When treating your mental health makes you gain weight

Would you rather be sad, or skinny? Would you rather be fat and happy, or thin and sad? These are questions that magazines are actually asking mostly women about the fact that treating depression and anxiety would some forms of medication could potentially cause weight gain

The articles featured in Vice and Self magazine echo a deeper sense of self- conflict about mental health – at what cost do we pursue our well-being and happiness? For some this can mean taking prescribed medication, which can lead to intended and unintended consequence. And one of the biggest ones whispered about in anonymous forums is this: weight gain.

This is an article focusing on the relationship between weight gain and medications to treat anxiety and medication, in particular SSRIs. I am not a doctor, but I did consult wiith a medical doctor and psychiatrist, Dr. Jason Rosen, for his insights about the possible causes of weight gain from anxiety meds. Nevertheless, none of the information in this piece should be construed as medical advice.

I have linked all of my research sources at the bottom of this article.

woman standing in front of mirror — Photo by DANNY G @ Unsplash

When anxiety becomes a problem

Before jumping into speciifc solutions, we have to understand the problem. When does anxiety become really problematic?

Recently Health Magazine devoted an entire issue to the science and treatment of anxiety. Here are a few high level observations from the articles:

First, anxiety itself is normal. Even the Dalai Lama gets stressed. We all experience feelings of worry and dread – that’s part of being human. But when these feelings interfere with our day to day lives, there is cause for concern for our mental health.
Anxiety is strongly correlated to fear. Fear is a natural response that protects us as a species – if we see a lion charging at us, our fight-or-flight response kicks in and we are pumped by adrenaline to run fast and survive. specific things, i.e., phobias, like fear of flying or public speaking.
The type of unhealthy fear that anxiety issues creates is that “what if” fear – worrying or obsessing over a hypothetical situation that may not actually be likely.
These types of fears and worries about the future are exacerbated by “doomscrolling” the negative news and negative messages on social media.
Anxiety can be worsened and even triggered by personal circumstances, like work or relatonship woes, or general circumstances, like geopolitcal and economic instability.
Like physical fitness, anxiety is correlated to a huge range of factors, like age, sex, family history, and environment. It does not manifest the same way in every person.
There are certain common threads like the impact of COVID, that can account for an increase in anxiety in the general population. Yet it does not manifest the same way in every person.
This Is why it is so important to see a medical professional to diagnose whether an anxiety disorder exists and the proper course of treatment for it.

adult lion walking beside tree — Cortisol is that hormone that can make you outrun a lion to survive. But when there is no immediate danger, cortisol can be a problem. Photo by DANNY G @ Unsplash

The “lion escape” impact of anxiety on the body

Close your eyes and imagine a lion chasing you. Now imagine what your body would feel like. Your pulse would be racing. Your muscles would tense up in anticipation of protecting your body against injury. Your body also releases certain hormones, in particular cortisol, when it is under stress. Cortisol is best known for producing the “fight or flight” response. This reaction evolved as a means of survival, enabling people to react to what could be a life-threatening situation.

However, when there is no actual life-threatening situation, all of this energy and hormone overdrive is trapped in your body with nowhere to actually be used. This has various effects on your mind and body, which I will explain next.

Why stress and anxiety can lead to weight gain

When there is a constant stream of stress responses and release of cortisol over a long period of time, this can cause problems with cardiovascular, digestive, immune, respiratory and central nervous systems. For this article, since it is about weight gain, it is worth focusing on one of the main symptoms of anxiety and depression – weight gain AND weight loss.

Back to the cortisol discussion, an excess of cortisol as I explained in this article, will cause an excess production of blood sugar (i.e., to run from the lion). These factors can cause an extra storage of fat and weight gain.

Anxiety can also increase cravings for comfort foods. You know when you are working against a deadline and a doughnut might just be the ticket to get you through this all-nighter. The food manufacturers are completely aware of this fact, too. They have experts that spend time devising processed foods with just the right amount of fat, sugar and technocarbs to light your brain up.

And sometimes weight loss

Conversely, anxiety can cause weight loss. Anxiety can make a person physically restless and lose their appetite. Again, this is very dependent on the person. If you can relate to that feeling of thriving from mainlining coffee to push through a stressful day without even thinking of food, you may be the type of person that can experience weight loss from anxiety. This is important to remember when we discuss medical treatment and weight gain.

Prevalence of antidepressants

There are many treatments for anxiety. Yet, antidepressant medications are increasingly accounting for the treatment of anxiety. According to this well-known article in the Atlantic, Antidepressants are the most-prescribed drugs in the U.S. for people between the ages of 18 and 44, and more than 10 percent of Americans are on them at any given time. According to the Pharmaceutical Journal, the number of antidepressant items prescribed over the past six years has increased by 35%.

Specifically, SSRIs (Selective Serotonin Reuptake Inhibitors).are a popular type of prescribed medication. SSRI medications are used to treat depression, anxiety, obsessive-compulsive disorder, post-traumatic stress disorder and more. These medications work by increasing serotonin levels in the brain which helps to regulate moods and decrease anxiety. They are the most commonly prescribed antidepressants in the US. Typical brands include Lexapro, Zoloft, Prozac, Celexa, Effexor, and Paxil.

