by Harriet Squier

Created on: March 02, 2008

There are many antidepressant medications out there, and all are equally likely to relieve the symptoms of depression. Which to choose for any individual patient depends, in part, on the patient's symptoms, potential side effects of the medications, and the patient's past experiences with taking antidepressants. For those who are already overweight, or for whom overeating is a symptom of their depression, choosing a medication that does not aggravate weight gain is essential. Alternatively, for patients who stop eating as a result of depression, a medication that stimulates appetite may be desired.

The first generation of antidepressants developed, the tricyclics, had many side effects, weight gain among them. These medications, including brand names* like Elavil, Tofranil, Pamelor, Anafranil, and others, all cause weight gain to more or less a degree, along with dry mouth, constipation, lightheadedness, and cardiac rhythm disturbances. Today we tend to use these medications only if others have not worked or if a patient has a very particular diagnosis that might make these medications particularly desirable.

The Selective serotonin reuptake inhibitors (SSRI's) have been developed over the last 20 years, and offer some improved options for patients with weight issues. Fluoxetine (Prozac) the first of the group to be developed, often, but not always, is associated with a decrease in appetite, and is often used in patients with eating disorders such as bulimia. Studies show that patients lose an average of seven pounds when beginning this medication. Longer term studies suggest, though, that many people over time will gain this weight back. Since Prozac is effective, tends to be rather stimulating (thus improving fatigue), and is reasonably free of side effects, it is frequently used as a first choice for the overweight patient with depression.

Byproducts of Prozac, namely Celexa and Lexapro, are weight neutral, meaning most patients have no change in their weight on these medications. Zoloft is occasionally associated with decreased appetite and weight loss. Paxil is the one SSRI clearly shown to be associated with weight gain, especially if taken for long periods of time. Often this weight gain is significant and can itself become a great source of distress for patients. While Paxil is effective for depression, it should be avoided in patients who over eat.

Many miscellaneous antidepressants are used for treatment of depression. Both Effexor and Cymbalta are considered

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