Weight Gain Associated with Sertraline (Zoloft)
Sertraline typically causes minimal weight changes, with studies showing it tends to be weight-neutral or even associated with modest weight loss in some patients. 1, 2
Evidence on Sertraline and Weight Changes
- According to the FDA drug label, weight loss (not weight gain) may occur with sertraline treatment, with most patients in controlled trials experiencing minimal 1-2 pound weight loss versus smaller changes on placebo 1
- In a 2024 comparative study of antidepressants, sertraline was used as the reference medication against which other antidepressants were compared, suggesting its relatively neutral effect on weight 2
- When compared to sertraline, escitalopram (0.41 kg), paroxetine (0.37 kg), duloxetine (0.34 kg), venlafaxine (0.17 kg), and citalopram (0.12 kg) all showed greater weight gain at 6 months 2
- Fluoxetine showed similar weight effects to sertraline, while bupropion showed less weight gain (or more weight loss) than sertraline (-0.22 kg) 2
Long-term Weight Effects
- In a 2.5-year study of OCD patients, sertraline was associated with one of the lowest rates of significant weight gain (≥7% increase in body weight) at only 4.5% of patients, comparable to fluoxetine (8.7%) 3
- Another study comparing long-term treatment with fluoxetine, sertraline, and paroxetine found that sertraline-treated patients had only a modest, non-significant weight increase, while paroxetine caused significant weight gain 4
- In a study of diabetic patients with depression, sertraline treatment for 12 weeks actually resulted in significant weight loss (-2kg), decreased BMI, and reduced waist circumference by an average of 7cm 5
Comparative Weight Effects Among Antidepressants
- Within the SSRI class, paroxetine has consistently shown the highest risk of weight gain, while sertraline typically causes minimal weight changes 6, 4
- Bupropion is the only antidepressant consistently shown to promote weight loss through appetite suppression 6, 2
- The American College of Physicians notes that sertraline has been studied for weight effects, but the evidence was limited to one small study with non-statistically significant results at the time of their guideline development 7
Clinical Implications and Monitoring
- 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 6, 2
- Regular weight monitoring is recommended during sertraline treatment, as individual responses may vary despite the generally minimal average weight changes 8
- In pediatric patients, sertraline has been associated with weight loss, particularly in children, with approximately 7% experiencing weight loss >7% of body weight compared to none of the placebo patients 1
Conclusion
Based on the most recent and highest quality evidence, sertraline appears to be a relatively weight-neutral antidepressant, with some studies even showing modest weight loss. When weight gain does occur, it is typically minimal compared to other antidepressants like paroxetine or escitalopram.