Does sertraline (selective serotonin reuptake inhibitor) increase appetite?

Does Sertraline Increase Appetite?

No, sertraline does not increase appetite—it typically causes decreased appetite and weight loss, particularly in the initial months of treatment. 1

Appetite and Weight Effects

Sertraline is associated with decreased appetite (anorexia) rather than increased appetite across multiple patient populations:

• In FDA-approved labeling, anorexia (decreased appetite) occurred in 3-11% of adult patients taking sertraline versus 2% on placebo across major depression, OCD, panic disorder, and PTSD trials 1
• In pediatric patients (ages 6-17), sertraline caused a mean weight loss of approximately 1 kilogram compared to slight weight gain with placebo 1
• Approximately 7% of children experienced clinically significant weight loss (>7% of body weight) on sertraline versus none on placebo 1

Weight Loss Profile

Sertraline is among the SSRIs least likely to cause weight gain and may actually promote weight loss:

• The American Psychiatric Association notes that paroxetine should be avoided in patients with comorbid obesity due to highest weight gain risk among SSRIs, implicitly positioning sertraline as a safer alternative 2
• Research demonstrates sertraline (100-200 mg/day) can be used therapeutically to enhance weight reduction in obese patients when combined with cognitive-behavioral therapy 3
• In diabetic patients with depression, sertraline improved dietary compliance without causing weight gain 4

Contrast with Weight-Gaining Antidepressants

Sertraline stands in stark contrast to antidepressants that genuinely increase appetite:

• Mirtazapine causes significant weight gain through potent antihistamine properties and ranks among antidepressants with the highest propensity for weight gain 5
• For patients with obesity or metabolic concerns, sertraline represents a weight-neutral or weight-loss alternative compared to mirtazapine 5
• Bupropion is the only antidepressant consistently associated with weight loss, representing the opposite end of the spectrum from mirtazapine, with sertraline positioned between these extremes 5

Clinical Monitoring Considerations

Long-term weight monitoring remains important despite sertraline's favorable profile:

• Pediatric patients who continued sertraline for 34 weeks eventually showed weight gain similar to age-adjusted peers after initial weight loss in the first 8 weeks 1
• Regular monitoring of weight and growth is recommended if long-term treatment of pediatric patients continues 1
• The initial appetite suppression and weight loss typically occur early in treatment and may diminish over time 1

Common Gastrointestinal Effects

The gastrointestinal side effects of sertraline relate to decreased—not increased—food intake:

• Nausea (25% vs 11% placebo) and diarrhea (20% vs 10% placebo) are among the most common adverse effects 1
• These GI effects contribute to the anorexigenic profile rather than appetite stimulation 6, 7