Does trazodone cause weight gain?

Does Trazodone Cause Weight Gain?

Trazodone is weight-neutral and does not cause clinically significant weight gain; in fact, it may produce slight weight loss in overweight patients, making it one of the safer antidepressant options when weight concerns are present. 1, 2, 3

Evidence from FDA Labeling and Clinical Trials

• The FDA label for trazodone reports weight gain occurring in only 1-5% of patients in controlled trials, with weight loss actually occurring at similar or higher rates (3-6%), indicating overall weight neutrality 1

• A direct comparison trial of 272 depressed patients found that trazodone produced slight weight loss in overweight patients, while amitriptyline (a tricyclic antidepressant) caused significant weight gain 3

• In a 6-week comparative trial, trazodone-treated patients experienced a mean weight gain of only 1.2 lbs, compared to bupropion which caused a 2.5 lb weight loss 4

Comparative Context Among Antidepressants

When considering antidepressants and weight effects, trazodone ranks among the most weight-favorable options available:

• Weight-neutral options: Trazodone, fluoxetine, sertraline, and most benzodiazepines/hypnotics 2, 5

• Weight-loss promoting: Bupropion is the only antidepressant consistently associated with weight loss through appetite suppression 5

• High weight gain risk (avoid these): Paroxetine (highest among SSRIs), mirtazapine, amitriptyline (highest among tricyclics), and MAO inhibitors 5, 3

Clinical Decision Algorithm for Antidepressant Selection

If weight is a primary concern:

1. First choice: Bupropion (if no contraindications such as seizure disorders or eating disorders exist) 5

2. Second-line choices: Trazodone, fluoxetine, or sertraline for their weight-neutral profiles 5, 2

3. Avoid entirely: Paroxetine, mirtazapine, amitriptyline, and MAO inhibitors 5

Mechanism and Clinical Implications

• Trazodone's weight neutrality distinguishes it from many other psychotropic medications that antagonize serotonin receptors and stimulate carbohydrate craving 6

• The low incidence of weight gain, combined with minimal sexual dysfunction, may improve long-term adherence to treatment 7

• Recent evidence confirms trazodone maintains its weight-neutral profile even with the once-daily formulation at therapeutic doses of 150-300 mg/day 7

Important Clinical Caveats

• While trazodone is weight-neutral, individual variations can occur; regular weight monitoring remains appropriate during any antidepressant treatment 2

• Trazodone's most common adverse effects are somnolence, headache, dizziness, and dry mouth—not metabolic effects 7

• The appetite increase reported with trazodone in FDA labeling occurred at rates similar to placebo, further supporting its weight-neutral classification 1