Does sertraline (selective serotonin reuptake inhibitor) cause weight gain or impair weight loss ability?

From the Guidelines

Sertraline is generally considered weight-neutral with long-term use, and it may even lead to weight loss in some individuals, particularly in the short term. When considering the impact of sertraline on weight, it's essential to look at the most recent and highest quality evidence available. According to a study published in Gastroenterology in 2017 1, selective serotonin reuptake inhibitors (SSRIs) like sertraline and fluoxetine are associated with weight loss in the short term and weight neutrality in the long term. Some key points to consider include:

• The study found that SSRIs, as a class, have a range of weight gain potential, but sertraline and fluoxetine are on the lower end of this spectrum 1.
• Other antidepressants, such as paroxetine and amitriptyline, are associated with a greater risk of weight gain 1.
• Bupropion, a norepinephrine and dopamine reuptake inhibitor, is the only antidepressant that has been shown to consistently promote weight loss 1.
• The choice of antidepressant should still be guided by the individual patient's circumstances, including the type of depression and any potential side effects 1. In terms of managing weight while taking sertraline, patients should be aware of the potential for weight changes and work with their healthcare provider to develop a plan for maintaining a healthy weight. This may include dietary modifications, exercise programs, or adjusting the dosage of sertraline. Overall, the evidence suggests that sertraline is a good option for patients who are concerned about weight gain, as it is generally considered weight-neutral and may even lead to weight loss in some individuals.

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. Significant weight loss may be an undesirable result of treatment with sertraline for some patients, but on average, patients in controlled trials had minimal, 1 to 2 pound weight loss, versus smaller changes on placebo.

Weight Change with Sertraline:

• Sertraline is associated with weight loss in some patients, particularly in the initial stages of treatment.
• On average, patients in controlled trials experienced minimal weight loss of 1 to 2 pounds.
• The difference in weight change between sertraline and placebo was roughly 1 kilogram, representing a slight weight loss for sertraline compared to a slight gain for placebo.
• Decreased appetite has also been observed in association with sertraline use.
• However, after the initial weight loss, patients may start gaining weight back, similar to that expected using data from age-adjusted peers 2.
• It is essential to monitor weight and growth in pediatric patients if treatment with sertraline is to be continued long-term 2.
• Regular monitoring of weight is recommended for patients on long-term sertraline treatment 2.

From the Research

Effects of Sertraline on Weight

• Sertraline, a selective serotonin reuptake inhibitor (SSRI), has been studied for its effects on weight and weight loss ability 3, 4, 5, 6, 7.
• A study comparing fluoxetine, sertraline, and paroxetine found that patients treated with sertraline had a modest but nonsignificant weight increase, whereas paroxetine-treated patients experienced a significant weight increase 4.
• Another study found that sertraline was not associated with significant weight gain, and in fact, may have a beneficial effect on weight, with patients losing an average of 2kg and 7cm in waist circumference over 12 weeks of treatment 7.
• The literature suggests that SSRIs, including sertraline, may be less likely to cause weight gain compared to other antidepressants, such as tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) 6.

Comparison to Other Antidepressants

• A study found that paroxetine may be more likely to cause weight gain than other SSRIs, including sertraline, during long-term treatment 4, 6.
• Sertraline has been shown to have a wider safety margin and fewer side effects compared to TCAs, making it a potentially more favorable option for patients concerned about weight gain 3, 5.

Clinical Implications

• The effects of sertraline on weight and weight loss ability may vary depending on individual patient factors and the specific study design 4, 7.
• Healthcare providers should consider the potential effects of sertraline on weight when prescribing the medication, particularly for patients with concerns about weight gain or loss 6, 7.