Does Sertraline Increase Appetite?
Sertraline does not increase appetite and is considered weight-neutral with long-term use, showing minimal weight changes over extended treatment periods. 1, 2
Evidence from Guidelines
The most recent high-quality evidence from the American Gastroenterological Association confirms that sertraline is weight-neutral with long-term use, demonstrating minimal weight changes over extended treatment periods. 1, 2 This distinguishes sertraline from other SSRIs, particularly paroxetine, which has consistently shown the highest risk of weight gain within the SSRI class. 1
Guidelines for managing Alzheimer's disease note that sertraline is "well tolerated" compared with other SSRIs, with no specific mention of appetite stimulation or weight gain as a characteristic side effect. 3
Appetite and Weight Effects
Changes in appetite can occur as a side effect of sertraline, but these changes are bidirectional (either increase or decrease) and typically mild. 3 The Journal of the American Academy of Child and Adolescent Psychiatry lists "changes in appetite" and "weight loss or gain" among possible adverse effects of SSRIs as a class, but emphasizes these effects are generally mild and emerge within the first few weeks of treatment. 3
Short-Term vs. Long-Term Effects
Research evidence reveals an important temporal pattern:
Short-term (first 6 weeks): Sertraline may actually reduce appetite and promote modest weight loss. One study showed sertraline subjects experienced significantly greater reductions in hunger and preoccupation with food during the initial 6 weeks of treatment. 4
Long-term use: After the initial period, sertraline demonstrates weight-neutral effects with minimal impact on appetite or body weight. 1, 2
Clinical Context: Sertraline for Weight Management
Interestingly, sertraline has been studied as an adjunct to weight loss programs rather than as a cause of weight gain. Research shows that when combined with cognitive-behavioral treatment, sertraline enhanced weight reduction in obese patients (6.5% BMI reduction vs. 3.0% with CBT alone). 5 This effect appears related to reduced hunger and food preoccupation rather than appetite stimulation. 5, 4
Practical Monitoring Recommendations
Regular weight monitoring is recommended during sertraline treatment, as individual responses may vary despite the generally minimal average weight changes. 1 While sertraline is weight-neutral on average, some patients may experience appetite changes in either direction during the initial weeks of treatment. 3
Common Pitfall to Avoid
Do not confuse sertraline with paroxetine or mirtazapine when counseling patients about weight effects. Paroxetine carries the highest weight gain risk among SSRIs 1, while mirtazapine is specifically noted to "promote sleep, appetite, and weight gain." 3 Sertraline's profile is distinctly different from these agents.