With Sean Wharton, MD, PharmD, Michael McGee, MD, and J. Michael Gonzalez-Campoy, MD, PhD, FACE

About one in eight Americans, or more than 12% of adults in the United States, is taking an antidepressant to address a mood disorder, according to recent estimates, and another 1.6% of individuals are on an antipsychotic medication to help manage mental health conditions such as obsessive compulsive disorder, schizophrenia, or bipolar disorder.¹  And for most of these individuals, the need to take the psych medication is for the long-term.

Taking an antidepressant or antipsychotic medication often produces the added worry of possible weight gain but starting a formal weight loss program can prevent it. Photo: 123rf

While these medications are very effective, they can come with a major downside for many patients—undesirable and often significant weight gain.²  For anyone who may benefit from a psychiatric drug but fears the prospect of obesity and its related complications, there is now a good answer.

As simple as it may sound, the best chance of avoiding, or lessening further, undesirable weight gain when taking a prescribed antidepressant or antipsychotic medical, is to simultaneously participate in a formal weight management program. This is true regardless of the psych medication you are taking, according to the experience of patients who were treated at the Wharton Medical Clinics in Toronto, Canada.²

Effect of Formal Weight Loss Programs with Psych Medication

Even if you are already taking one of these psych-related medications and you’re stressed about weight gain, or if your doctor has recently suggested that you consider taking one of these drugs but you’re stalling due to concerns about weight gain—this study points to an effective way forward—to enroll in a structured weight loss program.²

After evaluating the experience of more than 17,000 men and women, comparing medical data of those who were on psychiatric medications to those not taking such medication, the researchers found that an organized weight management plan helped everyone—overall and on average—to lose weight.²

Sean Wharton, MD, PharmD, an internal medicine specialist and director of the Wharton Medical Clinics, which is devoted to weight and diabetes management, in Toronto, Canada, and his team, reports that individuals who are taking a prescribed medication for a mental illness and following a structured weight loss program avoid weight gain based on their analysis.

In all, 4094 patients, or about 1 in 4 of those in the study, were taking at least one psychiatric medication. Most were taking an antidepressant, although about 11% took both. The aim of the study was to compare weight loss for those taking the medications and those not taking them. Data was collected from 2008 to 2017.²

The men and women were, on average, in their late 40s or early 50s. Their average body mass index or BMI was about 39 or 40.² The program stresses effective, personalized lifestyle changes, Dr. Wharton says. Patients answered questions about family medical history, weight management history, and other health information. Then, a trained weight management educator gave suggestions regarding eating and physical activity to help avoid weight gain.²

In general, participants were taught to cut out 500 calories a day from their usual intake, and they returned to the clinic for ongoing dietary guidance every 3-4 weeks.²

Over the average of 16 months of clinic attendance, on average, patients lost about 7.5 pounds, or 2.9% of their body weight. That translated to 27.6% of patients losing 5% or more of their baseline weight and 10.1% losing twice that amount or more.²

You may be saying….a 2.9% weight loss is not such a big deal…but according to Dr. Wharton, these results correlate with those of other weight loss interventions and, this number indicates an average, meaning some lost more, some lost less.

More importantly, Dr. Wharton tells EndocrineWeb, contrary to past beliefs, the findings from this study suggest that weight gain is not inevitable when taking psychiatric medications. Also, weight loss is achieved in direct contrast to the expectation that everyone would gain weight when taking an antidepressant or antipsychotic medication.²

Men who were taking antidepressants lost slightly less than people in the other groups, but it wasn’t a big difference,² says Ms. Christensen. While the researchers can’t explain the reason for this finding, they believe it could be that the other patients were feeling better mentally so they were a bit more successful with their weight loss goal but this would require further testing to gain a clear answer.

Weight Gain—Causes Added Worry with Psych Meds

You are not alone in gaining benefit from psychiatric medication—and you aren’t the only one who stresses about the weight gain linked with many of the drugs. As such, this challenge inspired Ms. Christensen to test for a solution that would address this vexing problem. She tells EndocrineWeb that concern about weight gain is both a real and almost universal experience among the patients in her clinic that are prescribed psychiatric medications.²

“The fear of weight gain is sometimes so powerful that people will stop taking their [mental health] medication,” says Dr. Wharton who is the senior investigator of the study that shows that participating in an organized, medical weight loss programs work.

As if to confirm how common this conundrum is, Michael McGee, MD, chief medical officer at The Haven at Pismo, an addiction treatment center near San Luis Obispo in California, says that he frequently hears about the anxiety linked with medication-related weight gain.

 “My patients fear and complain about weight gain, particularly the women, who often do gain weight, but it is not a given,” he tells EndocrineWeb. With years of practice, Dr. McGee has seen many patients who have experienced weight gain, increasing about five to 10% of their starting weight. That means, for example, a 150-pound woman would be facing up to a 15-pound gain in body weight.

Balancing Mental and Physical Health is Often Complicated

Even when not taking a psychiatric medication, some people with mental health disorders may already be battling overweight or obesity, says Dr. Wharton and his colleagues. Research has shown that those with mental health disorders seem to have up to 1.5 times greater odds of having obesity. ^2,3

In addition, the weight gain linked with antidepressant and antipsychotic drugs has been well recognized, although the experience varies and is not the same for everyone.^4-7

So how much weight gain are we talking about? In another recent study,⁷ researchers looked at the weight status of 362 patients taking an antidepressant medication for six to 36 months. More than half of them gained weight, with 40% of individuals gaining at least 7% of their starting weight. The only drug of the eight psych medications evaluated in the study not linked with weight gain was fluoxetine (ie, Prozac). The study did not have funding from pharmaceutical companies.⁷

The links between weight gain and medications have been shown to differ by medication type, says J. Michael Gonzalez-Campoy, MD, PhD, FACE, medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology.

“In general, the use of antipsychotic medications are most often associated with weight gain,” Dr. Gonzalez-Campoy tells EndocrineWeb “In general, the use of antidepressants is associated with more modest weight gain—with the exception of fluoxetine and bupropion (Wellbutrin, others), which appear to be weight neutral.”

Steps to Avoid Weight Gain When Starting a Psych Medication

Asking for a referral to a qualified weight loss program in your area is a good idea, says Dr. McGee.  What else?

• Focus on what (ie, choose a Mediterranean approach to eating) and how you eat (eg, seated at the table, with other people, chewing slowly and mindfully)
• Don’t eat for gratification, boredom, or self-soothing or overeat to punish yourself
• Discuss whether weight loss medicines, in addition to the structured weight loss program, may be appropriate, at least to start.

According to Dr. Gonzalez-Campoy, ”along with a prescription for antipsychotic medications and most antidepressants, a concomitant prescription for weight management should be provided [for patients who already have overweight or obesity].”

And for those on antipsychotics, you should be made aware of the health risks that come with significant weight gain such as the development or worsening of high blood sugar, high blood pressure, and high cholesterol, he says. These are medical issues that should be monitored as well, he says.

The bottom line—For anyone who is taking an antidepressant or antipsychotic medication: “Taking these medications [to manage a mental health issue] is very important,” Ms. Christensen says. “Don’t be concerned about the potential weight gain because that can be mitigated [ie, managed].”

None of the healthcare practitioners had relevant financial conflicts with regard to this study.

Last updated on 09/16/2019