SSRIs and Weight Gain

As the article in the Atlantic and many others observe, SSRIs have been shown to cause weight gain in many adults, although may also cause weight loss in some cases. Medical News Today reported that an estimated 25 percent of people using antidepressants experience an increase in weight.

Further, according to research summarized by Harvard Medical School, a study of 138 people over a 2.5 year period who took SSRIs found that on average, those who took the medications gained 2.5% of their baseline weight.

For some types of SSRIs, patients are more likely to gain a higher percentage of weight. In the Harvard study, 14% percent gained 7 % or more of their body weight during that period. Another study conducted by General Hospital Psychiatry showed that approximately half of the people who take the class of SSRIs including Lexapro may experience weight gain of 7% or more while taking this medication

The Harvard research also concluded that women are more likely to gain weight on antidepressants than men.

Other types of antidepressants, like MAOIs and TCAs, are also associated with weight gain.

Real life Examples of the SSRI-weight gain cycle

To be clear:. I am not asserting that SSRIs do cause weight gain. I am merely pointing out the evidence, both statistically and anecdotal, that this has been shown to happen. There is always a question of correlation and causation.

The depression-anxiety- weight gain cycle can be quite distressing. Here are some anectodal examples that illuminate this issue.

One 29-year-old woman who has been taking Zoloft for two years described her own internal battle on Reddit:

[All of the SSRIs I’ve taken] have caused weight gain, and lately it feels totally unmanageable. I work out 5 days a week, cardio and lifting free weights, and still the pounds keep coming. I watch what I eat. I don’t drink or do recreational drugs anymore, I even gave up smoking. I’m in therapy. Basically, I am doing all the shit necessarily for an emotionally healthy and stable life and it really frustrates me that I am still piling on the pounds. I was a fat kid and body issues are a big deal for me. Weight gain tends to spark feelings of panic and self-loathing and hopelessness, all of which can help me slip right into depression again.
-Reddit USER

And elsewhere on Reddit (where you can find countless threads discussing this)

“Summer of 2020, I was in a deep depression. I was also unrelatedly at my skinniest, around 130 lbs. During this time I ate like absolute garbage, ate out a ton, etc. I think what kept me from gaining a lot of weight at that time was simply the amount of steps I walked while at work (retail). At the end of that summer I decided to go on antidepressants for the first time to help get my depression and anxiety under control. I went on Lexapro and it really really helped my mental health. I don’t regret doing it – it was necessary. But after I started taking it, in a period of about 6 months I had gained 40 pounds. I know that weight gain/loss is not super well understood when it comes to SSRIs, but I was wondering if anyone had this experience or if going off of them aided in weight loss. I think I am at a time where I might be ready to go off of them in general, but I wonder if it would have an effect on my weight. Part of it is I just need to be more consistent, but most of the time I eat pretty moderately and count calories and I seem to always be fluctuating in the same 10 pound range. Two steps forward three steps back type of situation. So i am overall on a downward trend, it’s just frustrating.”

“I’ve been on Lexapro for about 2.5 years. It worked really well for me for I wanna say a year? And then we kept having to up my dose every 6 months or so from then on. It made me gain 30 pounds in about 6 months, & I’ve gained 50 total. I have completely overhauled my diet & exercise, the harder I try the more I gain.”
-REDDIT USERS

Although studies show a more modest weight gain statistically, as you can see by these examples, it can snowball. Psychology Today has reported on patients experiencing weight gain of up to 40 pounds.

Finally, from the Self article mentioned at the beginning, an even more compelling story:

I didn’t know that morning that Zyprexa could cause massive weight gain, swift and severe. In a widely reported 2009 study in The Journal of the American Medical Association, children and teenagers who took the drug for 12 weeks gained an average of one and a half pounds per week. Had I known of this possible side effect before my doctor handed me the pills, would I have refused them? All I can say is that I should have refused them, but it’s difficult to predict what one will do in times of desperation.
– From SELF maGAZINE, would you rather be fat or happy or thin and sad, authored by lauren slater

Chicken and the Egg?

This can create a vicious cycle. Psychological consequences of being overweight or obese can include lowered self-esteem and anxiety, and more serious disorders such as depression. So now it can seem like a chicken and egg situation – you feel anxious or depressed, so you start taking meds, but the meds caused unexplained uncontrollable weight gain, so the curbed anxiety is then reignited by the feelings caused by extra weight gain.

The studies alone do not show more than a single percentage weight gain – so what gives with people reporting 20+ pound gains? It’s a cycle. Depression, treating depression with medication, medication side effects including weight gain, depression from the weight gain, weight gain as a result of the depression. The older we get the more the last few pounds become harder to lose and therefore despite our best efforts to stay active, we could be falling into other traps like overcompensating with sedentary activity (which I have blogged about here in my article on the sedentary athlete syndrome).

This all created so much of a noticeable phenomenon that harvard Medical School’s Women’s Mental Health Resource site has a devoted subpage for Antidepressants and Weight Gain,

So why do SSRIs cause weight gain?

