From the Guidelines
Buspirone (BuSpar) is the anxiolytic that does not cause weight gain, as it is generally considered a weight-neutral option. Several anti-anxiety medications are less likely to cause weight gain, including SSRIs like escitalopram (Lexapro), sertraline (Zoloft), and fluoxetine (Prozac), as well as buspirone (BuSpar) 1. Bupropion (Wellbutrin), though primarily an antidepressant, may help with anxiety and is actually associated with slight weight loss. SNRIs such as venlafaxine (Effexor) and duloxetine (Cymbalta) are also generally weight-neutral options. These medications work by affecting neurotransmitters like serotonin, norepinephrine, and dopamine in the brain to reduce anxiety symptoms without significantly impacting metabolism or appetite regulation. When choosing an anxiolytic, it's essential to consider the side-effect profiles, interactions, response, patient age, and preference, as recommended by the American Society of Clinical Oncology guideline update 1. Some key points to consider when selecting an anxiolytic include:
- Side-effect profiles: Different medications have varying side effects, and some may be more suitable for certain patients.
- Interactions: Consider potential interactions with other medications the patient is taking.
- Response: Monitor the patient's response to the medication and adjust as needed.
- Patient age and preference: Take into account the patient's age and personal preferences when selecting a medication. It's also important to note that medication responses vary between individuals, and some people might still experience weight changes even with these typically weight-neutral options. When starting any anti-anxiety medication, begin at a low dose and gradually increase as directed by your healthcare provider, who should monitor both your anxiety symptoms and any side effects, including weight changes 1.
From the Research
Anxiolytic Medications and Weight Gain
- The study 2 found that benzodiazepines, non-benzodiazepine, and melatonergic hypnotics are weight neutral, suggesting that these anxiolytic medications do not cause significant weight gain.
- Another study 3 investigated the use of topiramate to induce weight loss in patients with anxiety disorders who had experienced SSRI-induced weight gain, but it did not directly compare the weight effects of different anxiolytic medications.
Comparison of Anxiolytic Medications
- There is limited direct comparison of the weight effects of different anxiolytic medications in the provided studies.
- However, the study 2 mentions that diphenhydramine may cause weight gain, and switching to a weight-neutral hypnotic may be considered if needed.
Other Relevant Findings
- The study 4 found that bupropion, an antidepressant, is less likely to cause weight gain and sexual dysfunction compared to other antidepressants.
- The study 5 found that bupropion does not appear to mitigate the weight gain risk associated with obesogenic medications, but this study focused on patients with depression rather than anxiety disorders.
- The study 6 investigated the use of fluoxetine for weight loss in overweight or obese adults, but it did not directly compare the weight effects of different anxiolytic medications.