Citalopram and Weight Gain
Citalopram (Celexa) can cause weight gain in some patients, though it is not among the antidepressants most strongly associated with weight gain. Based on recent evidence, citalopram causes modest weight gain compared to other antidepressants, with an estimated 6-month weight gain of 0.12 kg more than sertraline 1.
Weight Effects of Antidepressants
- Within the SSRI class, paroxetine has the highest risk of weight gain, while fluoxetine and sertraline are typically associated with initial weight loss followed by weight neutrality with long-term use 2
- Citalopram falls in the middle of SSRIs regarding weight gain potential, showing modest weight gain in comparative studies 1
- The FDA label for citalopram notes that patients treated with citalopram in controlled trials experienced a weight loss of about 0.5 kg compared to no change for placebo patients 3
- However, longer-term studies show that this initial weight loss may be followed by gradual weight gain over time 4
Comparative Weight Effects Among Antidepressants
- In a recent large-scale study comparing 8 common antidepressants, citalopram showed slightly more weight gain than sertraline (0.12 kg difference over 6 months) 1
- Escitalopram, paroxetine, and duloxetine showed higher weight gain than citalopram 1
- Bupropion is the only antidepressant consistently shown to promote weight loss through appetite suppression and reduced food cravings 5, 2
- Fluoxetine showed similar weight effects to sertraline, with minimal weight gain 1
Clinical Considerations
- Weight changes with citalopram may vary significantly between individuals 6
- In clinical trials for obesity treatment, citalopram was not found to be effective for weight loss when added to a calorie-restricted diet 7
- Weight gain during antidepressant treatment is often perceived as an undesired adverse effect by patients 6
- For patients with significant concerns about weight gain, bupropion may be a better alternative as it consistently shows the least weight gain or even weight loss 2, 1
Monitoring and Management
- Regular monitoring of weight is recommended during citalopram treatment 2
- Weight gain with antidepressants may be difficult to reverse even after discontinuation of the medication 8
- For patients who experience significant weight gain on citalopram and for whom weight is a concern, consider switching to a more weight-neutral option like fluoxetine or bupropion if clinically appropriate 2
- Be aware that bupropion is activating and may exacerbate anxiety; assess patient's anxiety levels before prescribing 2
Important Caveats
- Weight gain with citalopram appears to be less pronounced than with other psychotropic medications such as certain antipsychotics, mood stabilizers, and tricyclic antidepressants 5
- The clinical decision to use citalopram should balance its efficacy for depression against potential side effects including weight gain 8
- Weight changes during antidepressant treatment may be influenced by multiple factors including improvement in depressive symptoms, changes in appetite, and medication-specific effects 6