Is escitalopram (Selective Serotonin Reuptake Inhibitor, SSRI) associated with weight gain?

From the Guidelines

Escitalopram is associated with a lower risk of weight gain compared to other antidepressants, with approximately 5-7% of patients experiencing significant weight gain, typically averaging 1-5 pounds 1.

Key Points to Consider

• The selective serotonin reuptake inhibitors (SSRIs) fluoxetine and sertraline have been associated with weight loss with short-term use and weight neutrality with long-term use, similar to escitalopram 1.
• Within the SSRI class, paroxetine is associated with the greatest risk for weight gain, whereas escitalopram is considered to have a lower risk 1.
• The weight gain associated with escitalopram is usually modest and occurs because the medication affects serotonin levels, influencing appetite regulation and metabolism 1.

Management of Potential Weight Gain

• Regular physical activity, mindful eating habits, and a balanced diet can help manage potential weight gain while taking escitalopram.
• If weight gain becomes concerning, patients should discuss it with their healthcare provider, who may adjust the dosage, recommend lifestyle modifications, or consider switching to an alternative medication with less impact on weight.

Therapeutic Benefits and Considerations

• The therapeutic benefits of escitalopram for depression or anxiety often outweigh the potential side effect of weight gain for many patients.
• Healthcare providers should guide the choice of agent based on best practice for the individual patient's circumstance, considering the potential for weight gain and other side effects 1.

From the FDA Drug Label

Weight Changes Patients treated with Escitalopram in controlled trials did not differ from placebo-treated patients with regard to clinically important change in body weight Metabolic and Nutritional Disorders - increased weight.

Escitalopram and weight gain:

• There is no significant difference in weight change between patients treated with escitalopram and those treated with placebo in controlled trials.
• However, increased weight is listed as a possible adverse reaction under Metabolic and Nutritional Disorders.
• Key points:
  • No clinically important change in body weight.
  • Increased weight is a possible adverse reaction.
• Conclusion: Escitalopram may not cause significant weight gain in most patients, but increased weight is a possible side effect 2.

From the Research

Escitalopram and Weight Gain

• The risk of weight gain is an important determinant of the acceptability and tolerability of antidepressant medication 3.
• A study comparing changes in body weight during treatment with escitalopram or nortriptyline found that weight increased significantly more during treatment with nortriptyline compared to escitalopram 3.
• Participants who were underweight at baseline gained most weight, while participants who were obese at baseline did not gain more weight during treatment with escitalopram or nortriptyline 3.
• There was little weight change during treatment with escitalopram, with an average increase of 0.14 kg (0.05-point BMI increase) over 12 weeks of treatment 3.

Comparison with Other Antidepressants

• Escitalopram has a predictable tolerability profile with generally mild to moderate and transient adverse events, and a low propensity for drug interactions, similar to other SSRIs 4, 5.
• Escitalopram was found to be at least as effective as other comparator drugs, including SSRIs and serotonin-noradrenaline reuptake inhibitors, in adult patients with major depressive disorder 5.
• Escitalopram demonstrated a rapid onset of antidepressant action and was found to be cost-effective in several studies 5.

Pharmacokinetics and Tolerability

• Escitalopram is rapidly absorbed and reaches maximum plasma concentrations in approximately 3-4 hours after either single- or multiple-dose administration 6.
• The elimination half-life of escitalopram is about 27-33 hours and is consistent with once-daily administration 6.
• Escitalopram has a low propensity for drug interactions and is unlikely to cause clinically significant drug-drug interactions 6.
• Escitalopram has a favorable tolerability profile, with associated adverse events generally being mild and temporary 7.