What the experts say

“It’s not fully understood why weight gain occurs,” says Dr. Rosen. It’s mainly deduced from several side effects of the medications that are correlated to weight gain. Thus far, the data does not show a direct causation.

Here are some examples of what Dr. Rosen has identified as the potential correlative factors for weight gain:

SSRIs promote calmer feelings that reverse the lost appetite for the group of people that experience this and also perhaps experience weight loss from their anxiety. In some cases, the calmer feelings the SSRIs produce may compensate for this lack of nutrition and therefore stabilize a person’s weight.
SSRIs that may also boost satiety centers. When we feel anxious, it can often affect the appetite. The active ingredients in SSRIs can actually block signals from satiety centers, which cause you to eat more because that fullness signal is tampered with by the medication. So previously it may have taken less food to make you full, and by eating more because you want to achieve satiety, you may gain weight.
There is some research suggesting that SSRIs can affect your set point weight. Your set point weight explains why you may be doing everything you can to lose weight but the scale is not budging. It is a certain range your body, based on a variety of factors, decides it needs to remain within..For reasons that are not fully understood, SSRIs may increase the range of this set point, leading your weight to naturally gravitate upwards towards this higher ranger.
SSRIs can also curtail activity because of causing some more drowsiness and lethargy as side effects. Even if you keep up your gym routine, you may be more inclined to take shortcuts in other areas, like skipping the steps or taking a taxi instead of walking.

At the end of the day, many medications do cause an alteration in your hormone balance. And the relationship between hormones and our hunger, eating and satiety is inextricably intertwined. Signals to your brain indicating whether you are hungry and when you are full can, if altered, increase the threshold of food that you consume to achieve this level of satisfaction.

So what can you do?

Investigate.

See a doctor and get bloodwork done, including testing your thyroid levels and other factors that can be throwing your body off. Start diligently tracking your food intake with an app like MyFitnessPal. If you are eating excess portion sizes of healthy foods, as I explain in this post, this could be the culprit of the extra weight even if you have a 5-day in a row exercise regime.

Consider different options

Talk to your doctor about switching medications. There are alternative medications to treat anxiety known to not cause weight gain, such as Wellbutrin or LeMictal, where patients often report initial weight loss. In all cases, never go off medication or try to taper on your own.

Enhance the value of your therapy

There literally is no magic pill. The below factors are additional considerations to your holistic mental health treatment program:

Supplements – Dr. Rosen mentioned that some patients opt for supplements to help ease anxiety without all of the side effects of prescription drugs (note – this is very case-by-case and not a medical recommendation). Silexan is a lavender oil preparation available in 80-mg capsules. In clinical studies it has been shown to reduce anxiety in some patients after a two-week period compared to placebos, and did not have significant withdrawal effects. It is available in over the counter products such as Calmaid.

Meditation – Meditation can have a tremendous impact on your sense of grounding and calm. Check out my meditation playlist on YouTube for different options of guided meditation and affirmations

Exercise – According to published research by the Mayo Clinic, exercise can clearly alleviate symptoms of anxiety and depression.

Sleep- you know the days where you got a bad night sleep, you literally can feel like you are going crazy? According to the sleep foundation, sleep deprivation can worsen anxiety, spurring a negative cycle involving insomnia and anxiety disorders.

Diet – According to the Mayo clinic, eating complex sources of carbohydrates and proteins can increase the level of serotonin in the brain (do you see the connection to S-Serotonin-R-Is?)

Changes in external factors – Taking a break from social media and “doomscrolling” will help detox your mind and not pile onto to the thoughts circulating in your head that you are already trying to quiet. Consider subscribing to one of these 12 optimistic news websites.

Alcohol consumption- Alcohol is a known depressant. So if you have been feeling sad lately, think about starting dry January now and take a break from drinking if for no other reason to see how it affects your state of mind. If you are less moody and have more energy, it is a lifestyle change worth considering.

Do you have to choose between being sad or skinny?

In this article, Vice magazine discusses the slippery slope of the reputation of some antidepressants for “skinny” side effects . For example, Wellbutrin is promoted on social media as the “happy skinny sexy drug,” which has led to a filtered search for treatment by patients not for the drug best suited to treat their inside issues, but the one most likely to cause weight loss (for reasons that are not entirely understood.. In some cases, however, this is not the right drug to treat anxiety. In fact, Wellbutrin can increase anxiety, cause seizures, and exacerbate symptoms of eating disorders. It is therefore important not to be driven to a choice of medication by weight concerns alone.

One of the instructors I had at Equinox had documented her journey of getting shredded for her wedding. Months later, on Instagran, she had a posted a picture of herself smiling and glowing, but with a different message The caption talkies about how she took medication to help her anxiety and how it caused her to gain 25 pounds, but that she had never been happier.

All of these are balances we struggle to deal with in life – where our mental and physical health intersect.The power of information and options to consider is what I hope I have accomplished in this post. Finding the path to happiness can seem impossible when the pressure cooker is on, but it is the process of making discoveries about ourselves that provides the experience we need to take on challenges metally and physically.

Research sources:

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