.
• The choice of antidepressant should be based on individual patient needs, medical history, and overall treatment goals, and should always be made in consultation with a healthcare provider.

From the FDA Drug Label

Table 5: Incidence of Weight Gain or Weight Loss (≥5 lbs) in MDD Trials Using Bupropion HCl Sustained-Release Weight Change Bupropion HCl Sustained- Release 300 mg/day (n=339) Bupropion HCl Sustained- Release 400 mg/day (n=112) Placebo (n=347) Gained >5 lbs 3% 2% 4% Lost >5 lbs 14% 19% 6%

Table 6: Incidence of Weight Gain or Weight Loss (≥5 lbs) in SAD Trials Using Bupropion HCl Extended-Release Weight Change Bupropion HCl Extended-Release 150 to 300 mg/day (n=537) Placebo (n=511) Gained >5 lbs 11% 21% Lost >5 lbs 23% 11%

Bupropion appears to be associated with weight loss, with 14% to 19% of patients losing more than 5 pounds in MDD trials and 23% of patients losing more than 5 pounds in SAD trials 2.

• In contrast, fluoxetine is associated with weight loss in some patients, but the effect is less pronounced, with 1.4% of patients treated with fluoxetine reporting weight loss in clinical trials for major depressive disorder, and patients treated with fluoxetine 60 mg on average losing 0.45 kg compared with a gain of 0.16 kg by patients treated with placebo in the 16-week double-blind trial 3. Key points:
• Bupropion is associated with a higher incidence of weight loss compared to fluoxetine.
• The weight loss effect of bupropion is more pronounced in SAD trials compared to MDD trials.

From the Research

Antidepressants for Weight Loss

• Bupropion is an antidepressant that has been shown to be effective in promoting weight loss, particularly in patients who are resistant to other treatments 4, 5.
• Studies have demonstrated that bupropion is more likely to cause weight loss than weight gain, making it a potential option for patients who are concerned about weight gain associated with other antidepressants 4.
• The mechanism of action of bupropion is not fully understood, but it is thought to involve the inhibition of the reuptake of noradrenaline and dopamine, which may contribute to its weight loss effects 6.
• Other antidepressants, such as fluoxetine, have been shown to have varying effects on weight, with some studies suggesting that they may lead to weight gain 7.
• Probiotics, such as Lactobacillus and Bifidobacterium, have also been investigated as a potential treatment for depression and anxiety, and may have a role in promoting weight loss, particularly when administered in high doses 8.

Comparison of Antidepressants

• Bupropion has been compared to other antidepressants, such as fluoxetine, in several studies, with mixed results 5, 7.
• One study found that bupropion was effective in promoting weight loss and improving depressive symptoms in patients who were resistant to fluoxetine 5.
• Another study found that bupropion and fluoxetine had similar efficacy in relieving depressive symptoms, but bupropion was associated with fewer side effects, including weight gain 7.

Potential Benefits and Limitations

• Bupropion may be a useful option for patients who are concerned about weight gain associated with other antidepressants, or who have not responded to other treatments 4, 5.
• However, more research is needed to fully understand the effects of bupropion on weight loss and depressive symptoms, and to determine its potential benefits and limitations compared to other antidepressants 4, 6.
• Probiotics, such as Lactobacillus and Bifidobacterium, may also have a role in promoting weight loss and improving depressive symptoms, but more research is needed to confirm their efficacy and safety 8.