Bupropion and Weight: Associated with Weight Loss, Not Weight Gain
No, bupropion does not cause weight gain—it is the only antidepressant consistently associated with weight loss rather than weight gain, making it the optimal choice for adults with depression or anxiety when weight concerns are a priority. 1
Evidence for Weight Loss Effect
Bupropion promotes weight loss through appetite suppression and reduced food cravings, with clinical trial data showing 23% of patients losing ≥5 lbs compared to only 11% on placebo in long-term trials. 1, 2
Specific Weight Loss Data:
In long-term trials (up to 52 weeks), patients experienced modest mean weight losses that increased with increasing baseline body weight: 3
- BMI < 22: -0.1 kg mean weight change
- BMI 22-26: -0.6 kg mean weight change
- BMI ≥ 27: -1.4 kg mean weight change
- BMI ≥ 30: -2.4 kg mean weight change
FDA-approved seasonal affective disorder trials (up to 6 months) demonstrated that 23% of bupropion-treated patients lost ≥5 lbs versus only 11% on placebo, while only 11% gained ≥5 lbs on bupropion versus 21% on placebo. 2
In major depressive disorder trials using bupropion sustained-release, 14-19% of patients lost >5 lbs compared to only 6% on placebo, while only 2-3% gained >5 lbs compared to 4% on placebo. 2
FDA Approval for Weight Management
The FDA approves bupropion for chronic weight management in combination with naltrexone (as Contrave), and the American Gastroenterological Association made a conditional recommendation favoring the use of naltrexone-bupropion ER in individuals with obesity or overweight with weight-related complications. 4, 1
Comparative Context Among Antidepressants
When considering antidepressant options for patients concerned about weight:
Bupropion is the first-line choice if no contraindications exist (seizure disorders, eating disorders, uncontrolled hypertension). 1
Antidepressants to avoid due to significant weight gain risk include: 1
- Paroxetine (highest risk among all SSRIs)
- Mirtazapine (closely associated with significant weight gain)
- Amitriptyline (greatest risk among tricyclic antidepressants)
- Monoamine oxidase inhibitors
Weight-neutral alternatives include fluoxetine and sertraline (initial weight loss followed by long-term weight neutrality). 1
Critical Safety Considerations
While bupropion promotes weight loss rather than gain, important contraindications and precautions include:
Bupropion lowers seizure threshold and should be avoided in patients with epilepsy or history of seizures (seizure risk approximately 0.1%). 4, 5
Avoid in patients with eating disorders (anorexia nervosa, bulimia nervosa) due to increased seizure risk. 4
Use caution in uncontrolled hypertension, as bupropion can increase blood pressure. 4
Dose reduction required in moderate-to-severe renal or hepatic impairment. 6
Clinical Implementation
For adults with depression or anxiety where weight is a concern:
Start with bupropion 150 mg once daily, titrating to 300 mg daily for long-term treatment of recurrent major depression. 6
Monitor weight regularly to document the weight loss effect and adjust treatment as needed. 1
Common discontinuation reasons include nausea, headache, and dizziness—not weight gain. 6