From the Guidelines
Bupropion is the most effective medication for anxiety in patients who have experienced weight gain as a side effect of Zoloft (sertraline).
Reasons for this choice
- Bupropion is a norepinephrine and dopamine reuptake inhibitor that has been shown to consistently promote weight loss 1.
- It is approved by the FDA for chronic weight management in combination with another medication, naltrexone, under the brand name Contrave 1.
- Bupropion has been found to decrease body weight by suppressing appetite and reducing food cravings 1.
- Unlike other antidepressants, bupropion is not associated with significant weight gain, making it a good option for patients who have experienced weight gain with other medications like sertraline 1.
Important considerations
- Bupropion can exacerbate anxiety in some patients, so it should be used with caution in patients with anxiety disorders 1.
- The choice of agent must still be guided by best practice for the individual patient’s circumstance, taking into account the patient's medical history, current medications, and other factors 1.
- Other medications, such as topiramate, may also be considered for weight loss, but bupropion is a more established option for anxiety treatment 1.
- Selective serotonin reuptake inhibitors (SSRIs) like fluoxetine and sertraline are generally weight-neutral, but may not be the best option for patients who have already experienced weight gain with sertraline 1.
From the Research
Effective Medications for Anxiety
- Sertraline has been shown to be an effective treatment for anxiety disorders, including panic disorder, obsessive-compulsive disorder, and generalized anxiety disorder 2, 3, 4.
- However, sertraline can cause weight gain as a side effect, which may be a concern for some patients 5.
Alternative Medications
- Pregabalin has been shown to be an effective treatment for generalized anxiety disorder, with a faster onset of action compared to sertraline 6.
- Pregabalin may be a suitable alternative for patients who have experienced weight gain as a side effect of sertraline, as it has been shown to have a similar efficacy and tolerability profile 6.
Comparison of Medications
- A study comparing the efficacy and tolerability of pregabalin and sertraline in patients with generalized anxiety disorder found that both medications were effective, but pregabalin had a faster onset of action 6.
- Another study found that sertraline was associated with a lower risk of weight gain compared to other selective serotonin reuptake inhibitors (SSRIs) 5.